Office-Based Anesthesia

SAMBA’s Office Based Anesthesia Committee explores the particular issues related to administering anesthesia in a physician’s office outside of a hospital or surgery center.

Why Office-Based Anesthesia?

By: Grace Lee Dorsch, MD

For years I had been attending SAMBA conferences. I had heard about office-based practices and listened to lectures about it. Frankly, it scared me. I had always worked in hospitals and out patient centers (traditional anesthesia, operating rooms, anesthesia aides/techs, PACU nurses etc.). However, the practice I was working with as a part-time employee was changing. They were merging and were looking to hire only full time. It was then, that I seriously started looking into starting my own office-based practice. I wanted to work in an environment that put patients first and wasn’t all about the business. 

Advantages:

• Make your own schedule
• No call
• No more weekends
• Flexible hours
• You are in control of everything (type of cases, type of practice, adults, pediatric, cash or fee for service etc.)

Disadvantages: 

• There is no back-up
• There is no income unless you are working, unless multiple providers
• There are no lunch breaks
• There are no bathroom breaks

How to get started with an office based practice:

1. Consider what kind of cases you want
2. Talk to practitioners that you might be interested in working with
3. Research different business models

I selected a “concierge anesthesia model.” – I am fee-for-service only. I provide personal services for my offices “chair to car.” I pre-op, post-op, and follow-up. I have very low overhead. I take all equipment/supplies with me. Offices only supply oxygen, AED, and controlled substances. 

How to sell it? – Ask the practitioners – do you want to increase your productivity and be more time efficient in your office? Dentists or surgeons can be seeing patients up until time you are ready, and they can be back seeing patients while you are recovering and discharging. Their productivity increases; there is much less time out of office compared to cases in the OR where many have to block off large part of their day. 

Many dental practices have high anxiety patients or are doing more invasive or lengthy procedures where patients might prefer to be asleep. The pediatric dental population and special needs cases in the dental office often require anesthesia. This is an ideal scenario for your office based practice to flourish.

Revised OBA Curriculum

Society for Ambulatory Anesthesia Office-Based Anesthesia Revised 2020 Curriculum
Brian M. Osman, MD & Fred E. Shapiro, DO, FASA

Cognitive Objectives:
Upon completion of the office-based anesthesia rotation the resident will:

• Demonstrate a general knowledge of the office-based anesthesia literature for understanding the important changes in office-based anesthesia over the last 20 years
• Demonstrate an understanding of the perquisites for establishment of a safe office anesthesia environment
• Demonstrate knowledge of the anesthesia related safety requirements for establishing an office base anesthesia practice.
• Demonstrate knowledge of the factors that determine the types of surgeries suitable for office- based anesthesia.
• Demonstrate an understanding of the requirements for the appropriate selection of ambulatory patients for office-based anesthesia, including issues of risk, age, time requirements and possibility of complications.
• Demonstrate an understanding of the type of instructions to be given to an ambulatory patient prior to office based surgery
• Demonstrate an understanding of the limitations placed on pre-anesthetic medication by the outpatient status.
• Demonstrate an understanding of the criteria that determine whether a patient can be managed with a regional nerve block, major conduction anesthesia, or general anesthesia in an office- based setting.

View Curriculum