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Discussion in 'Dental Residents and Practicing Dentists' started by sucstotherescue, Sep 8, 2011.
Thanks for the info!
so anyone heard from
Isn't the match ranking dead line like 11/18 or something?
It's getting pretty close to the match date. Not sure why some of the other schools have not sent out interview invites. The entire application process needs a complete overhaul.
UCLA Nov. 8-9, via e-mail.
Sorry everyone got this last week.
St. Barnabas Interview
When: Nov 2nd either morning or afternoon session
I believe that pretty much wraps up most of the programs. It was good meeting some of you this week at Loma. Hope to meet more of you. Here is to all of us matching. Take care.
So did anyone hear from wyckoff?
does anyone know how many DA residents are accepted each year?
doing some quick math there should be around 29 spots between the US and Canada this year.
it looks like people have been on interviews to loma linda and pittsburgh. anybody have a take on the programs after their interview. looking for some feedback for next year
Spoke with Stony Brook PD today and seems that most are being interviewed for both GPR-medical track and straight DA. Each applicant will be ranked for both and applicants will do the same for the programs
pitt interviewed last week 10/21.
Top 5 programs are the school based ones:
LLU, Stony Brook, UCLA, The OSU, and Pitt
-The ny based programs are getting better
-Indiana U has a new program, with the director being dual trained in OMFS and Anes.
- Program at Pitt is stellar: the intern year + 2 hospital/school based years. one of the best hospital networks in the northeast and love from the medical attendings. Second to none faculty..Great experience in special needs also. and the medically challenged population of pittsburgh.
Wycoff to make interview decisions next week or two. cutting it close!!
I know this is about residency; however, I was wondering if some could explain what exactly a working dental anethesiologist does day-to-day? What areas do they work in; do they still perform desntistry?, etc.
Check out post #10.
Are you associated with Pitt? I'm just saying this considering your initials.
Know it's late but Wyckoff Nov. 15 Evening.
That about wraps things up.
did anyone get a call from indiana tonight?...
Dr. Kramer called me (left message) and then later sent email. Apparently there are a few problems and not enough support for the program. Thus, the program is in a state of flux and he cancelled the interview. He apologized and wished all of us luck. He also looks forward to meeting each and every one of us at future meetings. I was personally very excited to interview at IU and have only heard great things about Dr. Kramer. Unfortunately, our chosen field can be a political battle ground. I hope all of us work to change this throughout our careers. I believe DA is on the cusp of big things... Not to much longer until the 30th. It was great meeting some of you on the interview trail. Good luck everyone.
I am a dentist who has taken extensive training in sedation dentistry. I'm an old fart, and dental anesthesia residencies weren't around in my day. While I am not a "dental anesthesiologist", I wanted to write a few points to warn my fellow colleagues that are considering dental anesthesia.
1. Someone made a post earlier about Dental Anesthesiologists working in hospitals and being hired to run surgery centers. This is simply not true. Please note that the American Society of Anesthesiology has extensive barriers and by law, a dental anesthesiologist is not permitted to be in such position. This is due in part to JHACO standards, and also the fact that dental anesthesiologists do NOT take the board certification exams that MD anesthesiologists do. Hence, they are not board certified as far as the ASA is concerned.
2. Dental anesthesiologists have no training in cardiac, neuro, pediatric or regional anesthesia. Yes, they may be able to do dental OR cases. But lets face it. Those are the run of the mill straight forward cases. Have you ever noticed that dental anesthesiologists refer a significant percentage of cases where the patient is "medically compromised"? While it's nice that a dental anesthesiologist can intubate a healthy 11 year old, they are not bringing anything new to the table. What's next? Podiatrists now lobbying and saying that they want to start a specialty called "Podiatric Anesthesia"? We specialize in providing general anesthesia for any foot and ankle surgeries! Where do we draw the line? Isn't that what MD Anesthesiologists are for?
3. Anesthesia is like being an airline pilot. Most of the time things are smooth sailing. But when **** hits the fan, **** hits the fan. As a dentist, if I am employing someone in my office to provide general/IV sedation services, who am I going to hire? An MD ANESTHESIOLOGIST of course! 4 years med school, + 4 years residency is much more training than 3 years of dental anesthesia training. A patient's life is nothing to gamble with. That being said, I am also very much against employing CRNA's as well, so it's not just the dental anesthesiologists. I simply want the most qualified person to do the job when my reputation is on the line.
4. I know several dentists who went BACK to medical school, did another 4 years of MD anesthesia residencies, and are successful anesthesiologists. Dental anesthesiology makes no sense because it's such a gray area. Either you are passionate about sedation and you go the whole way and become an MD anesthesiologist through med school, OR you can be a dentist with an interest in sedation and you can do oral sedations, stacked dosing, IV sedations in your office through CE's (DO NOT DO the DOCS course --it's horrible). Don't be in the gray zone as a dental anesthesiologist, because you're only screwing yourself over. What's going to happen when GP's start doing their own IV sedations (like many already are) or when Pediatric Dentists do their own oral sedations? (we all know they do their own there too) Now, many pedo programs are offering IV sedation certification. The need for dental anesthesiologists goes down! And what will dental anesthesiologists do then? Go back and practice general dentistry? How? They will have lost their hand skills by being away from dentistry for so long. It's a lose lose situation.
I'm really not sure about point #1, but it sounds like you don't know what you're talking about on the rest of your post.
If you haven't done a residency, you should probably interview someone who has. Others, who are interested in DA, will be misled by your post. DA residencies don't water-down the anesthesia training by only assigning you to healthy ASA I or II pts. I do anesthesia on people who on death's doorstep everyday. It's a CODA requirement that DA residents see a significant number of ASA III and IV patients. There seems to be a misconception (unfortunately among dentists) about the quality of training that DA's receive. While you may be correct, in particular instances, about the privileges in states, hospitals, etc, it does not encompass all such entities. I hope I can clear-up further misunderstanding you or others may have about DA. Just ask.
Please don't give this troll any attention guys. Look at his previous posts...he graduated from Pitt in 2009...that tell you anything?
All of the recent deaths in the dental office using either a dental anesthesiologist or MD anesthesiologists have been under the watch of MD anesthesiologists....Our training is side by side with the MDs. Many MDs who advertise to dentists do so because they can not find jobs in hospitals....hospitals wont hire them etc. We do train and work on medically compromised patients in the hospital setting. No one is going to do anesthesia on a med compromised patient in an outpatient setting...MD or DMD trained. We get pretty much just as much training on peds as any MD anesthesiologist who doesn't do a fellowship in peds....maybe even more. We definitely get more experience with nasal intubations bec we do more dental cases than most MDs. AS for no training in neuro/cardiac etc? I am 6 months into my program and ran a neuro case last night for a subdural hematoma practically by myself at 2:30 in the AM....so clearly, you don't know what you are talking about. If you think that your sedation training is on par with a hospital based 2 or 3 year dental anesthesia program then you are dreaming my friend.
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.
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)
Below is link to the CODA minimum standards for a DA program.
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.
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..
I know the residents that have responding are very busy. Thank you for your responses. Looking forward to the vertical learning curve in July when I join you in residency..
I started working on response yesterday and didn't realize so many people responded. Probably no need for my post. Oh well. Hopefully its helpful for someone.
Great response and very informative. I am sure you will be a great asset to the field
LOL! I saw that guys post and I was waiting for you to reply, that's why I kept it short with him. Before he changed his last post to a smiley face, he was calling me out to answer him. But knowing you, I knew you were already working on a response. He had no clue what he's talking about. The only thing I would add to your response is that he contradicted himself in his statement. First, he says all the dentists are gonna do CE's in IV sedation and there's no need for DA. Then he says, if he was a dentist, he'd employ an MD because they have the best training. Well, in that case, why is he doing IVs? Aren't MD's and DA's the best trained for that? I'm not sure what his deal is, maybe he wanted to be DA and didn't? Maybe he sees DA as a threat to his IV sedation practice? Who knows... but it's people like him that spread misinformation about us. Can't wait for July!
I dont know much about this field-can anyone point me to a link or answer these questions;
1. Do DAs have thier own practices? Are they general dentists with extra sedation training or do they solely focus on sedation as per diem in pedo/omfs/hospital settings? It also looks like some people use this as a stepping stone to beef up the resumes for OMFS.
2. What is the outlook on the profession?
3. What is the lifestyle and average pay like?
Currently, most DAs engage in ambulatory practice providing anesthesia for pedo, os, perio, etc.. Although, some DAs act as anesthetist/operator, usually in their own practices, it is still not an ADA recognized specialty. So, any practicing DA, regardless of their practice focus, is technically a general dentist. There is a ongoing effort for DA to be recognized as a specialty (to be voted on by ADA in ~ Oct).
To be a DA as opposed to a dentist with sedation training, one has to complete a 2-3 yr dental anesthesia residency
Some DAs have appointments to hospital staffs while others work at surgery centers or some combination of the aforementioned.
I have 2 co-residents who applied to os after 1.5yr of DA residency and were accepted.
Fees are usually charged by the hour (some by the case). The amt. varies depending on the part of the country you're in, whether medicaid, pvt pay, or indemnity ins.
Most cases are started in the early morning to prevent pt.s who have been npo from becoming dehydrated or hypoglycemic (children). So, you will often be done by early afternoon.
Why would an OMFS ever use a DA? OMFS are sufficiently trained in anesthesia.
Let me relieve you of your ignorance young one...just bc an OS has sufficient training doesnt mean they always want to do it
A ton of OS will use seperate anesthesia providers for certain procedures...whether or not they choose a DA is based on familiarity, availability and preference
Yes, but the certain procedures that you speak of, BSSO, LeFort, etc., are not what most OS do in private practice. Impacted wisdom teeth, implants, and other extractions require little need for a DA. Why would an OS pay someone else to administer Ketamine, Propofol, etc.?
First of all you said "ever"...and there are plenty that work with DAs and other anesthetists in their office.
You seem to be under the impression that hiring someone else to do your anesthesia has some correlation to ability to anesthetize, when it doesn't. It makes sense for OSs who load their schedule to walk into a room to a patient who is sedated and already has local anesthesia placed.
Some just don't want to worry about it at all.
I still stand by that statement of ever. They are not really needed in academic settings, as anesthesia should be learned and practiced during residency training. Anesthesia can provide supplemental income for extractions with little work for OMFS, so there is no point giving that to someone else. Most private practice OMFS that I know work efficiently and have not needed another person to do anesthesia for them.
Now, I am not saying that there is not a role for DA. I believe that DA working with peds can turn out to be a great combo. However, not so for OMFS.
Well you're saying ever when you can go on google and find oral surgeons using them easily. Patrick McCarty is a DA on dental town and on faculty at BU and shares a practice with an OS...they work together everyday. So when you say "ever"...you're wrong. And many many OS have an anesthetist of some kind come to their office.
Honestly the way you talk I find it hard to believe you're an OS or resident...you seem inexperienced and close minded...even those that don't use outside anesthetists could understand those that would...especially the OSs without easy access to the OR.
do people do this? Apply to OMS, after DA? Does it really give you a leg up? That sounds like a dream, as I could see myself as a DA and would have a nice back up if OMS didn't work out.
There's only 27 DA spots available each year...Idk if it's a good idea as a backup...not to mention u could be looking at 9 years of school after dschool
I'm sorry, I really did not mean to offend you or trivialize DA, and I know it is competitive to get into. But OMS is also competitive, and speaking in loose, general terms here, someone on the cusp of OMS would likely be compettitive enough to get into DA.
So my question stands to anyone who can answer it (that includes you Dave). Although DA is relatively new....has anyone else heard of someone going from DA to OMS? Would this be transition make sense, and give you a leg up in applications? And Pleonasm - how can someone go to OMS after only 1.5 years of DA?
They're both competitive. A strong OMS candidate has a great shot at DA.
It's not new, Pittsburgh has had a program since the 50's.
There are very few DAs, you already know of 2 that matched to OMS, both of them did an OMS internship b4 DA residency. Both did not match to OMS first, but did later.
I think he meant that the person matched jan 2012 for a July 2012 OMS residency. So by the time he matriculates to OMS hell have completed the DA res. he can correct me if I'm wrong.
I simply meant that they applied in their second yr of DA residency. That means that when match results come out in Jan., they will have spent 1.5 yr. Some people apply in the first yr of residency and are accepted. Clearly, they go ahead and complete the term.
Do DA and OS ever work together?
Some of the DA programs work intimately with their associated OS program. These relationships are very strong, cohesive, and mutually beneficial to both programs. I personally wish the dental community would look at these programs and the relationships that have been established between OS and DA. I think this would eliminate a lot of turf battle with DA becoming a specialty. DA supports OS and their model of working as single operator/anesthetist. However, OS primarily uses this service (oper/anesth) to provide sedation for extractions, implants, etc. However, I know my current associated OS program will not sedate children under 10. Thus, these cases end up in the OR for a relatively simple procedures (mesodens, supernumerary extractions, etc). This is where a DA would be beneficial to an OS practice. Now every OS program is different and the level of training you receive with IV sedation ranges widely, but I agree with the other posters. These relationships can be very beneficial to both doctors and their patients (reduced fee of having procedure done in office vs going to hospital/surgery center, access to care, etc).
Would doing a DA program give you a leg up for OS residency?
Your level of training with anesthesia from a DA program would be unrivaled by the other applicants for an OS position. I personally believe this would absolutely give you a leg up on other applicants (my dental school program director of OS also mentioned this). However, there is increased training (DA residency is no joke and there is a push to make all of these programs 3 years in length) and you may be able to get in to OS from a one year OS internship or even a hospital based GPR program. As you know DA is up for specialty status in October and regardless if this passes or not DA is a growing field. I think many programs want resident who are committed to the field and its growth, not just using it as a stepping stone. In saying that it is true that many people do several residencies and the relationship between OS and DA is very strong. Once in a DA program, they can not stop you from applying (not to mention if this is truly what you wanted I believe most programs would support you). I just think it would be better to be up front and try a more direct path of internship/GPR.
Do you know anyone who has gone from DA to OS?
I personally graduated from dental school with someone who applied to OS during dental school and did not match. Thus, to improve his application for OS he did a one year OS internship. After his OS internship he attended a DA program (I believe this was before DA did match, not sure though). Then he applied to OS during his second year of the DA program and finally matched to an OS program (not sure if it was a 4 or 6 yr program). I am also not sure if he applied to OS after his internship or not. However, he did receive a large percentage of interviews from the programs he applied to (heard this through second hand source). This person did not have the greatest boards, class rank, etc so maybe he had to do more to achieve his end goal of OS residency. This is not the greatest first hand story but it does show you that other people have gone from DA to OS.
In the end I am sure you will do what it takes to achieve your goals regardless of what they maybe. Obviously, I am very much for DA and its growth so I would like to see residents committed to DA. However, I can understand OS is very competitive and sometimes you just have to do what it takes. Hope my post helps. Good luck.
Gold star. Awesome, informative post!
Yeah, he doesn't post often, but when he does I always learn something
I know this is a long shot. But, is anyone in a 3 year program and wanting to POSSIBLY switch to a 2 year? If you are PM me and we will see if it's even possible.
I am a pediatric dentist and I have a dental anesthesiologist that provides in office general anesthesia once per month. He covers most of the pedo practices and medicaid GP mills within 100 mile radius. Our GA cases are 70% medicaid, 30%PPO patients, which is typical for most for most of the pedo offices in this area of Texas.
Recently, our Dental Anesthesiologist told me that his reimbursement for in-office GA was going to drop to around 85$ per case as opposed to the 300$ he was used to getting. He felt that the guys in charge of medicaid were trying to stop the Dental Anesthesiologists from offering in office GA, because the general dentist pedo mills were making too much money.
There appears to be a push to only have these cases being treated at surgery centers.
Well Medicaid is state to state...so changes in Texas don't have impact on the rest of the 49's...and the medicaid situation in Texas is absolutely crazy...I don't like that change in anesthesia reimbursement...but they do need a change down there
But what is MORE important are the potential changes coming with ACA (obama-care)...looks like they are leaning towards putting Pediatric Dentistry on the bill...if pediatric dentistry gets included...that screws all of us...what do you know about that?