Why Dr. Swarbrick Switched to Third-Party Anesthesia—and Isn’t Going Back

Welcome to the Roots podcast presented
by Elite Anesthesia where we dive deep
with dental professionals about the
challenges, breakthroughs, and stories
behind their successful practices. Today
we have Dr. Jordan Schwarbick with us,
an oral surgeon with Reva Dental Implant
Center. Dr. Schwarber, welcome. Good to
be here. Thanks for having me. Yeah,
we've known each other for uh for a
while. We elite and Dr. Schwarrick
specifically, we've worked together
since I think since you moved to Utah.
Is that right? Yeah, pretty much. Yeah,
we go back probably pushing four years
now. Yeah. Doing cases all over the
state of Utah and uh just keeps getting
better and better. I remember I we
started off doing um like thirds with
you. Yeah. Started out in some offices
that I was providing coverage for uh
just doing mainly wisdom teeth and
fullmouth extractions, occasional, you
know, implants. And uh at the time I was
doing the sedation myself. Had a few
assistants that would travel with me. It
was a it was a traveling, you know, type
of situation and we weren't real happy
with that situation. I was doing the
sedations. The assistants were great,
but hadn't really been trained in
sedation and having to bring all of our
equipment, all of the meds, everything.
And uh it just we just thought there
there could be a better way to do it,
which is when I found you guys and
reached out. And after the first case, I
was hooked and I've been been stuck with
you been with you four years uh four
years since and yeah, multiple states,
multiple practitioners now working with
you and uh and always great experiences
and most importantly from the beginning.
uh you know this is my mindset everyone
at Reva it's what's best for the patient
and and I really truly believe this is
the best thing for the patient the best
way to um to for a patient to have the
procedure done and the safest and that's
one of the main reasons why we continue
to to work with you guys. Yeah, we
obviously agree and uh we've had a great
time working with you. We've had a great
time working with Reva and just to
reiterate, I mean, very same similar
feelings. You know, we work with implant
centers and dental surgeons everywhere
and all different walks of life,
different practices and always been
incredibly impressed with you and with
Reva. And I can I can say from personal
experience and then you know Elite as a
business, we've always felt like patient
safety comes first and I would say that
you know you you as much or more than
anyone have always recognized that and
it it means a lot to us and I think
means a lot to your patients and to your
business too. Yeah, exactly. Thank you
so much for saying that. Yeah, it's
something that uh you know, we not only
preach, but we implement and and that's
why this partnership works so well. I
think you know we we put the patient
first, put the patients uh experience,
comfort, safety first before anything.
Um, you know, when we were uh in the
process of creating the the clinical
workflow that we follow at Reva, um, you
know, me and several of the other
doctors sat down and said, "Okay, if
these were only family members or only
really good friends, how would we want
them treated and what would we do?" And
that's how we outlined uh the process
and and it started with, you know, doing
sedation the right way. I can do the
sedation. Do I want to do the sedation
now or do I feel like I should be doing
the sedation? No. I feel like there's a
better way. And so it's it's something
that I love offering to our patients. As
you know, many of these patients, they
have not been into the dentist for years
or decades because of dental fear. And
their teeth and their oral hygiene has
suffered because of that. And so when
they come into our office and we can let
them know, you're just going to take a
nap. You're going to take a nice
comfortable nap. And when you wake up,
everything's going to be done. you can
just feel and see that stress, you know,
come off their shoulders that they've
been carrying because they just just are
terrified of of having dental treatment
done. And so, it's it's so nice that we
can offer that. So nice that these
patients that have been, you know,
neglecting their oral health now can can
have it treated and and end up in a
better spot because of it. So for many
many reasons uh you know we're very
appreciative of the the service that you
guys offer and for the um results that
it allows us to give our patients. Yeah.
You know we talk to these patients as
well and and it's reciprocated. They
know that Reva is all about safety. They
know that Reva cares most about them and
that that means a lot to us too. I mean
we we definitely see both sides and uh
just overall really enjoy working with
you guys for that reason amongst others.
Can can you tell me a little bit more?
Um, you said a lot about doing it the
right way. I know that I think that's
kind of a controversial thing. Can you
tell me a little bit more about what
that means? Yeah. Yeah. My my
interpretation of it, you know, as I
mentioned, I can do the sedation. Um, in
certain situations, you know, there's
patients when it's a light, you know,
mild sedation and it's a quick
procedure. It's a little different
situation. um in this type of situation
that we're dealing with where it's it's
a procedure that's going to last more
than an hour. Um it's a procedure that's
a little more invasive. Um it's
something that uh you know if I were to
do the sedation, not only um does the
procedure end up taking longer. My
attention cannot be fully directed at
the surgery and the patient. I'm going
to, you know, I'm going between the
sedation, the procedure, the
medications, you know, have to having to
monitor everything at once. is basically
doing one person doing two jobs is what
it ends up, you know, being. Um, we're
actually the only specialty out there
that does their own sedation and the
surgery at the same time. And so when we
change that and when I can just focus on
the surgery, when I can be more
efficient with the procedure, um, it
leads to faster procedure times, quicker
recoveries. you know, it's been shown
time and time again. A lot of these
complications occur due to, you know,
prolonged surgery times and and um you
know, infections and things like that
can can occur when when it takes a lot
longer than it should. And so I can uh
work on you know, becoming more
efficient with the surgery. Um fully
fully, you know, concentrated on on what
I'm doing with the implants. And I know
that not only will the surgery go
better, but there is a specialist right
there at my side in elite anesthesia
that this is all they specialize in.
This is what they do day in and day out.
And they are 100% focused on the
patient, on their comfort level, on the
depth of sedation, on their vitals,
making sure everything goes smoothly
throughout the procedure. And having
seen both situations
firsthand, I choose specialists
monitoring and taking care of each
specialty item with the procedure, which
is an oral surgeon performing the
surgery, anesthesia provider in elite,
you know, a nurse anesthetist or
anesthesiologist handling the sedation,
and then also for us, the third part is
a prostadonist managing the you know,
prostadonic side of the procedure, which
is the teeth and and the bite and all of
that. Um, and it we just see time and
time again when specialists handle the
specialty portion of the procedure, you
have better outcomes, you know, better
success all around. So, yeah, that's
that's what we preach. Yeah, I mean, I
think it makes sense that uh putting the
right the right people in the right
place doing what they were trained to do
uh creates the best outcome for the
patient. Crazy, right? Yeah, it makes
sense. It's not too complicated. Yeah,
exactly. It is fun. I mean not
everyone's committed to doing that and I
think there are various re reasons for
it. I think it's important um you know
for anybody you know watching this to
understand you know REVA is a a dental
implant center specializes in all X
procedures. These are or can be long
cases and as you mentioned, you know,
these patients often are not the
healthiest dental pl dental patients
that come through the door. And so I
think it's important to kind of
differentiate or categorize the patients
that you guys are actually seeing and to
specifically talk about anesthesia and
in general why it's important to have
specialists dealing with complicated
patients. Um, you know, they're just in
general kind of unhealthy. Exactly.
Yeah. Uh due to the demographic um due
to um many situations going on and and
as we know oral health is so tied to
systemic health and these patients that
we're seeing, they're seeing us because
of their oral health situation and and
you know it having declined and being in
a bad situation and in a bad spot. And
so a lot of that can transition to and
and translate to other systemic issues
and coorbidities that we're dealing
with. And so, uh, yeah, it's sedation's
tough enough when you have a healthy,
you know, patient, healthy young patient
there in front of you. Um, when you have
a patient with some some health issues,
um, it just becomes that much more, um,
uh, don't want to say complicated, but
but more challenging and and that's why,
you know, that's that's when we call the
specialist. Yeah. You your background, I
mean, you are an oral surgeon. Um, where
did you do oral surgery residency? Yep.
So yeah, my quick background, I uh did
my oral maxel facial surgery training at
uh in Indianapolis through IU Health. Um
we covered all the main hospitals
downtown in Indianapolis and and you
receive, you know, training in in every
every aspect of oral maxyl facial
surgery, you know, trauma, cancer, uh
dental implants, uh dental aviolar, you
know, extractions, third mers, things
like that. and um and so great
background in the surgical uh aspect and
then also we receive uh uh training in
the anesthesia portion. So for you know
8 months we're there with the anesthesia
residents giving sedation and performing
procedures uh on the sedation side and
and so even with that background you
know and I feel very comfortable
performing a sedation. Yeah. Now when I
perform a sedation and do a surgery is
when is when you know I'm I'm I've
started to realize there's a better more
efficient safer way to go about doing
it. Yeah. Tell me about uh so obviously
residency did both things anesthesia and
uh the surgery portion. What was it like
getting into practice and actually
having to marry those things together?
Yep. You know we we obviously you know
did several cases in residency as well.
we were doing the the you know
extractions, dental implants with the
anesthesia. And so we we do train that
uh on that before you you're released
into private practice. Um but uh you
know it's it's it's I think as you will
talk to most practitioners, general
dentists, specialists, anyone um the
anesthesia uh can be the most stressful
part of your day-to-day life. And that
was probably one of the biggest things
for me and the most impactful things is
as I was traveling initially as we
talked about to all these remote
locations, the most stressful part was
performing the anesthesia. And it would
keep me up late at night, you know, have
trouble sleeping before cases just
because, you know, you think you think
you're dealing with a healthy patient,
next thing you know, you're you know,
you're you're into some into some issues
with anesthesia. And so healthy as far
as they tell you. Healthy as far as they
tell you. Exactly. And so uh and so
removing that stress and removing that
portion of my responsibility for the day
and I still am there and and and you
know um helping when I when I need to
but uh being able to focus just on the
procedure um was a significant
improvement in my in my you know work
life balance. Yeah. Um, yeah. I mean,
speaking about oral surgeons
specifically, I've noticed as we talk to
oral surgeons that are maybe a little
later in their career versus uh newer
surgeons that are fresh out of residency
or still in residency, the feeling about
having a third party come in and do
anesthesia seems to be slightly
different. Just just so I'm clear, I I
think I think we're on the same page.
But on the side, you notice you notice
that the that the older the older
surgeons are are kind of stuck in their
their ways a little bit. I think Yeah, I
think they have more concerns, more
questions about it and they've been
doing it their whole career. I mean,
from our from our standpoint, um you
know, we don't spec we don't uh we don't
take a side like elite anesthesia is not
trying to say that every you know, the
oral surgeon shouldn't do anesthesia.
that's not at all the position that we
take. I think there's a use case for
anybody. Um specifically with the um
oral surgeons that are, you know, later
in their careers that are experienced
and have been doing this and they they
know the game and know how to do it. I
feel like the use cases, you know, like
you were saying, patients are getting
more complicated. They're sicker than
they've ever been. Uh you know, drugs,
marijuana use, that kind of stuff is is
more of a factor. And so there there is
a use case for bigger cases, bigger
surgeries. Um, you know, maybe for
thirds and smaller cases, it doesn't
make sense. But in the younger surgeon
population, it feels more like, yeah, I
don't really want to do this at all. I'd
rather you guys handle all of it. No,
it's a really really interesting point
you bring up and and you definitely do
see it. Um, as you mentioned, you spoke
to it a little bit. You know, some of
these surgeons, they've been doing it
for 30 years. Um, they've been doing it
day in and day out. And for those young
healthy wisdom tooth, you know, third
patients, um, you know, I think some of
them are are a little hesitant to
change. They have something that's
working. And you know what, in that
situation, if you're comfortable, if
it's working, you know, like you're
saying, they can continue on and it's
and it's probably going to, you know,
continue to work great cuz it's worked
great for 30 years. the second that uh
you know you get that unhealthy patient
in the chair and I would say the second
that that surgeon starts to starts to
you know get a little nervous with the
case you got someone you can call you
know the second that you're get referred
that uh all onx case from your local
provider and it's going to be a
three-hour case I don't care who you are
and how long you've been doing it no one
really wants to to do a surgery and a
three-hour sedation and so now now they
got someone they can call and so yeah
like you said there's always there's
always a situation where it makes sense
um But, you know, for the folks that
have been doing it a long time and and
uh are a little bit stuck in their ways
and and want to continue doing it, um
you know, they can do that as well. But,
uh if there is a better way and if there
is if it's a chance that it makes your
life better, you know, I always I always
tell them at least give it a try. Yeah.
You know, I I don't want to talk about
anesthesia the whole time. We want to
hear about REA and about you. Uh tell me
it seems like for especially oral
surgeons seems like one of the bigger
um you know questions about using third
party anesthesia is the economical
aspect of it. Does it make sense for me
to now pay somebody else to do this or
for my patient to pay somebody else to
do this? And we usually talk about, you
know, increased efficiency, increased
um, you know, better surgical outcomes
and that kind of thing, but can you
speak just a little bit to the
economical piece of it? Yeah, it's a
good question. You know, it's something
that, you know, occasionally we get
asked for from providers that are
considering using you guys. And, uh, to
your point, um, you know, there are
groups out there that require the
patient to pay for the anesthesia
directly. Um, we wanted to create a
center and an environment where the
patient feels like we are taking care of
them every step of the way. No
surprises, no fine print, no no nothing
like that. And so when they decide to
move forward with us, we take care of
the anesthesia no matter how long it
goes. Um, and we take care of that so
that they uh so that they feel that they
feel they're taken care of. With that,
you know, it provides efficiencies as we
mentioned. So we're able to get them in
and out of the chair much much quicker.
And it's not that we're rushing. It's
not that we're flying through things
that, you know, we should be taking more
time. It's just that we can fully focus
on the procedure. And so, uh, it's it's
huge in our in our process and in our
workflow because our patients are
leaving the same day with a set of
permanent teeth. And so the faster that
we can get the procedure done and that
our lab can fabricate the teeth for for
us to then place in the patient's mouth
and and fix to the implants, the faster
they get to get home and start resting
and recovering. We see that with this
process and with the increased uh
increased efficiencies, patients are
recovering quicker, less pain, less
swelling, just just benefits them all
around. And so um for those reasons, you
know, the additional cost is completely
worth it for us. We have most of our
patients will mention it to their
friends. A lot of their friends are in
their similar situation. And so we we
get a lot of referrals because their
experience goes so smoothly. And so why
penny pinch on something that could be
so impactful to that patient and make
everything go so much smoother and in
the long run lead to, you know,
additional uh volume and business for us
just because we're taking care of our
patients the right way. Yeah. So and and
potentially money loss in the future
dealing with complications or Exactly.
Poor surgical outcomes that you got to
deal with later. No, 100%. So, yeah,
really really hard on in our minds um to
imagine doing it any other way. Yeah,
that means a lot to us. Like we we
genuinely care about the patients that
we work with, care about the outcomes.
Um it shows. And not just for the
patient. Thank you. Not just for the
patient, but for you too. like for you,
for the people that work for you, um for
the assistants, just overall feels like
a better experience um with it than
without it. 100%. Yeah. For for every
team member that's in the room, you
know, the patient uh their family, their
family seems to, you know, family member
that's dropping them off the day of
surgery seems to, you know, just be able
to rest a little easier knowing that
they're in the care of multiple
specialists handling each part of the
procedure. So yeah, it's like you said,
it's very few uh very few um scenarios
where we could ever imagine, you know,
not doing it this way. Yeah. I should
say no scenarios
cuz Yeah, cuz we we love it. So tell me
about working with Reva, you know, as an
oral surgeon. Revas has been a great
company. We've really enjoyed, you know,
working with them. What is it about Reva
that's that's different? You know, like
we mentioned earlier, um you know, the
the experience is so important to us.
Doing our best to to really provide the
absolute best patient experience is what
we're after. And uh and with that comes,
you know, specialists for each portion
of this. There's a lot of centers out
there that are doing this, trying to
learn how to do this, and they just
haven't received in our minds the proper
training. And so what I love about uh
Reva and why I love working there is
there's a surgery portion that trained
oral surgeons take care of and
responsible for. There's a teeth
portion, the prostidonic portion that
trained prostadonic specialists are
overseen and responsible for. There's
the anesthesia portion that our our team
in elite anesthesia is overseen and
responsible for. There's the lab portion
that we have a you know specialized lab
that helps. And so again, just it's it
we're really big on specialists doing
special specialty things and uh and we
think that's one of the reasons that uh
that a lot of our patients do end up
coming to us and that we see such great
outcomes. Um it's just it's just you
know for some reason in the dental world
it's not as clear as in say the medical
world. You never go to your general
family doctor for a heart procedure you
know heart cath and and for for some
reason in dental it's not quite as
clear. And so we really like that we're
keeping that, you know, clear and and um
and having specialists uh do specialty
things. Um and then also just the
culture, the people that we have there,
the staff, everyone truly truly loves
and cares for these patients and you can
see it day in and day out. Um which is
one reason we love working with you
guys. You can see that you guys truly
care for these patients. I'm receiving
text messages later that night from your
providers after they've done a case.
Hey, how did Bob do after surgery? Wake
up. Okay, he's doing okay. He's such a
nice guy. I mean, you don't see that
elsewhere all the time. And uh and so
love working with with staff that wants
the best for the patients that that um
celebrates p the patients and uh and
yeah, just just wouldn't do it any other
way. It's it's yeah, love working there.
I can personally attest to to both those
things. I I uh you know we've worked
with you worked with Reva as well for a
long time and you as I think about what
makes Reva different to me and and to
our providers uh I think that's what
stands out the most. I I think as a
business we feel taken care of by Reva
which is unique. you know, we work with
a lot of people and and I can't say the
same about everyone and I've always felt
like um you guys care about our
relationship more than anything else and
that you know business is is tough. You
know, everyone's got different motives.
And I think, you know, elite at the core
is trying to take good care of patients,
good care of dentists, good care of the
people that work with you guys, good
care of our own employees, and I think
I've always felt like Reva is the exact
same. We've always aligned on those
things, and it's it's been an awesome,
easy partnership. No, it's it's
reciprocated. Uh, for sure. Yeah. So
dental implants changing a whole lot
over the last we'll say 20 years but
especially probably over the last five.
What at Reva have you guys adopted
technology-wise that has kind of
furthered your practice more than
anything else? Yeah, it's interesting
you say that because even in the last
four years since we've been around,
there's been a lot of technological
advances that mainly benefit the
patient. And so we're always working
with what who we view as the top, you
know, uh companies in the in the dental
implant world on the implant side, on
the digital scanning side, um you know,
all the 3D technology and and are in the
process of testing some of these
products for these companies before they
come before they even come to market. We
want to make sure that if there is
something else available that improves,
you know, the patient experience, the
outcome, that we implement that
immediately. And so we've already, you
know, had things that we've implemented
that weren't around four years ago. But
some of those things are the new
scanners. Um, as you know, as you go
between, you know, offices and see the
different uh scanners out there, we feel
like the digital technology that we have
and the digital workflow is is the
absolute best that a patient can can
have right now. Um, it minimizes the
time in the chair, increases efficiency
and accuracy. These new scanners are
incredibly incredibly accurate which
ultimately leads to a very very nice
natural fit of the teeth and um and a
set of teeth that looks natural, feels
natural and and allows patients to
function the way that they should. So
all the digital technology that we have
uh we believe is the best that you can
you know that you can get right now. Um,
and any ch any chance we have to improve
that and as we mentioned, you know, as
these products come out, we we do what
we can to to, you know, change our
workflow as needed to implement anything
better that's coming to market. Sounds
like Reva is about the best people, the
best specialists, the best technology.
Uh, completely humble about all of it. I
think as a patient, if you go to Reva,
you expect to have as good as as good of
an experience as you could get anywhere
else or better. That's that's that's the
goal and everything. Again, all these
decisions that can be made for multiple
reasons. The reason at Reva is the
patient and that's what we love. It's
it's the patient. It's the patient
outcome. And so that they can look in
the mirror at the end of it and smile
and say, "Yes, this is this is my smile.
These are my teeth." And feel overjoyed
that that they have them. That's that's
our goal. So if my mom needs implants,
I'm going to appreciate it. and we have
done several family members that are
staff at Reva and and being able to do
that and help those those family
members. It's it's one of the best
feelings and and the
the you know selfishly as as a provider,
you know, the gratification that comes
from helping a patient go from being
edentilous, you know, without teeth or
from having just a mouth full of broken
down teeth to having the best smile in
the room and being able to eat steak and
vegetables again. It's just nothing else
in my opinion compares to that in in my
field of oral maxyl facial surgery. Out
of all the things that I could be doing,
I knew early on in my career. This is
what I wanted to focus on. Um because of
what I wanted to focus on. Um because of of
of because of it being such a
life-changing procedure because of this
ultimately changing the direction of
these people's lives. It's it's such a
fun thing to be a part of and uh and
love, you know, day in and day out being
able to help these patients. So, I've
been doing this almost as long as we've
been working together, about five years.
And I had no idea
um how impactful your smile is. I had no
idea until we started get, you know,
doing, you know, implant dentistry and
working with dentists, working with oral
surgeons. Um Allx specifically is just
uh incredibly impactful. And I same
thing for me like the gratification that
I get from facilitating these procedures
as as an anesthesia provider. Um you
know number one they're super nervous
during the day which is is you know
that's always part of anesthesia.
Everyone's nervous for any type of
Everyone's nervous for any type of surgery.
Um, that's something that I love about
anesthesia. But, you know, usually in a
hospital they're getting a like a a
colonoscopy or something like you don't
walk out of your colonoscopy feeling
like you do after getting a whole new
smile, right? It's a very it's a very
unique and different feeling. You know,
as I mentioned in my training, there's a
lot of things that an oral max facial
surgeon can do. And uh and again, just
in my opinion, nothing compares when
when you give that patient that final
set of beautiful teeth. Um it's like
immediately they they look in the mirror
and you can see in their eyes, they know
their life has been changed and and we
see them. They're getting better jobs.
They're they're back out dating again.
They're in the gym. Like it just just
all the other things start coming
together. It's like a catalyst for
everything else they do in their life.
You see him a year later and you hardly
recognize him. you're like, "Are are
you, you know, working with a company
that we work with?" Or, "Oh, no, you're
a patient." You know, it's like and and
and yeah, it's just it's just the
funnest thing to be a part of and and to
use our skills in that way to help these
patients. And so, absolutely love it.
Never plan on stopping. And again, such
a big part of it is, you know, this
relationship um doing it right, doing it
uh in a way that is safest for the
patient um so that they can use these
teeth afterwards. you know, we got to we
got to do the what's right and what's
safe so that so that they uh you know
that they can actually get the teeth and
use them. What do you think the
long-term vision is for for Reva and for
you and your career? Like what are we
hoping to do over the next five to 20
years? Yep. You know, my wife
occasionally asked me the same question
and I am exactly and there's and there's
surgeons that you know do these all on X
procedures for a while and then shift to
something else and they go back to the
hospital. I never see myself doing
anything else besides this procedure. It
utilizes all of my surgical skills
because it is it is a more complex
intricate procedure which I like. Uh
much different than taking out wisdom
teeth. And so I love the procedure. I
love um what I get to do for these
patients. Uh the satisfaction that it
brings me as a provider. Um and I love
working with Reva. Reva is a company
that I think you know they they believe
in doing things the right way and I love
being a part of that. Um, I love uh
helping them grow and and you know, help
other surgeons learn how to do this.
They haven't had as much as much
experience and so I I see myself doing
that uh um you know for the for the
foresee foreseeable future. Reva has
always been easy for us to root for. You
guys have always done things the right
way and treated us well. Obviously
treated patients well. I'd say um you
know we get a lot of feedback on
outcomes um from both patients and you
know just being in the community and
Reva is very very well regarded um and
it's we're grateful to be associated
with you guys. Oh that's great Jordan I
could ask you questions all day. We
could talk all day. I think we're uh I
think we're out of time, but I really
appreciate you you coming around. Of
course. You've been one of our our
greatest um friends, associates, allies
throughout our time here at Elite, and I
I hope it's reciprocated. I hope you
guys feel the same way. 100%. Yep. Let's
just get those mountain bikes out and
hit the trails. Let's get rid. You can
show me how to shoot. Exactly. Thanks so
much. Thanks, man. I appreciate it.