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They don't have general dentists on staff. Most emergencies that require acute care are handled by neurosurgery, head and neck surgeons and ENT. Oral surgeons are included in that rotation for call but most dental emergencies are not life threatening and do not require admission and can be discharged.
They don't have general dentists on staff. Most emergencies that require acute care are handled by neurosurgery, head and neck surgeons and ENT. Oral surgeons are included in that rotation for call but most dental emergencies are not life threatening and do not require admission and can be discharged.
Incorrect. Most people don't know this, but many hospitals DO have a general dentistry clinic with attending dentists and residents that are considered hospital staff, if the hospital offers a General Practice Residency (GPR) program. I did a GPR. We had a full-service dental clinic that operated from 8am-5pm. In addition to providing regular patient care, we also did OR cases weekly. Residents were on-call from 7am-7am the next day. GPR residents dealt with any soft tissue trauma from the neck up (mostly lacerations) and any mouth/dental related issues such as teeth knocked out from sports injuries, altercations, etc. If these occurred between the hours of 8am-5pm, then the patient was sent from triage directly to the dental clinics. If it was a head/neck trauma that occurred after hours, we took care of it in the ER. Any head/neck trauma that involved bone fractures also required the oral surgery resident on-call. Toothaches that occurred after hours were given antibiotics/pain meds and told to report to the dental clinic first thing in the morning.
Incorrect. Most people don't know this, but many hospitals DO have a general dentistry clinic with attending dentists and residents that are considered hospital staff, if the hospital offers a General Practice Residency (GPR) program. I did a GPR. We had a full-service dental clinic that operated from 8am-5pm. In addition to providing regular patient care, we also did OR cases weekly. Residents were on-call from 7am-7am the next day. GPR residents dealt with any soft tissue trauma from the neck up (mostly lacerations) and any mouth/dental related issues such as teeth knocked out from sports injuries, altercations, etc. If these occurred between the hours of 8am-5pm, then the patient was sent from triage directly to the dental clinics. If it was a head/neck trauma that occurred after hours, we took care of it in the ER. Any head/neck trauma that involved bone fractures also required the oral surgery resident on-call. Toothaches that occurred after hours were given antibiotics/pain meds and told to report to the dental clinic first thing in the morning.
I was going to say that as well, but it's hard telling people things who know it all.
I have known 2 MDs who did this. One stopped doing it once he figured out he can't get reimbursed for buying the supplies, much less the appliction. This lesson cost him a few thousand dollars. The other still does it because he's in a large community health clinic where they haven't figured out yet they are doing this at a loss.
Quote:
Originally Posted by azriverfan.
With all due respect, I don't believe you. There are CPT codes for every procedure. Doctor's require a CPT code in order to bill for a procedure. If the code doesn't exist, they can't bill for it. If a code exists, reimbursement for that CPT is readily available. This is a routine part of any medical practice.I don't believe for a second that a doctor would purchase fluoride in advance without knowing if a CPT code exists and what the reimbursement is for that code is.
Finally, let's play devils advocate and assume your story is true. The only doctors who would be involved with something like that would be a primary care doctor. No PCP would have the time to actually apply fluoride or use valuable office space to do a fluoride treatment. It's an extremely inefficient us of time and resources. They are too busy seeing patients and doing procedures that actually reimburse them like biopsies, steroid injections, cryotherapy etc.
Incorrect. Most people don't know this, but many hospitals DO have a general dentistry clinic with attending dentists and residents that are considered hospital staff, if the hospital offers a General Practice Residency (GPR) program. I did a GPR. We had a full-service dental clinic that operated from 8am-5pm. In addition to providing regular patient care, we also did OR cases weekly. Residents were on-call from 7am-7am the next day. GPR residents dealt with any soft tissue trauma from the neck up (mostly lacerations) and any mouth/dental related issues such as teeth knocked out from sports injuries, altercations, etc. If these occurred between the hours of 8am-5pm, then the patient was sent from triage directly to the dental clinics. If it was a head/neck trauma that occurred after hours, we took care of it in the ER. Any head/neck trauma that involved bone fractures also required the oral surgery resident on-call. Toothaches that occurred after hours were given antibiotics/pain meds and told to report to the dental clinic first thing in the morning.
Incorrect, "many" hospitals don't offer General Practice Residency programs. Most hospitals are not affiliated with a full service dental clinic. Furthermore, hospitals are paid by CMS for training medical residents. CMS does not pay hospitals to train general dentists hence the reason most hospitals do not have general dentistry residents on staff. The exception of course are oral surgery residents but they are considered medical residents and are affiliated with an ACGME program. Hospitals employ otorhinolaryngologists (ENT), general surgeons, plastic surgeons, head and neck surgeons, oral maxilofacial surgeons, and trauma surgeons to address head and neck emergencies including dental emergencies. Perhaps there are select hospitals that have chosen to become affiliated with General Practice Residency programs but it is a gross exaggeration to suggest many hospitals have them or imply they are common place.
I think you and others don't understand how hospitals work with regard to physician staff privileges. Physicians particularly surgeons require privileges to perform surgery in their operating rooms. And in most cases, they also require hospital privileges to be on private insurance plans. They also need privileges to be able to do consults. This is where many surgeons get the bulk of their patient referrals. In order to maintain these privileges, these surgeons have to agree to take call and be available for consults. In addition, hospitals are often associated with medical residency programs. These hospitals are paid by the government (CMS) to train medical residents. So in addition to private physicians, many hospitals have access to residents. Therefore, hospitals have a multitude of physicians on staff who are required to take call to address these emergencies. Hospitals simply have no need for general dentists to be on staff nor do they need the additional liability to supervise them. Now, that isn't to suggest that select hospitals may have arrangements in place with general practice residency programs who pay them to have their residents receive experience, but this is hardly the norm.
Finally, this is assuming that only surgeons handle dental emergencies. Many ER docs can easily drain an abscess. ER physicians intubate, put in central lines, perform I&D on superficial wounds, do pleurocentesis, put in chest tubes etc. Trust me, they are not afraid of draining an abscess if they need to. Most dental emergencies are something that an ER doc can stabilize until they follow-up with their general dentist the following day. Most ER docs won't bother a surgeon for most common dental emergencies.
As far as my background, I'm an interventional cardiologist that has been in practice for over 25 years. I am also a teaching attending and have staff privileges at 6 hospitals in the Phoenix metropolitan area. None of the hospitals I am affiliated with are affiliated with a General Practice Residency program and we have 2 dental schools in our city.
Last edited by azriverfan.; 10-26-2016 at 11:07 PM..
I am an oral surgeon who takes call at 3 hospitals including a level 1 trauma center. I have never met an ER doc who felt comfortable doing an I&D in the mouth. Bleeding in the airway is something they fear greatly. They don't even know how many teeth are in the mouth.
I do agree that hospitals generally have no need for general dentists to be on staff since "emergencies" treated by general dentists can wait until the office is open again. Oral surgeons can cover the emergencies that require immediate care. At least for hospitals that can give oral surgeons a good reason to be on staff.
Incorrect, "many" hospitals don't offer General Practice Residency programs. Most hospitals are not affiliated with a full service dental clinic. There are currently 172 ADA-approved General Practice Residency programs in the US, each operating at a separate hospital. While this is by no means "most", (which I never said anyway) some people could consider that to be "many" depending on perspective, but I see your point. Furthermore, hospitals are paid by CMS for training medical residents. CMS does not pay hospitals to train general dentists hence the reason most hospitals do not have general dentistry residents on staff. The exception of course are oral surgery residents but they are considered medical residents and are affiliated with an ACGME program. Our program received GME funding through HHS via CMS. 99.9% of patients we saw were on the state Medicaid program. We did not participate with any private dental insurance company. Dental residents were officially considered medical residents/hospital staff and made the standard PGY-1 resident salary for that hospital. We had formal rotations in internal medicine, anesthesiology, and emergency medicine. Hospitals employ otorhinolaryngologists (ENT), general surgeons, plastic surgeons, head and neck surgeons, oral maxilofacial surgeons, and trauma surgeons to address head and neck emergencies including dental emergencies. Perhaps there are select hospitals that have chosen to become affiliated with General Practice Residency programs but it is a gross exaggeration to suggest many hospitals have them or imply they are common place. True it is not common, but my point was not to automatically dismiss the notion that a hospital will not have a dentist on staff. There is even an American Association of Hospital Dentists (now operating as a council under the Special Care Dentistry Association).
I think you and others don't understand how hospitals work with regard to physician staff privileges. Physicians particularly surgeons require privileges to perform surgery in their operating rooms. And in most cases, they also require hospital privileges to be on private insurance plans. They also need privileges to be able to do consults. This is where many surgeons get the bulk of their patient referrals. In order to maintain these privileges, these surgeons have to agree to take call and be available for consults. In addition, hospitals are often associated with medical residency programs. These hospitals are paid by the government (CMS) to train medical residents. So in addition to private physicians, many hospitals have access to residents. Therefore, hospitals have a multitude of physicians on staff who are required to take call to address these emergencies. Hospitals simply have no need for general dentists to be on staff nor do they need the additional liability to supervise them. Now, that isn't to suggest that select hospitals may have arrangements in place with general practice residency programs who pay them to have their residents receive experience, but this is hardly the norm. I think you are not understanding what a GPR program is - the GPR programs are formal hospital residencies that receive government funding, not the other way around. It is not some "under the table" arrangement made between the local dentists and the hospital. These are fully-accredited programs in the eyes of the ADA and the CODA.
Finally, this is assuming that only surgeons handle dental emergencies. Many ER docs can easily drain an abscess. ER physicians intubate, put in central lines, perform I&D on superficial wounds, do pleurocentesis, put in chest tubes etc. Trust me, they are not afraid of draining an abscess if they need to. Most dental emergencies are something that an ER doc can stabilize until they follow-up with their general dentist the following day. Most ER docs won't bother a surgeon for most common dental emergencies. I can only speak from the experience during my residency, but from my experience this did not happen. Anything involving the head and neck meant a page for us to consult. I had an ER doctor once tell me a patient had a LeFort I fracture when really they had an upper denture.
The reality is that the average dentist knows a heck of a lot more about medicine than the average physician knows about dentistry. Most physicians I have met do not even know how many teeth are in the mouth or can't tell a real tooth from a fake one. I don't entirely blame them, as it is largely a result of training. Dentist receive a much more extensive education in medicine than a physician receives in dentistry (understandable due to the sheer volume of information needed to cram into four years).
As far as my background, I'm an interventional cardiologist that has been in practice for over 25 years. I am also a teaching attending and have staff privileges at 6 hospitals in the Phoenix metropolitan area. None of the hospitals I am affiliated with are affiliated with a General Practice Residency program and we have 2 dental schools in our city. Impressive credentials, but this frankly blows my mind, since your statements about CMS and GPR residency funding are highly inaccurate, and most of your posts, particularly this one on another thread about deep cleanings
"My personal opinion is the deep cleaning is a scam. It was never offered as a routine practice in the past. Anesthesia is nothing new and they could have offered deep cleanings a long time ago. This is relatively new practice that is being increasingly employed by dentists to make more money. It seems like this scam really caught on about 10-15 years ago. The hygienist or associate dentist like gets a kickback for selling you on a deep cleaning much like the cashier at Target gets a bonus if you sign up for a Target rewards card. Essentially you are paying for the anesthesia which is very profitable. There is no strict criteria to determine who merits a deep cleaning. It is subjective hence the reason it is increasing offered. And a lot of people fall prey to this tactic fearing a regular cleaning won't do the job. I think there are select cases where it probably be beneficial but in most cases it's comparable to the car dealership service department recommending an optional engine flush for an extra $300.
I would be very leery of agreeing to a deep cleaning without seeing another dentist first. I think you will be surprised that another hygienist won't recommend it."
are not what I would expect to hear from a healthcare professional. Then again, maybe it just further substantiates my claim that physicians, on average, don't know anything about teeth and dentistry.
I have swelling alot of pain a nasty taste in my mouth and it's like a hard as a ball in my cheek. Also running alittle fever. Will they do anything for me at the hospital?
For the same reason dentists don't fix broken legs.
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