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I have had people ask me a lot of questions about this new specialty, thought I'd create this thread for anyone who is interested in the field!
IAMA Dental Anesthesiology resident. Feel free to ask me anything!
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I chose this specialty for a number of reasons:
1. I always had an interest in medicine (I originally thought about going to medical school) and wanted to pursue a field which I could further fulfill that passion
2. Even though I really enjoyed dentistry, I found it to be pretty hard on my body
3. The job market is more favorable (as with being any type of specialist)
Current and future job market is great! Everyone I know in the field is doing really well. As more and more dentists and patients learn about us, the greater demand there will be for our services. This is also a very niche field, and there are still some states with only a few DA's. If you're willing to market yourself, you could easily have entire counties to yourself.
1 what are salaries like?
2 what is work life balance like?
3 is residency hard?
4 where will you work? Is it in hospitals or more so small private clinics?
5 why is this suddenly a specialty? Who was doing the work before? Regular anesthetists? Why do we need dental anesthetists?
It sounds like a great specialty!
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1. Salary the lowest I've heard starting first year is about 225k...highest is 1mill+.
2. The beauty of this job is you get to choose how you work. Most DA's function kind of like independent contractors and go office to office to provide their services. You can work with the office and tell them which days you want to run the sedations. Most DA's who do in-office sedations will arrive at the dental office around 6-7am to setup, start the first case around 8am, then finish the last case around 2-3pm. Pack up and go home. Of course it's really up to you how many days of the week you want to work.
3. Residency can be hard, but it's not as bad as OMFS. Most dental anesthesia programs don't take as much call as the other medical residents or their OMFS counterparts. For most programs though, you have to be at the hospital by 6am and then finish around 3-5pm, depending on how many cases you get during the day. From talking to most other residents, you get used to it and it's really not that bad!
4. You can work in a hospital or in private clinics, depending on the state. In some states you can be hired full/part time with hospital anesthesia privileges. Most DAs work in private practice though, because that's their bread and butter and offers way more flexibility and $$.
5. DAs existed way before it became a specialty. It's been around for decades. The only reason it wasn't a specialty before was because mostly of politics. OMFS controls the anesthesia world in dentistry and likes to keep it that way. Now over time, people have learned how well trained we are and OMFS + Dental anesthesia often work very closely together.
Dental anesthesia allows children, those with special needs, those with dental phobias, and others going through complex procedures to receive dental treatment that they may not have been able to receive before without sedation. Hospital waiting periods can take months/years for an OR booking. Not to mention hospital costs are significantly higher. Of course, most DAs aren't treating severely medically compromised individuals in the dental office. As people become more aware that in-office sedation is an option for them, even for routine dental procedures, the field will definitely continue to grow.
2. The beauty of this job is you get to choose how you work. Most DA's function kind of like independent contractors and go office to office to provide their services. You can work with the office and tell them which days you want to run the sedations. Most DA's who do in-office sedations will arrive at the dental office around 6-7am to setup, start the first case around 8am, then finish the last case around 2-3pm. Pack up and go home. Of course it's really up to you how many days of the week you want to work.
3. Residency can be hard, but it's not as bad as OMFS. Most dental anesthesia programs don't take as much call as the other medical residents or their OMFS counterparts. For most programs though, you have to be at the hospital by 6am and then finish around 3-5pm, depending on how many cases you get during the day. From talking to most other residents, you get used to it and it's really not that bad!
4. You can work in a hospital or in private clinics, depending on the state. In some states you can be hired full/part time with hospital anesthesia privileges. Most DAs work in private practice though, because that's their bread and butter and offers way more flexibility and $$.
5. DAs existed way before it became a specialty. It's been around for decades. The only reason it wasn't a specialty before was because mostly of politics. OMFS controls the anesthesia world in dentistry and likes to keep it that way. Now over time, people have learned how well trained we are and OMFS + Dental anesthesia often work very closely together.
Dental anesthesia allows children, those with special needs, those with dental phobias, and others going through complex procedures to receive dental treatment that they may not have been able to receive before without sedation. Hospital waiting periods can take months/years for an OR booking. Not to mention hospital costs are significantly higher. Of course, most DAs aren't treating severely medically compromised individuals in the dental office. As people become more aware that in-office sedation is an option for them, even for routine dental procedures, the field will definitely continue to grow.
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Since one of the most common questions I get is "where can you work/what can you do once you're done", here is a list of the most common set-ups as a dental anesthesiologist:
1. In-office sedations for dental practitioners (usually Pedo, special needs, OMFS)
2. In-office sedations for your own dental procedures, as long as you have the correct number of trained and qualified personnel assisting you with the case.
3. Hospital anesthesiologist/Academia. Depending on the hospital/state you can either get full hospital privileges, be assigned to anesthesia cases for only head/neck procedures, be assigned to anesthesia cases for dental procedures, or a combination of the above. You may additionally have an Academic component required as well, where you train DA residents
4. Surgical centre. Depending on your state you can build your own surgical centre where other dentists/physicians bring their patients to be anesthetized by you.
I'll update this as I become aware of more opportunities.
1. In-office sedations for dental practitioners (usually Pedo, special needs, OMFS)
2. In-office sedations for your own dental procedures, as long as you have the correct number of trained and qualified personnel assisting you with the case.
3. Hospital anesthesiologist/Academia. Depending on the hospital/state you can either get full hospital privileges, be assigned to anesthesia cases for only head/neck procedures, be assigned to anesthesia cases for dental procedures, or a combination of the above. You may additionally have an Academic component required as well, where you train DA residents
4. Surgical centre. Depending on your state you can build your own surgical centre where other dentists/physicians bring their patients to be anesthetized by you.
I'll update this as I become aware of more opportunities.
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Are dental anesthesiology residents viewed in the same way as medical anesthesiology residents in the hospital? Also, would you say the level of training between the two are very similar? Or would you say the training is closer to CRNAs?
I’m just curious to see how our medical colleagues view dental anesthesiology.
Thank you!
I’m just curious to see how our medical colleagues view dental anesthesiology.
Thank you!
1. You mentioned Dentistry was hard on your body. Did you practice for a while before specializing?
2. How do you get paid? Is medical/dental insurance paying? And if so then do you have to file a claim for the patient or do the doctor offices take care of that? What do you typically bill for an hour of anesthesia?
3. How do you like traveling office to office? (If that’s what you do?)
4. Do you have an assistant or do you work by yourself?
5. Do you work as part of a larger group or are you solo?
Thanks for doing this!
Edit: I think some questions have already been answered in above posts. Thanks.
2. How do you get paid? Is medical/dental insurance paying? And if so then do you have to file a claim for the patient or do the doctor offices take care of that? What do you typically bill for an hour of anesthesia?
3. How do you like traveling office to office? (If that’s what you do?)
4. Do you have an assistant or do you work by yourself?
5. Do you work as part of a larger group or are you solo?
Thanks for doing this!
Edit: I think some questions have already been answered in above posts. Thanks.
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Yes very much so! In most programs you are classified as a medical physician resident. No one has any idea you're a dentist. Even when we do tell the medical guys who we are, it's usually a reaction of interest and amazement rather than belittlement. Level of training is on par with Medical anesthesiologists. We mostly the same cases, however at my program the MDs will do the more complex cases (Neuro, cardiac, transplants) because they need that training. For medical anesthesia residents, they do a year internship, then do 3 years of anesthesia. At OSU for example, their dental anesthesia residents join the MD residents after the intern year. After about a few months, everyone is on the same level, with some DA residents excelling beyond their medical counterparts.
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What’s required to apply for an anesthesia residency? And how competitive is it compared to other specialties?
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With most specialties, it seems that practicing somewhere more rural is the key to success. Do you think that the opposite is true for DA? It seems that if you were to set up shop somewhere like SoCal, NYC, SF Bay area there would be a large amount of pediatric dentists and periodontists interested in your services. As <30 DAs graduate per year I wouldn't imagine saturation to be a factor anywhere.
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How long have you been a DA? And what did your path look like? Since there are so few programs, how competitive is it/is it as competitive as OMFS? I read that OSU gives you a salary, is that how most programs are?
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As a DA do you ever plan on using a handpiece in the future (assuming you no longer practice dentistry as DA seems more profitable)?
What really becomes the difference between a Medical vs a Dental Anesthesiologist?
Why wouldn't offices just do it themselves or get a medical anesthesiologist?
Yes the money is good but how frequent do you have jobs lined up? Hospital work is never guaranteed long term employment. People with special needs may not be able to afford the expensive anesthesia costs since they spend their money on other medical treatments.
The field is incredibly interesting and honestly not one I have given much serious thought of until just now researching it
What really becomes the difference between a Medical vs a Dental Anesthesiologist?
Why wouldn't offices just do it themselves or get a medical anesthesiologist?
Yes the money is good but how frequent do you have jobs lined up? Hospital work is never guaranteed long term employment. People with special needs may not be able to afford the expensive anesthesia costs since they spend their money on other medical treatments.
The field is incredibly interesting and honestly not one I have given much serious thought of until just now researching it
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What is your call schedule like in residency? Is your DA residency as brutal as everyone makes it out to be? Do you get along with oral surgeons?
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No problem!
1. I actually started having problems in dental school! That's when I realized I wanted to find something else and chose to pursue this specialty.
2. Most often its fee-for-service (meaning you bill the patient directly) and they deal with their insurance, or you can handle insurance for them, or you can bill medicaid as well for those who have it. Typical hourly bill is anywhere between 600-1000 for the first hour, then a smaller amount every 15 mins additional. Medicaid reimbursement is about half that.
3. I'm not a practicing DA yet, but most of the people I shadowed get used to it. If you don't like that model, there are also dental surgery centers you can work full time at and avoid the traveling component.
4. You can use the assistants at the dental office you're working at, or travel with your own. Some travel with RNs that have previous trauma/hospital/emergency department experience. Number of assistants required and their qualifications vary by state.
5. You can do a solo thing or work in a group..totally up to you! Both have their pros and cons as with any business model
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Nothing extra required other than typical grades, CV, and LOR to apply. Competitiveness is getting up there now due to specialty recognition and awareness of the field. For a list of programs and application requirements follow here: CASSchoolPages
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You got it. The market is super open for us, where areas of dentist saturation actually work in our favor. A lot of business comes through referrals as well, so once you start working for one office, the next one comes relatively quick.
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I'm a first year resident! But I have experience from shadowing and talking to others. I did pretty well in dental school (top 10%), however, from talking to other students who matched, not all of them were top of their class. I don't believe it is as competitive as OMFS but it certainly heading towards that level as more people find out about this field.
All programs pay PGY 1, 2, and 3 medical resident salary, similar to OMFS residents. No tuition!
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I don't know yet if I will go back to using a handpiece, although the option is always there. Dentist Anesthesiologists can still do dental procedures. As you mentioned, most of us don't go back because just doing the anesthesia is way more lucrative.
Dental offices can not provide deep sedation/General anesthesia without the service of a CRNA/Dental Anesthesiologist/Medical anesthesiologist, depending on the state. Medical anesthesiologists don't really enter the dental office because that's not what they are trained/comfortable in. Dental Anesthesiologists have the advantage of having the knowledge of the dental procedures being performed, and what the best method of anesthesia would be for both the patient and surgeon.
I'm not in the workforce yet, but I have not heard of anyone struggling to find work/cases. Of course in the beginning you have to pick things up yourself if you're doing your own solo gig, but once things get going your schedule can get pretty packed and can get booked out months in advance. Most of us don't work in hospitals, it's mostly Pedo offices.
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this really depends on which program you're at. It can vary by about once a week to once a month. It can get tough at times, but IMO is nowhere near as bad as OMFS has it. And yes, DAs and OMFS get along very well! We are all in it together at the end of the day
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What is the best thing an applicant can do if taking a gap year before applying? GPR/AEGD? Does it matter much?
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If I am unable to shadow a DA in my area, how would programs view shadowing a medical anesthesiologist?
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Tbh i'm not sure if there is anything specifically program directors look out for. However, anything where you can get further exposure to the hospital environment and anesthesia helps a lot! I would say doing a GPR can definitely help with that.... GPR residents get a lot of exposure to various medical rotations/specialties (sometimes including Dental Anesthesia).
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Nothing wrong with shadowing an MD, and it's definitely better than not having any shadowing experience. For your own benefit, it would be worth traveling to spend a day with a private practice DA, as the work environment is very different.
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Hey! Thanks for taking the time to make this thread. I am applying to DA programs this cycle but due to COVID I wasn't able to externship at all the ones I wanted to!
I am wondering if you could speak to your resident experience? These are some of the questions I had in mind:
1) Do you live close to the hospital or do you have a longer commute?
2) Are there weekend shifts?
3) How are opportunities for personal development - do you attend conferences etc?
4) Do you find down time to be able to hang out with the other residents?
5) Are there exams throughout the year or is it more of a self study for your upcoming patient?
6) Maybe any advice you have, or a general thoughts regarding your experience so far!
Thanks so much!
I am wondering if you could speak to your resident experience? These are some of the questions I had in mind:
1) Do you live close to the hospital or do you have a longer commute?
2) Are there weekend shifts?
3) How are opportunities for personal development - do you attend conferences etc?
4) Do you find down time to be able to hang out with the other residents?
5) Are there exams throughout the year or is it more of a self study for your upcoming patient?
6) Maybe any advice you have, or a general thoughts regarding your experience so far!
Thanks so much!
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No problem! I think program directors understand the externship situation with COVID and will definitely take that into consideration.
1. Close to the hospital/dental school. You usually also have to rotate at different hospitals/facilities, so one could also considering living in a more central location.
2. Yes there are weekend shifts! Although it's not every week
3. Yup tons of conferences and meetings organized by both DAs and OMFS. Look into ASDA (american society of dental anesthesiologists) and ADSA (american dental society of anesthesia)
4. Yup, definitely still have down time during the week to relax/hang out/do other things that you enjoy in life
5. It's mostly self study, with some didactic components. There are exams throughout the 3 years that monitor your progress, although i've never heard of a resident being kicked out for poor performance on these. Of course, there are also board exams to be passed.
6. Advice would be to shadow a private practice DA if you have one in your area, or see if you can travel to one. It's really a complete different ball game from doing dentistry! Also try your best to keep your grades up, and form a dental anesthesia club at your school if you don't have one already 🙂
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I know there has been talk for years about the potential of limiting who can perform anesthesia in the dental setting, with some proposals even wanting OMS to be unable to do the provider/anesthesia model. Does this ever get brought up in your residency? This would probably be a big boon for dental anesthesiologists if it did pass.
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Good question! I'm only a first year resident, thus my exposure is slightly limited. However, I have NEVER once heard a DA advocating/suggesting that OMS should not be able to do provider/anesthesia. The vast majority of our patients are pediatric dental cases that would otherwise be done in a hospital OR, not by an OMFS. Thus, the idea that we would "take over" is not realistic. OMFS still controls a large portion of anesthesia regulations within dentistry..and the last thing we would want is to step on any feet. Additionally, any DA who currently works for an OMFS is due to the surgeon's own desire...not because of a push from the DA.
I shadowed an OMFS/DA team in Manhattan. I talked to the OMFS and he told me he loved having the DA run his more complex cases (patient was intubated and paralyzed for surgery) as it allowed it him to simply walk-in, finish the surgery, walk-out and move on to the next case while the DA provided the post-surgical/anesthesia care. Additionally, the OMFS avoids having to do an OR booking and has the comfort/flexibility of doing the surgery in-office. That OMFS had his practice running like a well-oiled machine and was definitely still making a killing.
Where do people look to find jobs as DAs? It seems like the number of them practicing is so low. Do most people find them through job posting boards or do they send recruiters to the residency programs?
Also what is the most stressful part of this job? Most of the time you would not be dealing with critically ill patients. I’ve heard anesthesia is pretty chill most of the time.
Also what is the most stressful part of this job? Most of the time you would not be dealing with critically ill patients. I’ve heard anesthesia is pretty chill most of the time.
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Thanks for the question!
1. There are a number of ways to find a job. Since the community is pretty small, if you're joining a group practice usually you just get recruited by someone who already knows you / referred by a colleague. If you want to start your own gig, then yes you can reach out to dentists you know or cold call to let people know you're available. I've never heard of anyone having difficulty finding jobs.
2. Since i'm not a practicing DA yet, I can only give a limited answer based on what I've seen so far. It is pretty chill most of the time, but things can get hairy here and there, and every once in a while there will be moments where you'll **** bricks....whether it be from a loose/disconnected line, equipment malfunction, or an actual medical emergency. But as long as you know what you're doing (which you will be after any residency program) you'll be fine.
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Great question. The answer is yes..But It depends on the state and hospital themselves, and at the moment is not very common. From what I've seen so far, most Dental Anesthesiology attendings working in hospital systems run anesthesia for surgery cases involving the head/neck. This is why they usually work really close to OMFS in the hospital. Keep in mind as a Dental Anesthesia resident, however, you run anesthesia cases for ALL general surgery cases with MD attendings as well. A full time DA position in a hospital usually has an Academic component, if that is something that interests you.
Again, yes I have seen DA attendings supervise CRNAs. Although not as common and they usually are supervised by the MD attendings.
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Another great question. There a number of reasons why a dentist would choose a DA vs CRNA.
1. State regulations. CRNAs are not legislated to independently run GA (general anesthesia) cases in all states. In the majority of states, they must work under the supervision of a physician/dentist with a GA permit. This means they can only work under a Medical or Dental Anesthesiologist or OMFS.
2. Dental experience. DAs have the invaluable quality of being dentists as well. We know what "pulpectomy of tooth A" means and what it entails. We know how to tailor anesthesia to provide a better experience for both the surgeon and the patient.
3. Training. DAs spend much more time training for office-based anesthesia. Although all the CRNAs I have met have been awesome, most would not be comfortable providing in office deep sedation/general anesthesia by themself in a dental office.
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Regional anesthetic techniques of the maxillo-facial region is something we are definitely trained in. We get to do Epidurals and other peripheral nerve blocks during some hospital rotations, although it's not as much as the MD residents...however, this varies between programs. In practice however, we never really need to block outside of the head/neck region.
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Hey thanks for the question! It's a bit tougher to get anesthesia experience depending on your location/school, but here are some ideas:
1. Join or create a dental anesthesia club at your school (can include journal club)
2. Research is not mandatory by any means, but it def doesn't hurt. There are dental anesthesia journals you can publish in with a faculty member. Additionally ADSA has a magazine called "Pulse" which accepts student pieces as well
3. Conferences are tough since they are usually limited to practicing DAs/residents, however, it doesn't hurt to reach out to organizers to see if they would accept students. There are annual meetings held by ADSA (american dental society of anesthesiology) and by ASDA (american society of dental anesthesiologists)
4. Shadow a Dentist Anesthesiologist either in your school/hospital/private practice. If there isn't any nearby, shadowing an MD/DO anesthesiologist is also a great option and will give you a lot of experience.
5. Have your own hobbies or something outside of school that you really enjoy, that you could talk about during your interview. A lot of program directors are really just looking for down to earth and personable people!
D
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This might be too specific, but I had a rough first semester and got a lot of C's, but I'm getting B's and A's now. Am I kind of in the gutter at this point for getting into a DA residency? Also, are the majority of patients you/practicing DA's see pediatric patients or do you get to see a lot of special needs patients and the elderly?
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Grades are important, but they aren't everything! Also you're still early in the ball game...there's still many more courses/semesters ahead of you, so just focus on doing the best you can. There were people in the bottom of my class first semester who then realized they wanted to specialize, worked their way up over time, and match into many competitive specialties (omfs, ortho, anes, pedo, etc.)...so don't count yourself out.
In residency we get training in the dental school and in the hospital. In the dental school we do mostly special needs, then pedo and oms. In the hospital you do everything. Out in practice, the majority of the demand is in pedo..but it's really up to you what types of patients you want to see/treat.
Dental Anesthesia is basically medical tier residency, but there doesn't seem to be any licensure/board exams in place akin to the CBSE/step-1 for OMFS. What happens when the malpractice rates of Dental Anesthetists is significantly higher than the MD counterparts? It would be a bad look for the DA's and the dental field as a whole. Also I am surprised DA residents can perform or even keep up with the MD counterpart without the same comprehensive background in medical education.
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Please refrain from posting evidence-lacking presumptuous opinions on this thread.
There are board exams administered by the American Dental Board of Anesthesiology that we must pass to prove competency and obtain specialty licensure.
Additionally, there is no evidence what-so-ever that anesthesia administered by Dentist Anesthesiologists is on a trend to become more dangerous or associated with more adverse events compared to anesthesia administered by MD anesthesiologists. In a 2017 study by Spera et. al looking at outcomes of office-based pediatric anesthesia provided by DAs over a 4 year period, it was reported that of the cases reviewed, "no cases resulted in serious complications, including death, anaphylaxis, aspiration, cardiovascular adverse events, or neurologic adverse events"(Office-Based Anesthesia: Safety and Outcomes in Pediatric Dental Patients)
I see you are from Oklahoma. Although there are no DA programs down there, if you are interested in learning more about our training and capabilities I suggest reaching out to a local DA or traveling to participate in an externship with an accredited program.
The CBSE was not even a requirement until about 8 or so years ago. They just went by their scored NBDE which meant nothing to demonstrate their medical knowledge. Also, only 6 year OMFS take the Step 1. Does that mean that those OMFS that graduated before the requirement and are from 4 year programs not as capable and are therefore subject to more lawsuits?
As OP said though, there are board exams that they need to pass for DA.
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What are some reasons why an office or hospital would hire a dental anesthesiologist over a nurse anesthetist?
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I answered this above!
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Is this a specialty that you can pretty much do anywhere in the country, or are there specific locations/types of areas where it’s more desired? I would like to practice in a mid-sized city in the Southeast once I’m out (think Jacksonville and Orlando in Florida, or Charleston in SC) and find dental anesthesiology pretty interesting, but I’m just not sure how realistic it may or may not be to practice it in one of these locations.
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You can pretty much open up shop anywhere in the country....but you need to have dental offices/surgery centres in the area that are willing to work with you. Of course, the more dental offices in the area the more likely you are to find work and travel less. You shouldn't have much of an issue in any of those areas you mentioned.
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To be honest it's not very common for a DA to work in a hospital position full-time, so I would say it wouldn't be that easy. With that being said, once you graduate as a DA the chance of you wanting to go back to working the hospital is pretty slim lol. Private practice lifestyle offers way more flexibility, less politics, more money, and you get to run your own show. The only DAs I've seen go back to working in the hospital are those who really want to teach/love the academic component, and thus join as faculty at hospital DA programs.
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Are you doing intubations right now as a resident, and are they letting you run your own rooms? I'm an OMFS resident on anesthesia and they're finally letting us manage our own rooms and also I've gotten to attempt the intubation every single case. Just curious how it differs for DA residency.
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