Dental anesthesiology

[luysion]

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Hi, I just found out about this rather unnoticed speciality (generalisation forgive me lol). I've taken an interest as the pharamacological side of dental surgery has really stuck to me. Just wondering on the job prospective sides though.. How is the employment? Pay? (im not money minded but I need to make sure it is a safe decision and will allow me to pay debts + family needs this stuff doesn't just clear out when you are a doctor)

Also how about the hours? Regular ? Or is there great possibility of on-call. I assume this specialisation is integrated with pedo as sedation is a common technique there.

Cheers guys for the help

 

[Ething]

Hi, I just found out about this rather unnoticed speciality (generalisation forgive me lol). I've taken an interest as the pharamacological side of dental surgery has really stuck to me. Just wondering on the job prospective sides though.. How is the employment? Pay? (im not money minded but I need to make sure it is a safe decision and will allow me to pay debts + family needs this stuff doesn't just clear out when you are a doctor)

Also how about the hours? Regular ? Or is there great possibility of on-call. I assume this specialisation is integrated with pedo as sedation is a common technique there.

Cheers guys for the help

Are you pre-med or pre-dent? If you are genuinely interested in pharmacology and anesthesiology then i suggest you stick with the med route. DO NOT go to dental school to pursue dental anesthesiology.....dental school will kick your butt in the process. You also have more options with an MD. I did know that anesthesia existed through dentistry but i was interested in dentistry and explored all of my options before I decided on it. What exactly do you mean when you say that the pharmacological aspect of dental surgery interests you?? The pharmacology and the drugs are pretty much the same in dental surgery as they are for med surgeries. You will do fine in the field but it varies from city to city/state to state. You will be able to pay your bills but the amount pple make varies. Again, I think you have more options through medicine although technically you can do the same thing...most hospitals give preference to MDs. Hope this helps.

 

[Drabuisa]

Besides the obvious, what exactly does a dental anesthesiologist do? I mean what would a typical workday be like for that specialty? Financially, is it a lucrative specialty?

 

[Munchy]

there must be some reasons as to why many of us have never heard about it. Some of the reasons I can think of are:
1) there is not much demand
2) it does not pay well

 

[Drabuisa]

there must be some reasons as to why many of us have never heard about it. Some of the reasons I can think of are:
1) there is not much demand
2) it does not pay well

I would think that since there is such a high cost for IV sedation that anyone who made a living doing it would make pretty good money (assuming that they have a full schedule).

 

[Munchy]

then i assume it's the former?

 

[browncrack]

At a good GPR you can get certified for iv sedation. Then you can administer in your office. Anything beyond semiconscious sedation is probably best done with someone with a license actually monitoring the anesthesia while the dentist works. I'm not entirely sure why a residency is required for this at all- you could also get certified in a CE course.

 

[ItsGavinC]

At a good GPR you can get certified for iv sedation. Then you can administer in your office. Anything beyond semiconscious sedation is probably best done with someone with a license actually monitoring the anesthesia while the dentist works. I'm not entirely sure why a residency is required for this at all- you could also get certified in a CE course.

The state you are practicing in will determine whether or not you have met the educational requirements for administering different types of anesthesia in that specific state. Completing a GPR doesn't equate to being licensed for anesthesia any more than completing dental school means you are licensed.

I personally do not believe that anybody who has completed a GPR has received adequate knowledge or training to administer IV sedation (and I did a 2 year specialty residency with 2 straight months of running general anesthesia cases in the OR--hip and knee surgeries, hernia repairs, dental surgeries, facial trauma, etc.). I crapped my pants too many times to recall on that service, and that's how I learned.

I disagree 100% with your statement about residency. In Arizona you have to complete a dental anesthesia residency, or be a medical anesthesiologist, or complete an OMFS residency in order to administer general anesthesia. That's why there are residencies. You can NOT learn that from a CE course, and I believe that CE courses cannot teach 100% virgin anesthesia administrators anything worthwhile. It's a recipe for disaster.

 

[ItsGavinC]

Besides the obvious, what exactly does a dental anesthesiologist do? I mean what would a typical workday be like for that specialty? Financially, is it a lucrative specialty?

Very much so for the group we work with. They do peds only general anesthesia cases in our office and do 4-6 cases each morning. Done with work by 1 or 2 (start at 6:30). $650 payed to them up front by the patient. Cases take about an hour.

That's $1/2 million right there with minimal overhead.

 

[Drabuisa]

Very much so for the group we work with. They do peds only general anesthesia cases in our office and do 4-6 cases each morning. Done with work by 1 or 2 (start at 6:30). $650 payed to them up front by the patient. Cases take about an hour.

That's $1/2 million right there with minimal overhead.

Why is everyone always talking about OMFS and ortho if there is a specialty out there like this!? Is the residency tough in comparison to other specialties?

With a wife and 2 kids, a schedule like that sounds like heaven. I would be able to make decent money without working my life away like a slave. Dental anesthesiology here I come

 

[Munchy]

Sounds too good to be true. Like the old saying, if it is too good to be true, then it probably is not.

Good hours, good pay, minimal overhead....

What are some disadvantages? Perhaps high malpractice insurance fee, high stress (but then some other specialties can be stressful), restriction to certain states, etc???

Shine some light on this.

 

[mooredge]

I looked into this specialty last year and in the end determined is was probably not the best choice. The problem with dental anesthesiology is that there is a lot of competition from MD anesthesiologists, OMFS, and general dentists certified in iv sedation. The laws governing sedation and what doctors are allowed to do with certain training vary from state to state. I know for a example in california, a dental sedation assistant permit can be issued to your assistant to monitor the patient while the sedating doctor performs the surgery. So an OMFS with a GA permit can have their assistant draw up the drugs, administer the drugs, and monitor the patient all under the "supervision" of the doctor. GA sedation permits can be issued to OMFS in about 4 months of training and to general dentists with about 1 year of training.
An MD anesthesiologist will always have a competitive advantage simply because they have 4 years of training and are better equipped to deal with emergency situations. If/when a patient dies under the supervision of a dental sedation assistant, the MD's will rightly morally, and ethically be able to argue that dentists are incapable of safely being able to deliver anesthesia. I think its possible to find some niche markets that do a lot of dentistry this way such as pedo surgery center, however, i just don't believe there is enough of a market out there for DA's.
Currently it is a 2 year program, but i think very soon it is being changed to a 3 year program. In my mind i met as well throw in a 4th year and just apply to an OMFS residency and get trained in anesthesiology as a bonus.

 

[ItsGavinC]

I looked into this specialty last year and in the end determined is was probably not the best choice. The problem with dental anesthesiology is that there is a lot of competition from MD anesthesiologists, OMFS, and general dentists certified in iv sedation. The laws governing sedation and what doctors are allowed to do with certain training vary from state to state. I know for a example in california, a dental sedation assistant permit can be issued to your assistant to monitor the patient while the sedating doctor performs the surgery. So an OMFS with a GA permit can have their assistant draw up the drugs, administer the drugs, and monitor the patient all under the "supervision" of the doctor. GA sedation permits can be issued to OMFS in about 4 months of training and to general dentists with about 1 year of training.
An MD anesthesiologist will always have a competitive advantage simply because they have 4 years of training and are better equipped to deal with emergency situations. If/when a patient dies under the supervision of a dental sedation assistant, the MD's will rightly morally, and ethically be able to argue that dentists are incapable of safely being able to deliver anesthesia. I think its possible to find some niche markets that do a lot of dentistry this way such as pedo surgery center, however, i just don't believe there is enough of a market out there for DA's.
Currently it is a 2 year program, but i think very soon it is being changed to a 3 year program. In my mind i met as well throw in a 4th year and just apply to an OMFS residency and get trained in anesthesiology as a bonus.

If a dental anesthesiologist can get aligned with pediatric dentists, then it's a great model. Under that model there is VERY limited competition from MD anesthesiologists, and NO competition from oral surgeons or general dentists. There are probably 70 pediatric dentists here in the Phoenix area, and I'd say 65 of those use a dental anesthesiologist for in-office GA. The other 5 go to the hospital or surgery center where the cases are run by an MD.

Pediatric dentists use in-office general anesthesia (NOT sedation!!), which is administered as non-intubated. The cases are largely run on propofol alone.

If the DA is performing adult cases, then they certainly would have competition from OMFS. Most OMFS run their own anesthesia during sedation cases. There would still be a need for sedation dentistry in some general offices, but it may be difficult to find those offices.

GA sedation permits vary from state to state. Having a GA permit as a general dentist wouldn't be very beneficial in terms of making money. You can't run a GA case and perform the dental work, so what's the point? Nobody in their right mind would hire you to do GA either unless you graduated from an accredited program. You probably wouldn't be able to get malpractice insurance either (even if you have a state GA permit). Malpractice companies want to see the residency that you attended.

 

[Cold Front]

I researched on DA extensively while I was in dental school, even had lunch with practicing DA's and program faculties.

In short, pros are:

1. Very lucrative if you are in high demand, with minimum effort in comparison to what oral surgeons have to go through to make a good living.
2. 2 yrs residency with relatively low competition.
3. Great hours if you schedule your cases together on certain days.
4. Very small overhead in terms of business (just need to buy the meds, and pay for 1 assistant who travels with DA).
5. It's a cheaper route for Pediatric dentists than sending patients to the hospital for GA, they can do GA in-house with the DA.

Cons:
1. Long and odd trips between practices. Some DA's go to one city for few cases, the next day they could be on the other side of the state (if not on neighboring states). All those driving can ultimately turn the DA to a truck driver.
2. Malpractice Insurance is uber high.
3. Tricky to sell DA service to dentists who need the services, you have to win their confidence with time and patience.
4. Competing with Medical anesthesiologist and OS guys in some markets, and there was even talks about DA's should not exist by the AAOMFS.
5. Adult cases usually go to an oral surgeon, child cases are mostly special needs.

Overall, good gig if you REALLY love the field. Bad if you are doing it for the money.

 

[ItsGavinC]

5. It's a cheaper route for Pediatric dentists than sending patients to the hospital for GA, they can do GA in-house with the DA.

Really good post, well-thought out. My only point of disagreement is the above. I don't pay money to go to the hospital, so it isn't cheaper for me. It isn't always cheaper for my patients either. Sometimes in-office GA is actually MORE expensive for my patients (medical insurance will sometimes cover hospital GA but never in office GA).

The convenience and quickness of case turnaround is where DAs in office are really beneficial. Like I said, great post.