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Discussion in 'Anesthesiology' started by Leotigers, Jan 5, 2002.
If you were an ASA class 4 or 5 patient going under general anesthesia would you want a Anesthesiologist or certified dentist? I would definately want the former. It is not all about who has the ability to administer GA but who has the experties to keep the patient alive when things don't stay the course. Just a thought
there's no way i'd let a dentist give me GA, i've had Concious Sedation done before but that is different. Even though you are on the virge of being concious you are still concious and can breathe on your own. I wouldn't want GA in an office anyway.
What's your take on in office surgery with General Anesthesia done? Would you do it? Personally I don't think I would do it even if there is a MD or CRNA doing it. I would rather have it done in a freestanding surgery center or have it done in the hospital.
Like gasrx said.... if i was going under GA and something devastating happened. A dentist is not trained to deal with emrgencies in this situation, they can deal with the initiation fo anesthesia, but i want someone there who can save me, if need be.
For the enlightenment of medical students, a dentist trained in anesthesiology is as qualify as the physician counterpart in all regards, including management of complications. With regard to office based anesthesia, the cost of performing surgery and anesthesia in an ambulatory center much cheaper than taking the patient to the hospital OR, allowing efficient and cost effective care to the patients. OMFS surgeons (a dental specilist) has an impeccable record when it comes to safety delivering GA in the office setting! You should judge a doctor by the work that he/she does and not by the letters after their name!
How can a dentist perform surgery on the patient at the same time keep the patient alive under GA? That's my only question.
This is a reply to DentStud:
Not to be condescending, but you are so wrong about being equally qualified to administer general anesthesia as a board certified anesthesiologist. I am at a University based anesthesiology program which also trains dentists and yes, they do rotate with us. But these residents are given the easiest run of the mill cases where they would have to try hard to screw up. Dental residents are not allowed to do complicated cases such as CABGs, neuro procedures,etc... all they do are the easy ENT cases. All perceived difficult airways are given to anesthesiology residents. And to be honest, when things do go wrong, the dental residents just step aside and the watch the anesthesia residents or attendings take over the case. So as to your statement, I would have to wholeheartedly disagree. Rebuttals are welcomed.
D.A. - Anesthesia PGY3
I don't want to sound offensive to the dentist people out there, but I don't think there is or ever will be an argument in this!!
Anesthesia guys are the PREFERED and always will be vs. a dentist for preforming any anesth. outside of block anesth. in the oral cavity.
That might be offensive, but that is the truth. There is no turf battle here.
Now, CRNA's that is another story!!
Well I happen to know a little about this, yes dentists are trained to give anesthesia just a medical docotrs are,my uncle happened to train my dentist in anesthesia. Point being, they are not as qualified as a person who has completed residency in anesthesia. My point is that even if it were true you couldn't work anywhere outside rural ares because it would be a legal nightmare for a hospital to hire a dentist for surgical or ambulatory anesthesia. So they are sufficiently trained, but it is nothing more than an interesting piece of trivia. Let's leave it at that.
Don't mean to start a different thread.
this question is for 'ER'. I'm interested in going into emergency medicine. Research looked at heavily when directors look at applicants? If so how extensive does my research have to be?
If anyone has any input please respond
"the scope of practice of a D.D.S. anesthesiologist is limited by K.S.A. 65-2899 to the practice of anesthesiology but has no restrictions which would otherwise make it different from the practice of anesthesiology by a D.O. or M.D. Accordingly, for the reasons discussed in answer to your first question, it is our opinion that a D.D.S. anesthesiologist has the same supervisory qualifications as a D.O. or M.D. anesthesiologist when engaged in the practice of anesthesiology."
okay here is the official difference:
Official statutory requirements:
a one-year residency in general anesthesia at
an institution certified by the American Society of
Anesthesiology, the American Medical Association, or the Joint Commission on Hospital Accreditation, resulting in the dentist becoming clinically competent in the administration of general anesthesia. The residency must include a minimum of 390 hours of didactic study, 1,040 hours of clinical anesthesiology, and 260 cases of administration of general anesthesia to an ambulatory outpatient
However most programs provide 24 months of training... which includes 2 months of Internal Medicine Rotations (as an intern), 1 month of SICU rotation, 3 months of classroom lectures and 6 months of main OR anesthesia training, followed by 12 months of ambulatory anesthesia for patients receiving maxillofacial or dental procedures...
Now that is the summary of the training.... One of my best mentors ever (the head of vascular anesthesia at MGH) was a DDS and did dental anesthesia... then realized he needed an MD (which he got) and redid a full Anesthesia residency.... i wonder why...
oh by the way, if anybody thinks that a DDS (even if anesthesia trained) has the training to manage even a slighlty complicated patient... then they are very, very mistaken....
just ask the patient...nurses, dentists, and physicians do anesthesia here: which one would you prefer?
When given informed consent, I think they'll answer in concert
When I had my wisdom teeth extracted I had GA with a DDS. I had a MAJOR problem. This was before my becomming an NP and silly me thought you had to be an MDA to give anesthesia. Boy was I wrong. Luckly the DDS pulled through but it was a very scary situation.
Comming from a "midlevel" provider I can tell you that NO ONE but a MDA is going to ever put me to sleep again. I had a minor surgery about six months ago and actually had an arguement with a CRNA who didn't want to give up the case. CRNA didn't really even want to admit they weren't a physician. Introduced themself as my "Anesthestist". I finally did get an MD though.
Np's/PA's/CRNA's... we all have our place. But do I want one doing surgery, anesthesia and other life and death procdeures? Not a chance.
Cosmo, I'm actually not suprised that it took you going to NP school to learn that a dentist giving GA for tooth extraction isn't really the most popular option. Tell me, which version of education for NP did you take - the online course over the internet , the weekend course over a 3 year time period, or the full-time route? I find it amazing that you can get a job that equates with a PA via the internet.
As far as the "anesthestist" thing goes, ITS IN OUR TITLE. Get over it. I know of no CRNA that tries to fool the patient into believing he/she are a MD. And I am sure that the first words out of your mouth when introducing yourself to the patient are in fact the following..."Mr. X, I am not a doctor, I am a nurse practitioner." Money says that you introduce yourself as a "practitioner" and conveniently leave out the word "nurse".
The comment that NP/PA/CRNAs all have our place....one doing surgery and other life or death situations....First off, a comment concerning NP and surgery should not even be in the same sentence. You most certainly do have a place. You train for the floor and CRNAs train for sugery. You sealed your fate with the quote. I hope in the future that every patient you have will allow you as a NP to do a rectal, but insist on a MD to listen to their lungs and perform the rest of the assessment as you so eloquently stated, that you are just a midlevel.......
Go ahead students and flame me, but this is crap comparing NPs to CRNAs. Sorry to bog down your site with this.
I hate to say this, but NPs are equivalent to CRNAs, in as much as they are both master-level degrees after BSN...
Actually I attended Duke as a full time student on campus.
Family Practitioner is in mine. However if I introduced myself as that to a patient they could easily equate that I am Family Practice PHYSICIAN. After all, they're comming to a "Doctors office". The average patient is going to think that a Family Practitioner is a physician, thus the move to calling FP Family MEDICINE. Just ask the average patient if they know the difference between an Anesthestist and Anesthesiologist.
Will you be paying by cash, check or money order?
When I meet a new patient I always introduce myself by saying "Hi, I'm Cosmo. I'm the NURSE PRACTITIONER here with Dr. XXX"
For people who have any questions there are pamplets in every exam room which tell them what an NP is, what we do, how we are trained and the services we offer.
And BTW... CRNA's have a masters just like NP's. To boast that your masters is superior to mine (and I have a DSNc if you really wanna start a title war) is really rather childish.
This is actually quite entertaining. One mid-level provider doesn't want another mid-level provider treating them. I love it!
Despite what a lot of our (NP) professional organizations will try to have people believe there are times when a physician is needed. We provide top notch care in the primary care arena and are of great assistance in other areas, that I will not deny. However any responsible healthcare provider needs to know their limits. We all want the best care for our patients and I personally believe that the best care in an anesthesia setting is provided by a physician.
Cosmo has it right. It's quite refreshing to see an NP that has a tight grasp on what it is to be a mid-level (unlike many others seen in this forum).
Nurse anesthetists--I'm pained to say--introduce themselves inappropiately all the time, often as "one of the anesthetists." I've seen it happen more than I'd like to recall. I've also heard pts call refer to them as "doctor"... without correction by the CRNA! This goes for many mid-level nurses, especially those who overstep their bounds and begin thinking their "just like the doctor." This is particularly important in the setting the Florida study, which showed CRNA outcomes to be inferior to MDA outcomes.
However, most know their role and what they are not qualified to treat, and most mid-levels do introduce themselves appropiately (except for CRNAs for some reason).
Humm...[scratching head]...not sure why you love it. I'm not sure any patient loves inferior care. Remind me, my family, and my patients to stay away from your practice.
I've always believed (and maybe wrongly so but it makes sense to me) that a lot of the title tweaking and level boosting which goes on among NP's, PA's, and CRNA's is done because they wanted to be a physician and as they realize they are not, feel somehow inferior.
Myself and a close friend (who is also an NP) both interviewed and were accepted to medical school. We CHOSE to become NPs because we felt being an NP "fitted" and as NPs we could make a huge contribution to our area. I went against a long family tradition when I became an NP. My family reunion is like a physicians lounge. Did I or do I want to be a physician? Not now, not ever!
People need to be happy and realize that no matter what they do they are important in the process. Try it a week without a nurse aids or janitors or housekeeping. That said, we as NP's and PA's have a very important role too. Most physicians I know will tell you that a good NP or PA is worth their weight in gold (now what they pay them is another story )
Think we all just need to be happy where we're at and stop trying to be something we're not. Especially when it puts someone elses life in to question.
Sorry for being so OT.
Going... downhill... quickly... uh-oh...
Actually, I think in England and Australia an Anesthesiologist is called an Anesthetist. I think because they don't have CRNAs anyways so there's no confusion.
So all anesthesia care by non-physicians is inferior? The majority of anesthetics in this country are administered in an anesthesia care team practice, composed of MD's, CRNA's, and AA's working together for the patient's best interests.
My practice includes 36 MD's, and more than 70 AA's and CRNA's. We provide anesthesia services for more than 35,000 procedures a year and are the busiest surgical hospital in the Southeast. On top of that, our hospital does in excess of 17,000 deliveries a year. Our department includes a past president of the ASA, past presidents of the state component society, as well as past presidents of both state and national CRNA and AA organizations.
I know as an M3 you know it all. I'm sure that month of your surgery rotation you saw everything there is to see. I'm intrigued (not to be confused with believe) that you've seen so many CRNA's try and pass themselves off as MD's. I've never seen this happen in 25 years of practice. I introduce myself appropriately to my patients, and happily tell them the difference between an MD, an AA, and a CRNA, as well as detail how and by whom their anesthetic is provided. (That's called informed consent, BTW). In 25 years, I have NEVER been asked by a patient to step aside and have one of the anesthesiologists do the case personally, although if it does happen, I will be more than happy to defer to one of the docs.
You continue to bash mid-level providers as incompetent. That simply isn't the case. Maybe by the time you finish med-school and residency, you'll have a clue. Right now you don't. Treat your colleagues, associates, and support staff with the respect you show on this board and see how far it gets you.
Sorry - just can't resist taking the bait...........
Interesting that you refer to yourself in your profile as a "family practitioner".
Perhaps this isn't the best arena to have nursing discussions on what is and what isn't appropriate care, since many members here think non-MD delivery of anesthesia is a joke, but how can you justify your position and scope of practice (when you trained for a FP model) and then dismiss CRNAs and AAs (who train for anesthesia delivery) when the educational requirements for FNP and CRNA are both master level nursing degrees? The educations are certainly not the same in material and in fact CRNAs require more pre-grad critical care experience, but I am interested in how you can make that realization when you yourself are a mid-level nursing provider. I realize you have a DSNc, but that is besides the point. Thanks in advance for this discussion.
You think I'm clueless. That's funny. I guess I was admitted to medical school as a result thereof. Keep on assisting doctors and student doctors while I become one.
Your practice? Your department? Humm...let's ask the MDAs who practice it is. Well, I suppose they wouldn't care anyway, since they want to keep support staff happy (while they walk with > $250,000 / yr). This notwithstanding, what reflection does that have on you (other than any practice needs support staff)?
I've been in clinics for a while now. This includes ALL specialities in medicine (you can look these up). The fact, however, is that ANESTHETISTS ARE NOT ONLY IN SURGERY. There're on OB, medicine, heme/onc...etc. I suppose that your AA training doesn't include anything outside of IVs, catheters, and how to push the succ in the OR. FYI, I've seen in on medicine and surgery thus far, two times too many...and heard of it PLENTY of times from CAs.
Respect? Humm...interesting you bring that up since you refer to student doctors as "clueless." Trust me, we have more of a clue than you think. Should I refer to AAs as "med school rejects" or "nursing rejects"?
Keeping it real...