Dental anesthesia practice

[AKMD_1984]

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Please show me where I wrote that a new grad crna is superior to a dental anesthesiologist. On what basis did you come up with that comparison?

Yes, sometimes it’s important to “dumb it down” to educate the uninformed so they do not make dangerous choices and mislead patients and colleagues likewise. Loud and obnoxious does not mean correct.

 

[UscGhost]

Please show me where I wrote that a new grad crna is superior to a dental anesthesiologist. On what basis did you come up with that comparison?

Yes, sometimes it’s important to “dumb it down” to educate the uninformed so they do not make dangerous choices and mislead patients and colleagues likewise. Loud and obnoxious does not mean correct.

Because you quoted and apparently disagreed with my post in which i compared dental anesthesiologists to crnas in doing rountine level cases and disagreed with it (my same post also mentioned that MDs should be utilized for high complexity cases)...

So not sure who you arguing with then..

In terms of loud and obnoxious...i would suggest purchasing a mirror, as you were the first to start throwing the insults..

Good job chief! Lol

 

[SuxDrugs&Rocuronium]

The History of the Specialty of Dental Anesthesiology - PMC

pmc.ncbi.nlm.nih.gov

 

[AKMD_1984]

Because you quoted and apparently disagreed with my post in which i compared dental anesthesiologists to crnas in doing rountine level cases and disagreed with it (my same post also mentioned that MDs should be utilized for high complexity cases)...

So not sure who you arguing with then..

In terms of loud and obnoxious...i would suggest purchasing a mirror, as you were the first to start throwing the insults..

Good job chief! Lol

Ok you are a liar and dishonest. Got it.

Again, please show me where I wrote what you stated. You really do not know anything…”bless your heart…”lol …

 

[UscGhost]

Ok you are a liar and dishonest. Got it.

Again, please show me where I wrote what you stated. You really do not know anything…”bless your heart…”lol …

Oooh...a liar AND dishonest?? What about a fibber or a deceiver??

As i said, you had quoted my post, which based on your statement, implies that you disagree with the statement you are quoting.

Feel free to read your Post #146 my friend

 

[Gern Blansten]

(btw, why would an anesthesiologist manage both OB and an emergency OR?)..also a scenario that crnas couldnt handle and many anesthesiologists wouldnt be comfortable handling.

Covering OB at the same time as 1-2 emergency ORs is a very common part of anesthesia call at many locations across the country. In my experience, it is the normal scenario at the multiple places I have been. Have you never had the joy of covering the trauma patient who is trying to die and the 2AM appy, while also having OB call a stat c-section?

 

[Mman]

Covering OB at the same time as 1-2 emergency ORs is a very common part of anesthesia call at many locations across the country. In my experience, it is the normal scenario at the multiple places I have been. Have you never had the joy of covering the trauma patient who is trying to die and the 2AM appy, while also having OB call a stat c-section?

it's far more fun when you are near coding a bad trauma patient and the L&D nurse is wondering how long it will be til her G1 that still has a foley bulb in can get her epidural.

 

[AKMD_1984]

Oooh...a liar AND dishonest?? What about a fibber or a deceiver??

As i said, you had quoted my post, which based on your statement, implies that you disagree with the statement you are quoting.

Feel free to read your Post #146 my friend

Again, you did NOT answer my question and you’re swaying what’s asked and unable to provide basis for a claim you made. So yes, I’d call that dishonest and being slick. The basis of your argument is weak that’s the the issue.

FYI I am a solo MD and I do my own cases 95% of the time. I mostly do ENT and spine cases. I do a few days of pain injections and I use a sedation nurse (not CRNA) for versed/ fentanyl. I don’t employ CRNAs myself. I have a mixed anesthesia/ pain practice where I see both sides of the hospital - as a physician who brings in cases, and as an expense as an anesthesiologist.

Once in a while I do supervision close to my house for a hospital at a discounted rate, but that’s 1-2 x a month.

I am not promoting CRNAs. They are a useful and important aspect of anesthesia delivery as they provide labor, but things go south when they’re put in places of position/ power/ scheduling/ administration and leadership because inherently they have inferior training to MDs and they can never truly and organically be equivalent despite them pretending to be equal.

Thats it. Thats the basis of all dynamics and conflicts in groups. Unless and until you understand that, it will be very difficult to navigate this career esp if you choose to work in an AMC settings.

Point is, it’s folks like you - weak “clock in clock out” earn my 500-750k anesthesiologist without any real passion to protect speciality types- that enable practice scope creep.

Yesterday it was CRNA, today is a dental anesthesiologist; tomorrow it will be AI robots. I see no real reason why dental anesthesiologists should have equivalence of a boarded anesthesiologist through ABA which encompasses far more than a dentists training or CRNA.

It’s a secondary question how and when equivalence can be established between dentists and anesthesiologists. Maybe it does exist - I don’t know. But the point is, until that’s done - everyone needs to be scrutinized in regards to their skills and abilities esp when they’re dealing with acute and critical situations.

 

[AKMD_1984]

Covering OB at the same time as 1-2 emergency ORs is a very common part of anesthesia call at many locations across the country. In my experience, it is the normal scenario at the multiple places I have been. Have you never had the joy of covering the trauma patient who is trying to die and the 2AM appy, while also having OB call a stat c-section?

Yes. The fact that USC ghost is arguing on this issue shows me that he hasn’t really experienced bread and butter community anesthesia practice. This is typical and customary for many anesthesia jobs…

 

[Mman]

Yes. The fact that USC ghost is arguing on this issue shows me that he hasn’t really experienced bread and butter community anesthesia practice. This is typical and customary for many anesthesia jobs…

IMHO unless you are doing more than maybe 5,000-6,000 deliveries a year, the doc covering L&D can also cover ORs.

 

[aneftp]

IMHO unless you are doing more than maybe 5,000-6,000 deliveries a year, the doc covering L&D can also cover ORs.

Really depends on the bodies
1 doc
1 crna on ob (cs going)
1 crna in the or (transplant running already)

It’s 2am

Trauma comes on
Backup is 30 minute out.

This is also common

Call doc starts OR case solo and backup comes in

But you leave stroke intervention unattended when you go start a case solo

Does it happen often? With 5000 deliveries a year it happens 10-15 times a year where admin crunches the numbers and says you don’t need 3 crnas at night continuously

Mind you. The average night generally has a cs between 11p-4am when ur 3rd crna leaves at 11p and you are down to one crna or or and one crna for ob. With stroke and trauma to cover.

 

[Mman]

Really depends on the bodies
1 doc
1 crna on ob (cs going)
1 crna in the or (transplant running already)

It’s 2am

Trauma comes on
Backup is 30 minute out.

This is also common

Call doc starts OR case solo and backup comes in

But you leave stroke intervention unattended when you go start a case solo

Does it happen often? With 5000 deliveries a year it happens 10-15 times a year where admin crunches the numbers and says you don’t need 3 crnas at night continuously

Mind you. The average night generally has a cs between 11p-4am when ur 3rd crna leaves at 11p and you are down to one crna or or and one crna for ob. With stroke and trauma to cover.

I'm not really getting into the CRNA/AA aspect of the call coverage as that can complicate the issue quite a bit and can have massive variations between locations. Just pointing out one doc can cover ORs and L&D at the same time in the overwhelming majority of scenarios.

 

[cittykat]

Covering OB at the same time as 1-2 emergency ORs is a very common part of anesthesia call at many locations across the country. In my experience, it is the normal scenario at the multiple places I have been. Have you never had the joy of covering the trauma patient who is trying to die and the 2AM appy, while also having OB call a stat c-section?

@UscGhost is likely in California. Most of us personally take care of one patient at a time here. No midlevels.

 

[AKMD_1984]

I'm not really getting into the CRNA/AA aspect of the call coverage as that can complicate the issue quite a bit and can have massive variations between locations. Just pointing out one doc can cover ORs and L&D at the same time in the overwhelming majority of scenarios.

Yes different variations of staffing and hospital bylaws exist. But as i mentioned before, no one is sending the dental anesthesiologist from the bench to take care of this.

 

[cittykat]

IMHO unless you are doing more than maybe 5,000-6,000 deliveries a year, the doc covering L&D can also cover ORs.

In our community the maternity hospital that does that volume has 2 anesthesiologists on L&D 24/7. Separate anesthesiologists cover the ORs.

 

[aneftp]

I'm not really getting into the CRNA/AA aspect of the call coverage as that can complicate the issue quite a bit and can have massive variations between locations. Just pointing out one doc can cover ORs and L&D at the same time in the overwhelming majority of scenarios.

This isn’t about AA or crna

It depends on how tight u want to run it. Running bare bones like many places without an extra body available besides you is very stressful. 5000 deliveries is not a small amount.

No dedicated in house 3rd crna to handle immediate stroke or trauma (assuming cs and or already going at 2am ) puts a lot of pressure on the doc covering when both cs and or are simultaneously running.

If you have a spare body all the time. It’s not a big deal. But if you are the spare body. It can be a problem

 

[UscGhost]

Covering OB at the same time as 1-2 emergency ORs is a very common part of anesthesia call at many locations across the country. In my experience, it is the normal scenario at the multiple places I have been. Have you never had the joy of covering the trauma patient who is trying to die and the 2AM appy, while also having OB call a stat c-section?

That may be the case at small low volume hospitals. But not at any of the major hospitals i have been at in So cal.

And thats fine. AKMD was arguing that a dental anesthesiologist cant manage all of that. And thats fine too, as nobody was arguing they could. CRNAs certainly cant manage that. Only some anesthesiologists can comfortably manage a trauma OR and OB (and we all know plenty that cant)

The argument was whether a dental anes can practice to a similar capability that a typical crna can... and there isnt any objective reason that they couldn't

 

[UscGhost]

Yes different variations of staffing and hospital bylaws exist. But as i mentioned before, no one is sending the dental anesthesiologist from the bench to take care of this.

Nobody is sending the crna to manage two rooms (an OB and a trauma OR either)

 

[UscGhost]

IMHO unless you are doing more than maybe 5,000-6,000 deliveries a year, the doc covering L&D can also cover ORs.

Most hospitals in California that handle that many deliveries will have one for C sections one for L&D and one for OR

 

[UscGhost]

Yes. The fact that USC ghost is arguing on this issue shows me that he hasn’t really experienced bread and butter community anesthesia practice. This is typical and customary for many anesthesia jobs…

Lol.

Its not common at all in busy places

 

[UscGhost]

Again, you did NOT answer my question and you’re swaying what’s asked and unable to provide basis for a claim you made. So yes, I’d call that dishonest and being slick. The basis of your argument is weak that’s the the issue.

FYI I am a solo MD and I do my own cases 95% of the time. I mostly do ENT and spine cases. I do a few days of pain injections and I use a sedation nurse (not CRNA) for versed/ fentanyl. I don’t employ CRNAs myself. I have a mixed anesthesia/ pain practice where I see both sides of the hospital - as a physician who brings in cases, and as an expense as an anesthesiologist.

Once in a while I do supervision close to my house for a hospital at a discounted rate, but that’s 1-2 x a month.

I am not promoting CRNAs. They are a useful and important aspect of anesthesia delivery as they provide labor, but things go south when they’re put in places of position/ power/ scheduling/ administration and leadership because inherently they have inferior training to MDs and they can never truly and organically be equivalent despite them pretending to be equal.

Thats it. Thats the basis of all dynamics and conflicts in groups. Unless and until you understand that, it will be very difficult to navigate this career esp if you choose to work in an AMC settings.

Point is, it’s folks like you - weak “clock in clock out” earn my 500-750k anesthesiologist without any real passion to protect speciality types- that enable practice scope creep.

Yesterday it was CRNA, today is a dental anesthesiologist; tomorrow it will be AI robots. I see no real reason why dental anesthesiologists should have equivalence of a boarded anesthesiologist through ABA which encompasses far more than a dentists training or CRNA.

It’s a secondary question how and when equivalence can be established between dentists and anesthesiologists. Maybe it does exist - I don’t know. But the point is, until that’s done - everyone needs to be scrutinized in regards to their skills and abilities esp when they’re dealing with acute and critical situations.

Thats a nice post an everything.

But nobody said a dental anesthesiologist was equivalent to a anesthesiologist. In fact, i stated multiple times that they werent.

I simply stated that dental anes have better training than CRNAs.

Gotta work on your reading comprehension my friend.

 

[Mman]

Most hospitals in California that handle that many deliveries will have one for C sections one for L&D and one for OR

I'm not familiar with practice in California, but isn't it mostly physician only? East Coast is almost purely ACT model with 1 doc covering 3-4 CRNAs. I literally can't imagine doing only L&D in the middle of the night for somewhere doing 5000 deliveries as you would very often be bored out of your mind (and/or sleeping). I'd rather work hard and be up all night and be in the hospital half as many nights.

 

[UscGhost]

I'm not familiar with practice in California, but isn't it mostly physician only? East Coast is almost purely ACT model with 1 doc covering 3-4 CRNAs. I literally can't imagine doing only L&D in the middle of the night for somewhere doing 5000 deliveries as you would very often be bored out of your mind (and/or sleeping). I'd rather work hard and be up all night and be in the hospital half as many nights.

Mostly solo out in California unless its kaiser or academic.

Some places have crnas.

Just for my clarification..is the same person placing epidurals and doing c sections?

That sounds rough if you are doing 15 epidurals a day plus 1-2 csxns

 

[Mman]

Mostly solo out in California unless its kaiser or academic.

Some places have crnas.

Just for my clarification..is the same person placing epidurals and doing c sections?

That sounds rough if you are doing 15 epidurals a day plus 1-2 csxns

CRNA sitting in room for csection while the doc does the procedures. And 15 epidurals per day would be nearly 5500 epidurals a year. Most places that deliver 5000 babies in a year are doing maybe 2000-3000 epidurals at most. I mean something like 25% of the cases should be scheduled csections. And nobody gets a 100% epidural rate. Even 75% epidural rate is pretty damn high. So 5000 deliveries a year is something like 5-7 epidurals per 24 hours.

 

[UscGhost]

CRNA sitting in room for csection while the doc does the procedures. And 15 epidurals would be nearly 5500 epidurals a year. Most places that deliver 5000 babies in a year are doing maybe 2000-3000 epidurals at most. I mean something like 25% of the cases should be scheduled csections. And nobody gets a 100% epidural rate. Even 75% epidural rate is pretty damn high. So 5000 deliveries a year is something like 5-7 epidurals per 24 hours.

Thats not too bad then.

Most OB places i have been at had closer to 70% epidural rates (nurses tend to push them)

I have been at places that the epidural doc places all epid (1-5 per day) and did c sections. No assist.

But gets hectic on a busy day

 

[AKMD_1984]

Thats a nice post an everything.

But nobody said a dental anesthesiologist was equivalent to a anesthesiologist. In fact, i stated multiple times that they werent.

I simply stated that dental anes have better training than CRNAs.

Gotta work on your reading comprehension my friend.

You say a lot of things. Most of it is BS.

Yawn.

 

[UscGhost]

You say a lot of things. Most of it is BS.

Yawn.

Lol.

Still not sure what point you are arguing with.

I said that MD and Dental anes are not equivalent (multiple times btw)

I also said, that Dental anes have more training than CRNAs (which is well documented)

So which point are you disagreeing with now, since you said most of its BS?

Or is this just one of those "Old man yells at a cloud" situations?

 

[SuxDrugs&Rocuronium]

Again, you did NOT answer my question and you’re swaying what’s asked and unable to provide basis for a claim you made. So yes, I’d call that dishonest and being slick. The basis of your argument is weak that’s the the issue.

FYI I am a solo MD and I do my own cases 95% of the time. I mostly do ENT and spine cases. I do a few days of pain injections and I use a sedation nurse (not CRNA) for versed/ fentanyl. I don’t employ CRNAs myself. I have a mixed anesthesia/ pain practice where I see both sides of the hospital - as a physician who brings in cases, and as an expense as an anesthesiologist.

Once in a while I do supervision close to my house for a hospital at a discounted rate, but that’s 1-2 x a month.

I am not promoting CRNAs. They are a useful and important aspect of anesthesia delivery as they provide labor, but things go south when they’re put in places of position/ power/ scheduling/ administration and leadership because inherently they have inferior training to MDs and they can never truly and organically be equivalent despite them pretending to be equal.

Thats it. Thats the basis of all dynamics and conflicts in groups. Unless and until you understand that, it will be very difficult to navigate this career esp if you choose to work in an AMC settings.

Point is, it’s folks like you - weak “clock in clock out” earn my 500-750k anesthesiologist without any real passion to protect speciality types- that enable practice scope creep.

Yesterday it was CRNA, today is a dental anesthesiologist; tomorrow it will be AI robots. I see no real reason why dental anesthesiologists should have equivalence of a boarded anesthesiologist through ABA which encompasses far more than a dentists training or CRNA.

It’s a secondary question how and when equivalence can be established between dentists and anesthesiologists. Maybe it does exist - I don’t know. But the point is, until that’s done - everyone needs to be scrutinized in regards to their skills and abilities esp when they’re dealing with acute and critical situations.

So let’s get a few things straight. Dentist anesthesiologists have never once tried to claim equivalence to physician anesthesiologists. I don’t know where this came from. Our training has many similarities, and we wholly acknowledge that we serve a different role in the world of anesthesia. We train specifically to be able to provide safe care in the dental office setting.

During our three years of residency, we learn all aspects of anesthesia besides cardiac and OB. It’s not really necessary for us to know how to place epidurals. None of us will ever be placing an epidural after residency.

Our goal is to be able to elevate the safety in dental offices when anesthesia is administered. We all hear about the CRNAs or oral surgeons who have bad outcomes. We come in as a separate provider with extensive training in anesthesia, both in hospital and office settings, while most other anesthesia providers get very limited exposure to office based settings (in Brooklyn where I trained the physician anesthesiologists only had 1-2 weeks of an “out of OR” rotation which was just doing endo cases still within the hospital).

Like I’ve stated before, most of us didn’t know we wanted to go into an anesthesia residency until we were already in dental school. I don’t claim equivalence to physician anesthesiologists. I don’t want to work in a hospital seeing ICU level patients. I did it in residency and am glad I don’t have to do it anymore. I have utmost respect for physician anesthesiologists and what you do. I learned a ton from my physician attendings and colleagues during residency.

If you’re upset that we exist, I have a few suggestions. First, encourage your hospitals to see more dental cases. Pediatric and special needs patients who cannot safely sit for dental procedures awake unfortunately require some form of sedation to safely get their dental work done. Your hospitals wont see more than a few cases a week because the money they make is abysmal. They’d much rather give that block time to the orthopedic surgeon who wants to do a total hip on the 95 year old demented grandma who arguably won’t ever walk again with her new hip. Why? Because of money. If you don’t like that we do these cases in a dental office, fight your hospital administrators to do them in hospital (spoiler alert: they won’t)

So we have some alternatives. More MDs can come to these cases (we welcome that because the demand is so high). But many of you don’t want to, and I respect that. It’s a very different setting. So instead CRNAs come and do them. Most of the time they do okay, but then you get some who are underprepared and arrogant, and then you end up with a CRNA killing two people in the same year (see the Arizona cases).

There’s less than 500 of us in the country. You’re fighting the wrong fight.

 

[UscGhost]

So let’s get a few things straight. Dentist anesthesiologists have never once tried to claim equivalence to physician anesthesiologists. I don’t know where this came from. Our training has many similarities, and we wholly acknowledge that we serve a different role in the world of anesthesia. We train specifically to be able to provide safe care in the dental office setting.

During our three years of residency, we learn all aspects of anesthesia besides cardiac and OB. It’s not really necessary for us to know how to place epidurals. None of us will ever be placing an epidural after residency.

Our goal is to be able to elevate the safety in dental offices when anesthesia is administered. We all hear about the CRNAs or oral surgeons who have bad outcomes. We come in as a separate provider with extensive training in anesthesia, both in hospital and office settings, while most other anesthesia providers get very limited exposure to office based settings (in Brooklyn where I trained the physician anesthesiologists only had 1-2 weeks of an “out of OR” rotation which was just doing endo cases still within the hospital).

Like I’ve stated before, most of us didn’t know we wanted to go into an anesthesia residency until we were already in dental school. I don’t claim equivalence to physician anesthesiologists. I don’t want to work in a hospital seeing ICU level patients. I did it in residency and am glad I don’t have to do it anymore. I have utmost respect for physician anesthesiologists and what you do. I learned a ton from my physician attendings and colleagues during residency.

If you’re upset that we exist, I have a few suggestions. First, encourage your hospitals to see more dental cases. Pediatric and special needs patients who cannot safely sit for dental procedures awake unfortunately require some form of sedation to safely get their dental work done. Your hospitals wont see more than a few cases a week because the money they make is abysmal. They’d much rather give that block time to the orthopedic surgeon who wants to do a total hip on the 95 year old demented grandma who arguably won’t ever walk again with her new hip. Why? Because of money. If you don’t like that we do these cases in a dental office, fight your hospital administrators to do them in hospital (spoiler alert: they won’t)

So we have some alternatives. More MDs can come to these cases (we welcome that because the demand is so high). But many of you don’t want to, and I respect that. It’s a very different setting. So instead CRNAs come and do them. Most of the time they do okay, but then you get some who are underprepared and arrogant, and then you end up with a CRNA killing two people in the same year (see the Arizona cases).

There’s less than 500 of us in the country. You’re fighting the wrong fight.

Yes.

Most anesthesiologists have little interest in changing their practice environments to work in offsite dental offices with minimal ancillary support.

Not sure why AKMD is so turnt up.

Its a pretty small niche that doesn't encroach on anesthesiologists practice and needs good patient care

I just find it odd that he seems to be so hard up against Dental anes when CRNAs are much less qualified (both in baseline qualifications to get into CRNA prog vs Dental anes prog and in clinical training) and CRNAs openly encroaching on physician territory as they proclaim equal outcomes.

 

[cittykat]

CRNA sitting in room for csection while the doc does the procedures. And 15 epidurals per day would be nearly 5500 epidurals a year. Most places that deliver 5000 babies in a year are doing maybe 2000-3000 epidurals at most. I mean something like 25% of the cases should be scheduled csections. And nobody gets a 100% epidural rate. Even 75% epidural rate is pretty damn high. So 5000 deliveries a year is something like 5-7 epidurals per 24 hours.

I don’t do OB any more but in my experience busy high volume birth centers with good anesthesia coverage also tend to have higher epidural rates. Epidural-AROM-pit-baby. And places that are low volume with spotty coverage have lower epidural rates.

Products - Data Briefs - Number 553 - March 2026

Published: 03/25/2026

www.cdc.gov

Data from the National Vital Statistics System

• In 2024, 75.4% of mothers with singleton vaginal births used epidural or spinal anesthesia, an 8% increase from 2016.
• The use of epidural or spinal anesthesia increased for all maternal age groups from 2016 to 2024.
• From 2016 to 2024, the percentage of mothers using epidural or spinal anesthesia increased 5%–17% across all race and Hispanic-origin groups.
• The use of epidural or spinal anesthesia increased for mothers covered by Medicaid, private insurance, and other sources of payment, while it decreased for mothers who self-paid for their deliveries.
• From 2016 to 2024, the use of epidural or spinal anesthesia increased in 44 states and the District of Columbia, decreased in 2 states, and was essentially unchanged in 4 states.

 

[Mman]

I don’t do OB any more but in my experience busy high volume birth centers with good anesthesia coverage also tend to have higher epidural rates. Epidural-AROM-pit-baby. And places that are low volume with spotty coverage have lower epidural rates.

Products - Data Briefs - Number 553 - March 2026

Published: 03/25/2026

www.cdc.gov

Data from the National Vital Statistics System

• In 2024, 75.4% of mothers with singleton vaginal births used epidural or spinal anesthesia, an 8% increase from 2016.
• The use of epidural or spinal anesthesia increased for all maternal age groups from 2016 to 2024.
• From 2016 to 2024, the percentage of mothers using epidural or spinal anesthesia increased 5%–17% across all race and Hispanic-origin groups.
• The use of epidural or spinal anesthesia increased for mothers covered by Medicaid, private insurance, and other sources of payment, while it decreased for mothers who self-paid for their deliveries.
• From 2016 to 2024, the use of epidural or spinal anesthesia increased in 44 states and the District of Columbia, decreased in 2 states, and was essentially unchanged in 4 states.

View attachment 422679

that would be about 8 epidurals per 24 hours for 5000 deliveries

 

[cittykat]

that would be about 8 epidurals per 24 hours for 5000 deliveries

I posted the link because you said a 75% epidural rate is “pretty damn high”. 75% is average.

 

[Mman]

I posted the link because you said a 75% epidural rate is “pretty damn high”. 75% is average.

I suspect the mean is higher than the median because the highest volume centers will have the highest epidural rates. So almost by definition the lower volume centers will have a lower rate.

 

[abolt18]

CRNA sitting in room for csection while the doc does the procedures. And 15 epidurals per day would be nearly 5500 epidurals a year. Most places that deliver 5000 babies in a year are doing maybe 2000-3000 epidurals at most. I mean something like 25% of the cases should be scheduled csections. And nobody gets a 100% epidural rate. Even 75% epidural rate is pretty damn high. So 5000 deliveries a year is something like 5-7 epidurals per 24 hours.

Yes, but there will be shifts in a place like that where you do 15 epidurals and 3-4 sections in the same day. just like there will be days they only do a couple epidurals. I do not want to be working that day they do 15.

We do ~3000 deliveries/year and I have done as many as 11 epidurals in a shift with 3 sections. But, I've also had many shifts where I did 0-4 epidurals and no sections at all.

(We are physician only)

 

[cittykat]

I suspect the mean is higher than the median because the highest volume centers will have the highest epidural rates. So almost by definition the lower volume centers will have a lower rate.

The link doesn’t break out the epidural rate by birth center volume but it does break it out by geography, maternal age, race, and insurance. For example the epidural rate in Alaska is 50% while it is 80% in Alabama. Pretty interesting.

 

[Mman]

Yes, but there will be shifts in a place like that where you do 15 epidurals and 3-4 sections in the same day. just like there will be days they only do a couple epidurals. I do not want to be working that day they do 15.

We do ~3000 deliveries/year and I have done as many as 11 epidurals in a shift with 3 sections. But, I've also had many shifts where I did 0-4 epidurals and no sections at all.

(We are physician only)

I get it, I've been there myself, just with ACT model. I'm just saying from a coverage model, a doc can cover L&D and cover ORs. You have backup docs and CRNAs at home you can call in if you get overwhelmed in either location.

 

[UscGhost]

I get it, I've been there myself, just with ACT model. I'm just saying from a coverage model, a doc can cover L&D and cover ORs. You have backup docs and CRNAs at home you can call in if you get overwhelmed in either location.

Yes,

But AKMD was making an example out of simultaneously covering a placenta accreta csxn, GSW, and ruptured AAA....as somehow an example of why dental anesthesia shouldn't exist

Being able to call in backup basically makes it a pretty routine day.

 

[Mman]

Yes,

But AKMD was making an example out of simultaneously covering a placenta accreta csxn, GSW, and ruptured AAA....as somehow an example of why dental anesthesia shouldn't exist

Being able to call in backup basically makes it a pretty routine day.

While that topic was going on in this thread, I specifically did not chime in on it. I was merely pointing out the commonplace nature of covering L&D while also covering ORs overnight or on weekends at even level 1 trauma centers.

 

[aneftp]

@UscGhost is likely in California. Most of us personally take care of one patient at a time here. No midlevels.

Well hopefully ur solo practice doesn’t have 4-5 or running after 7pm solo in a 14 doc single hospital practice with trauma and ob. Plus the surgery center with 2-3 rooms daily.
Too much coverage. Too many rooms running. Getting home at 630-730p 3x a week plus taking call and late call gets old quick. Pre call was the only gurantee early day.

That stuff gets old when I worked in California.

 

[cittykat]

Well hopefully ur solo practice doesn’t have 4-5 or running after 7pm solo in a 14 doc single hospital practice with trauma and ob. Plus the surgery center with 2-3 rooms daily.
Too much coverage. Too many rooms running. Getting home at 630-730p 3x a week plus taking call and late call gets old quick. Pre call was the only gurantee early day.

That stuff gets old when I worked in California.

Sometimes we have 4-5 rooms running between 5-7pm. Usually down to 2 rooms by 7pm.

While we have 24 permanent anesthesiologists on the roster only 14-17 are working on any given weekday. Usually 4-5 are on vacation, postcall is off, and some are on their weekly scheduled day off. We do have some people who may work late 2-3x/week but they do it by choice by moving up the call list. As assigned by our schedulemaker, we should be working late only 1x/week. If someone is doing more than that, it’s because they made a swap after the schedule was published.

Think I posted my 1st case start-last case stop times before. I average 30-35hrs/week at 0.8 FTE. Everybody at my hospital is 0.8 FTE but some choose to work on their off days. That is voluntary. Working at surgicenters and doing OB are voluntary. I don’t do either. I do lose money (~100-130k/yr) by opting out of OB but it’s not worth it to me. Overnight in-house trauma shifts are assigned to everyone but they can be offloaded in under a minute by group chat because they’re very well compensated. It only happens 2-3x/year because people tend to hang onto those shifts.

 

[aneftp]

Sometimes we have 4-5 rooms running between 5-7pm. Usually down to 2 rooms by 7pm.

While we have 24 permanent anesthesiologists on the roster only 14-17 are working on any given weekday. Usually 4-5 are on vacation, postcall is off, and some are on their weekly scheduled day off. We do have some people who may work late 2-3x/week but they do it by choice by moving up the call list. As assigned by our schedulemaker, we should be working late only 1x/week. If someone is doing more than that, it’s because they made a swap after the schedule was published.

Think I posted my 1st case start-last case stop times before. I average 30-35hrs/week at 0.8 FTE. Everybody at my hospital is 0.8 FTE but some choose to work on their off days. That is voluntary. Working at surgicenters and doing OB are voluntary. I don’t do either. I do lose money (~100-130k/yr) by opting out of OB but it’s not worth it to me. Overnight in-house trauma shifts are assigned to everyone but they can be offloaded in under a minute by group chat because they’re very well compensated. It only happens 2-3x/year because people tend to hang onto those shifts.

That’s fine. It’s pretty proves working 1.0 fte with mandatory schedule block is not sustainable for most people in solo MD practices these days doing the tradition call schedule these days.

Like you said. People like choices. They can work on their days off if they choose. Some will pick up the shifts.

 

[AKMD_1984]

So let’s get a few things straight. Dentist anesthesiologists have never once tried to claim equivalence to physician anesthesiologists. I don’t know where this came from. Our training has many similarities, and we wholly acknowledge that we serve a different role in the world of anesthesia. We train specifically to be able to provide safe care in the dental office setting.

During our three years of residency, we learn all aspects of anesthesia besides cardiac and OB. It’s not really necessary for us to know how to place epidurals. None of us will ever be placing an epidural after residency.

Our goal is to be able to elevate the safety in dental offices when anesthesia is administered. We all hear about the CRNAs or oral surgeons who have bad outcomes. We come in as a separate provider with extensive training in anesthesia, both in hospital and office settings, while most other anesthesia providers get very limited exposure to office based settings (in Brooklyn where I trained the physician anesthesiologists only had 1-2 weeks of an “out of OR” rotation which was just doing endo cases still within the hospital).

Like I’ve stated before, most of us didn’t know we wanted to go into an anesthesia residency until we were already in dental school. I don’t claim equivalence to physician anesthesiologists. I don’t want to work in a hospital seeing ICU level patients. I did it in residency and am glad I don’t have to do it anymore. I have utmost respect for physician anesthesiologists and what you do. I learned a ton from my physician attendings and colleagues during residency.

If you’re upset that we exist, I have a few suggestions. First, encourage your hospitals to see more dental cases. Pediatric and special needs patients who cannot safely sit for dental procedures awake unfortunately require some form of sedation to safely get their dental work done. Your hospitals wont see more than a few cases a week because the money they make is abysmal. They’d much rather give that block time to the orthopedic surgeon who wants to do a total hip on the 95 year old demented grandma who arguably won’t ever walk again with her new hip. Why? Because of money. If you don’t like that we do these cases in a dental office, fight your hospital administrators to do them in hospital (spoiler alert: they won’t)

So we have some alternatives. More MDs can come to these cases (we welcome that because the demand is so high). But many of you don’t want to, and I respect that. It’s a very different setting. So instead CRNAs come and do them. Most of the time they do okay, but then you get some who are underprepared and arrogant, and then you end up with a CRNA killing two people in the same year (see the Arizona cases).

There’s less than 500 of us in the country. You’re fighting the wrong fight.

do what you want. just don’t pretend to be equal to an anesthesiologist and f**k up basic cases.

 

[AKMD_1984]

Yes,

But AKMD was making an example out of simultaneously covering a placenta accreta csxn, GSW, and ruptured AAA....as somehow an example of why dental anesthesia shouldn't exist

Being able to call in backup basically makes it a pretty routine day.

it shouldn’t exactly for that reason. don’t you get it? a board certified anesthesiologist should have the ability to learn and be brought up to speed in that environment if needed.

i cannot say the same about a dentist.

 

[AKMD_1984]

So let’s get a few things straight. Dentist anesthesiologists have never once tried to claim equivalence to physician anesthesiologists. I don’t know where this came from. Our training has many similarities, and we wholly acknowledge that we serve a different role in the world of anesthesia. We train specifically to be able to provide safe care in the dental office setting.

During our three years of residency, we learn all aspects of anesthesia besides cardiac and OB. It’s not really necessary for us to know how to place epidurals. None of us will ever be placing an epidural after residency.

Our goal is to be able to elevate the safety in dental offices when anesthesia is administered. We all hear about the CRNAs or oral surgeons who have bad outcomes. We come in as a separate provider with extensive training in anesthesia, both in hospital and office settings, while most other anesthesia providers get very limited exposure to office based settings (in Brooklyn where I trained the physician anesthesiologists only had 1-2 weeks of an “out of OR” rotation which was just doing endo cases still within the hospital).

Like I’ve stated before, most of us didn’t know we wanted to go into an anesthesia residency until we were already in dental school. I don’t claim equivalence to physician anesthesiologists. I don’t want to work in a hospital seeing ICU level patients. I did it in residency and am glad I don’t have to do it anymore. I have utmost respect for physician anesthesiologists and what you do. I learned a ton from my physician attendings and colleagues during residency.

If you’re upset that we exist, I have a few suggestions. First, encourage your hospitals to see more dental cases. Pediatric and special needs patients who cannot safely sit for dental procedures awake unfortunately require some form of sedation to safely get their dental work done. Your hospitals wont see more than a few cases a week because the money they make is abysmal. They’d much rather give that block time to the orthopedic surgeon who wants to do a total hip on the 95 year old demented grandma who arguably won’t ever walk again with her new hip. Why? Because of money. If you don’t like that we do these cases in a dental office, fight your hospital administrators to do them in hospital (spoiler alert: they won’t)

So we have some alternatives. More MDs can come to these cases (we welcome that because the demand is so high). But many of you don’t want to, and I respect that. It’s a very different setting. So instead CRNAs come and do them. Most of the time they do okay, but then you get some who are underprepared and arrogant, and then you end up with a CRNA killing two people in the same year (see the Arizona cases).

There’s less than 500 of us in the country. You’re fighting the wrong fight.

please show me which anesthesiology practices have dental anesthesiologists providing care similar to your run of the mill call taking anesthesiologists.

call, acuity, case management are important part of anesthesiology practice even though you may not do one particular thing over a 30 year career.

i used to work at level 1 trauma center and do peds. now i don’t. it doesn’t mean I can’t go back and do it down the road. because my training encapsulates all those experiences. i can even do anesthesia for dental surgery.

can a dental anesthesiologist be an expert in bread and butter anesthesia practice? im not sure. its a dentistry degree, not medicine.

 

[UscGhost]

please show me which anesthesiology practices have dental anesthesiologists providing care similar to your run of the mill call taking anesthesiologists.

call, acuity, case management are important part of anesthesiology practice even though you may not do one particular thing over a 30 year career.

i used to work at level 1 trauma center and do peds. now i don’t. it doesn’t mean I can’t go back and do it down the road. because my training encapsulates all those experiences. i can even do anesthesia for dental surgery.

can a dental anesthesiologist be an expert in bread and butter anesthesia practice? im not sure. its a dentistry degree, not medicine.

Still not sure who you are arguing with...

Do you even read the posts that you quote or just start yelling with your keyboard

 

[UscGhost]

do what you want. just don’t pretend to be equal to an anesthesiologist and f**k up basic cases.

Lol

He literally said they werent equivalent..along with everyone else.

Sounds like you agree with him

 

[AKMD_1984]

Lol

He literally said they werent equivalent..along with everyone else.

Sounds like you agree with him

Correct. Dentists are not medical doctors. And dental anesthesiologists are not boarded anesthesiologists. Scope of work is not the same. Anesthesiologists can do dental cases along with general cases. Dental anesthesiologists likely cannot do all the cases anesthesiologists do and would likely struggle with privileges.

If “everyone” agrees with that, then sure.

 

[cittykat]

Correct. Dentists are not medical doctors. And dental anesthesiologists are not boarded anesthesiologists. Scope of work is not the same. Anesthesiologists can do dental cases along with general cases. Dental anesthesiologists likely cannot do all the cases anesthesiologists do and would likely struggle with privileges.

If “everyone” agrees with that, then sure.

At least in my state, physician anesthesiologists need a permit from the dental board to perform anesthesia in dental offices. Does not apply to hospitals or surgicenters.

Medical General Anesthesia Permits to Administer Deep Sedation and General Anesthesia (Physician and Surgeon) - Dental Board of California

www.dbc.ca.gov

 

[SuxDrugs&Rocuronium]

please show me which anesthesiology practices have dental anesthesiologists providing care similar to your run of the mill call taking anesthesiologists.

call, acuity, case management are important part of anesthesiology practice even though you may not do one particular thing over a 30 year career.

i used to work at level 1 trauma center and do peds. now i don’t. it doesn’t mean I can’t go back and do it down the road. because my training encapsulates all those experiences. i can even do anesthesia for dental surgery.

can a dental anesthesiologist be an expert in bread and butter anesthesia practice? im not sure. its a dentistry degree, not medicine.

Did you read my post?

 

[UscGhost]

Correct. Dentists are not medical doctors. And dental anesthesiologists are not boarded anesthesiologists. Scope of work is not the same. Anesthesiologists can do dental cases along with general cases. Dental anesthesiologists likely cannot do all the cases anesthesiologists do and would likely struggle with privileges.

If “everyone” agrees with that, then sure.

Thanks for the contribution.

Any other cogent thoughts? Trees have leaves? The sky is blue? Earth rotates around the sun?