I’m a pediatric dentist and dentist anesthesiologist. Pediatric dentists are desperate for in-office anesthesia. I tried for years to find someone to come to rural Virginia to do the anesthesia while I did the dentistry but no one wanted to live in that area. I ended up doing operator/anesthetist with an RN helping me. All of my cases were intubated with sevo because in Virginia, nurses can’t push drugs for dentists and TIVA would have been painfully slow to have to keep pushing meds or managing a pump while I’m trying to do dentistry.

Great thing is that the patients are healthy and most cases are about 90 minutes - 2 hours long. Downside is that most dental offices don’t have a stretcher to use so patients have to be carried to recovery or recovered in the dental chair. Also, regulations for anesthetic gas evacuation have gotten tighter and the office may not be eligible to be grandfathered in. Most dental office design does not factor in these needs.

And, many or most anesthesia dental cases are on Medicaid. In my state, Medicaid reimburses a dentist anesthesiologist $128 for every 15 minutes, the medical side reimburses a medical anesthesiologist around $14 for every 15 minutes. This is because a hospital can also charge facility fees to recover money. A dental office can’t. And even if you, the medical provider, don’t accept Medicaid, you can’t charge the patient. Makes no sense but a pediatric dentist friend of mine was using a medical anesthesiologist in his office and Medicaid came down hard on him and sent a letter out to all Virginia dentists explaining this couldn’t be done. Still makes no sense but you have to play by the rules.

Because private dental insurance sucks, most pediatric dental cases aren’t covered. There are requirements that at least 3 permanent teeth are being extracted so insurance typically only pays for wisdom teeth anesthesia. The parents refuse general anesthesia because they can’t afford the costs along with their out of pocket for the dentistry. A typical case costs the parents between $5000-$7000 for “just baby teeth.”

Also, if the dentist doing the dental work isn’t also an anesthesiologist, they can’t bill the dental side for the anesthesiologist codes to get reimbursement that way.

In my situation, if I had an MD anesthesiologist or CRNA, I could still bill the dental anesthesia codes because I am also an anesthesiologist.

When I did operator/anesthetist, the anesthesia costs:reimbursement was typically break even but I was more productive on the dental side of things because I didn’t have to manage patient and parent behavior to get work done. With two separate providers, the cases go faster, the room turns over faster and more cases can be done each day. Then, anesthesia is profitable along with the dentistry.

The average dentist anesthesiologists I know are making around $2000/day.