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Wednesday
Dec052012

« WHAT WOULD HORACE DO? »

 In 1864, the ADA recognized dentist Horace Wells for introducing anesthesia to the United States.

Anesthesia — in gas, liquid and solid form — has always played a vital role in the delivery of dental care. In October, ADA House of Delegates had a rousing debate over Resolution 16, which would have recognized dental anesthesia as a specialty. It lost. I rarely indulge in post mortems on resolutions but this one still bothers me. 

So what happened? The ADA has six requirements for specialty recognition. In brief, it must have a sponsoring agency that can sustain a certifying board, it must be a distinct field, it must have advanced knowledge and skills that are not being met by other dentists or specialists, it must meet some aspect of patient care, and it must have formal advanced education of at least two years beyond dental school.

Both the ADA Committee on Recognition of Specialties and Interest areas in General Dentistry, and the ADA Board of Trustees supported the application made by the American Society of Dental Anesthesiologists. The American Association of Oral and Maxillofacial Surgeons opposed it. 

The supporters argue that becoming a specialty increases acceptability of dental anesthesiologists by the public and marketplace. Their billing capabilities will be enhanced. Dental schools will be able to expand training programs for anesthesia. Having in-house programs will lend support to training more undergraduate dental students in anesthesia.

 The opposition maintains that dentistry has survived using the current model for over 100 years. They maintain “anesthesia belongs to all,” and fear that specialist anesthesiologists will be able to set policy and make rules that would injure general dentists and specialists who currently provide anesthesia. They do not think anesthesia will improve access to care because there are too few dental anesthesiologists to matter. They are concerned that the itinerant model does not provide enough safety precautions, and there are not hospital admitting privileges. They believe patient costs would be greater with specialty recognition. 

Hmmm. I can see that one specialty cannot restrict the rights of others practicing in kind. The supporters assure us that they would not impinge, but we all know that as generations of leaders change so does the tone of a group. 

 Increased patient cost? Dental anesthesiologists’ training is impeccable. They deserve their fees. Some things just cost.

I can see that an itinerant practice might not have all the bells and whistles for safety, but this kind of practice has been going on for years with an excellent record. If a patient has to be transported to a hospital, does it really matter if the anesthesiologist has hospital privileges? It is not as if they are going to ride in the ambulance, and commandeer the ER.

I worked with a dental anesthesiologist at a FQHC for eight years. I loved it! It solved so many of our problems. When we found teeth with nine-millimeter pockets and compressible mobility on a thirteen-year-old severely developmentally disabled girl, my dentist anesthesiologist was able to support me, and help me explain to her mother that we could not “just prescribe mouthwash” and let her go. 

I have schizophrenic patients that I fear will hurt me. I have kept one eye on the mouth and the other on their fists for too many years. For what I have accomplished, I am very lucky. There are all kinds of patients that I have been wrestling with who really need anesthesia. It is time for me to offer them better options. There is need.

“Take them to the operating room,” people say. It is the safest, albeit most expensive, option. I was just credentialed by a local hospital. It took 93 pages of paperwork. I hear that in other states only specialists and dentists with advanced training are credentialed. I would not qualify. I also fear that my patients will have a hard time paying for parking and finding me in a large hospital. 

As I discuss how to hire an anesthesiologist with dentists, I am surprised at how many of them advise me to hire an MD anesthesiologist. The theory is that if there is an adverse reaction the courts will be kinder if I hired the top of the line instead of anyone lower. 

 I don’t want an MD. I want one of us. I want our anesthesiologists to be the very best in the field we actually pioneered. I fear in the current marketplace a dental anesthesiologist will not be considered top tier until they gain specialty recognition. 

The ADA will be reviewing its policies on specialty recognition this year. The ASDA cannot submit another application for twenty-four months. We need to spend that time sorting out these issues. We have the skill, expertise, and knowledge to turn this problem around…Horace would have wanted it that way.

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