Shomopo23, thank you for your post and your opinions. I would like to reply by offering information you may or may not have already read, and my own personal experience. I will comment on each of your points separately. I would advise anyone who is interested in Dental Anesthesia to be sure to read each of the links I have included in this post.
Couple quick things
Dental Anesthesia Residencies have been around for some time now. Ohio State graduated its first dental anesthesia class in 1974 (this was Dr. Joel Weaver who is now the ADA's official voice on sedation) and I believe Pittsburgh program was created before then. During the 50's and 60's many medical anesthesia residencies accepted dentists into their programs for a one-year program. However, as anesthesia became more popular these residencies discontinued this practice. That is when DA residencies were first created. Finally, Dental Anesthesia is not a specialty; it is currently applying for specialty status this year.
#1. You are correct, Dental Anesthesiologists (I will refer to as DAs and Dental Anesthesia as DA from now on) do not take the same board as MD Anesthesiologists. Thus, they are not board certified as the same. However, each state has different laws and thus the role of DA in a hospital varies according to the bylaws of that state but more importantly in each individual hospital. I know firsthand several DAs who hold positions in several hospitals. This is not the norm for most DAs but to say it is unlawful is simply not true. Also, most surgery centers function as stand-alone practices thus as long as you have the license (either medical or dental) to provide the level of care (general anesthesia) you can practice there. I also personally know DAs who have been recruited to work in and even run surgery centers. I agree that it is foolish to think that if you become a DA you can work in any hospital you wish. This ability will depend on the program you came from, your experience, and most importantly, the hospital. Furthermore, one of the main goals of the field is to increase access to care by providing GA in an office setting-- not to replace medical anesthesia in a hospital.
#2. You state DAs have no training in regional, neuro, pediatric, or cardiac anesthesia.
Below are links to the training of two Dental Anesthesia programs.
Ohio State
http://dentanes.osu.edu/aboutus/curriculumplan/index.cfm
Note: CA stands for clinical anesthesia so CA 1= clinical anesthesia training year 1, CA 2= clinical anesthesia training year 2, etc
Pittsburgh (scroll down for info on DA program)
http://www.dental.pitt.edu/students/residency_program.php#dental
Below is link to the CODA minimum standards for a DA program.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1893091/
Note: Every program I interviewed at met these standards within the first 6 months of training.
Every single DA program spends significant time during the residency program performing general anesthesia for solely medical procedures. As you can see from the above curriculum residents are trained side by side with their medical counterparts. There is no distinguishing medical residents with dental anesthesia residents at many programs. Furthermore, I interviewed at a program where during one month long rotation the Dental Anesthesia resident (on that rotation) was in charge of all regional blocks required in the ORs on that day. I will grant cardiac cases are the pinnacle of anesthesia and many DA residents have minimal exposure to this. However, cardiac anesthesia is a sub-specialty in anesthesia. Thus to provide anesthesia for solely cardiac cases many MD anesthesiologists have done the sub-specialty. Finally, you say DAs refer many of their patients out. I am not entirely sure what you mean by this. But I will say one of the very basics of DA residency is to obtain the medical knowledge in order to distinguish between which patients can safely receive GA in an office setting and who needs to receive this in a hospital setting.
#3. I agree with you completely: a vast majority of the time anesthesia is relatively simple and straight forward. However, when complications arise they need to be dealt with swiftly or else dire consequences can result. At every program I interviewed at (you can also see this from the above curriculums) when on the medical anesthesia service DA residents function as a medical anesthesia resident. This includes responding to all blue codes (Cardiac/Respiratory arrest) and being the person in charge for anesthesia during emergency surgeries/trauma extra when on call. In fact, many residents explained this is one of the biggest challenges when you are a resident. The person who needs emergency surgery and the whole room is looking at you to put the patient asleep and keep them alive.
You also mention that anesthesia training is 4 years long. The first year is an intern year where medical knowledge is gained but anesthesia training is not provided. Thus, anesthesia residency is actually 3 years in length. This is why there is a push to make all DA programs three years in length in order to match the length of training of their medical counterparts.
Furthermore, the ASDA (American Society of Dental Anesthesiologists) has met with and discussed the scope of dental anesthesia with the ASA (American Society of Anesthesia). The ASA is supportive of DAs and their scope/training. Their primary goal is to ensure deep sedation/general anesthesia is practiced safely. This trust has been gained through working with DA residents and seeing first hand their knowledge and skill set. While on my interviews a few MD anesthesiologists informed me that in the past their dental anesthesia residents have performed as well or better on the tests given to all anesthesia residents during residency. They have used this to motivate their medical residents (no MD wants to be outperformed by a dentist).
In saying all of that if you feel more comfortable with a MD performing the anesthesia then I encourage you to continue to use these doctors. The whole reason for the creation/need of DAs is that many dentists cannot get an MD to come to their office or find it incredibly difficult to attain access to hospital operating rooms (gaining privileges or time for cases). If MDs were readily available and willing to come to private offices in order to provide general anesthesia and all the equipment necessary for it then there would be no need for DAs.
4. I also know a few dentists who went to medical school and became an anesthesiologist, ENT, etc. I commend these individuals and their drive to chase their dreams. However, I disagree with you this is necessary in order to be become knowledgeable and fully qualified in providing general anesthesia. In my opinion the difference between an MD anesthesiologist and a DA is where they practice and the cases that they routinely provide anesthesia forNOT knowledge or skill.
You mention DAs are not needed because GPs and pediatric dentists provide their own sedation. This comment misses the point and role of DAs. Anesthesia consists of a very broad spectrum and many patients require only minimal or moderate sedation, this can be done by knowledgeable and properly trained dentists. The role of DAs is to provide general anesthesia/deep sedation for patients that require this level of anesthesia. I am currently a pediatric dental resident and before coming back to residency I performed over 300 oral sedations as a GP on my pediatric patients through the help of my mentor, a pediatric dentist. Thus, I am very aware of the capabilities of all properly trained providers in providing minimal/moderate sedation. However, I acutely aware of the limitations of minimal and moderate sedation, especially for pediatric and special need patients. I believe most pediatric dentists would agree oral minimal/moderate sedation is simply not effective enough for a three year old with all primary molars exhibiting gross caries or the non-communicative autistic 18 year old. Furthermore, the IV CE courses taught throughout the country where dentists receive IV sedation training are taught almost exclusively by DAs. DAs would like to promote sedation and education doctors in providing this care to their patients. Dentists invented general anesthesia and by having a specialty within Dentistry we can self-govern sedation guidelines and regulations within our field. Please remember in some countries all sedation has been stripped from dentists and in our own country medicine has questioned our ability (dentists) to provide this care for our patients.
The link below is ASDA's application for Dental Anesthesia as a specialty. Reading the introduction gives a good insight into Dental Anesthesia .I highly recommend reading this.
http://www.asdahq.org/LinkClick.aspx?fileticket=aBtQuCqENSc=&tabid=71
In conclusion:
Pediatric dentistry faced strong opposition in becoming a specialty in the 70's and today no one would question its place as a specialty. I believe this is because we all went to dental school where pediatric dentists were common and part of the curriculum. When I went to dental school I never heard about Dental Anesthesiologists and it was only through my pediatric background that I have been exposed to DA. In fact, having Dental anesthesia as a division in dental schools (in order to teach local anesthesia and even possibly minimal/moderate sedation) is a one of the arguments for it to become a specialty.
. Finally, everyone is entitled to his or her opinion and mutual respect for both sides of this issue needs to be maintained. My only wish is that before making a decision about where you stand on Dental Anesthesia I would like everyone to review the facts with an open mind. I hope my post has been informative. Please send me any and all questions..