Consolidation is Here to Stay
Consolidation is a trend across many industries. Just 40 years ago, pharmacies were all mom-and-pop businesses. Now, one would have to drive past hundreds of CVSs and Walgreens to find one mom-and-pop pharmacy. Likewise, dentistry is following suit. And not far behind it, we here at GDN see the consolidation trend happening in veterinary, plastic surgery, as well as other healthcare verticals. Unquestionably, consolidation in dentistry is an unstoppable trend.

Having been around since the early 1970s, there were missteps in the beginning, and much of the misconceptions about DSOs stem from them. However, DSOs have learned from these missteps. Once held perceptions are eroding and the modern DSO has evolved into something completely different.

The Biggest Misperceptions About DSOs
There is a misperception about DSOs that a business person will come in with quotas and tell the dentists, who as healthcare providers are concerned about the patients’ well-being, what to do. While that may have been somewhat true in the past, modern DSOs stay out of clinical decisions because they want to ensure quality work and patient care in order to protect their investment.

Many solo practitioners struggle to implement systems. Within the symbiotic relationship of non-clinician and clinician, a DSO has a system of checks-and-balances that is just not possible for a solo practitioner. DSOs are careful to make sure there is vigorous compliance, a strong chart review process, and quality metrics in place to ensure quality dental care.  Having systems and processes in place does not eliminate product choices or effective care. Additionally, DSOs can also offer big data analysis and reports which ultimately improve outcomes for patients.

Within a DSO setting, dentists have autonomy and collaboration is encouraged. There are good dentists and bad dentists no matter if they are a solo private practitioner or work for a dental group practice or DSO. A dental support organization has the systems and reporting capabilities to identify dentists that are not providing adequate patient care. The DSO can provide training, education and mentorship to these dentists to improve their clinical skill set.

The Costco Effect (a.k.a. Economies of Scale)
Profitability can be attained in two ways: production numbers (which all dentists think about whether they are a solo or group practitioner) and economies of scale. Simply put, efficiency leads to higher profits. This is the Costco effect. Groups buy in high quantities, which saves money. The management organization and dentist relationship is mutually beneficial. One has clinical strength; one does not. One has business strength; the other does not.

Change is Hard
Most people inherently resist change because it pushes them out of their comfort zone. However if the reason for change is compelling, then the discomfort and opposition is possible to overcome.  DSOs were once ridiculed, opposed and ignored. They were seen as inferior. But through learning, shifting and adapting, it has become evident that this is the future in dentistry. What was once seen as inferior, is now how things should be done. Why? Because dentists want options.

Options, Options, Options
Just a few decades ago, starting a practice or becoming an associate in an established practice were the only options for dentists. College and dental school debt is insurmountable for many now. What was once the standard path, is now just one option. Senior dental students, residents, practicing, and retiring dentists’ options have evolved.

In the past, dentists only had two options for practicing:

  1. Starting a practice
  2. Joining an established practice as an associate.

Now, dentists have four options for practicing:

  1. Starting a practice
  2. Joining an established practice as an associate
  3. Joining a DSO
  4. A dentist with an established practice forms a DSO with other dentists in a geographic area, or within a similar specialty (endo, pedo, etc.)

Professional and Personal Growth
Most dentists want to have a nice quality of life and attractive income. DSOs provide 401K options, malpractice insurance, vacation, health insurance, free CE courses, leadership training, access to cutting edge technology, implant placement classes, and staff facility positions.

Some DSOs allow their dentists to purchase equity in the DSO which can be used, in essence, as a retirement account. In the past, selling the practice would be a dentist’s retirement account. Some DSOs also offer a percentage of the office, bonus structures, and other options for ownership.

Support from a DSO allows practitioners freedom from mundane business tasks that they never trained for. To be blunt, dentists don’t learn how to run an office in dental school.  Starting a practice from scratch after graduation can be daunting from a managerial, logistical and financial perspective. Managing staff, dealing with a leaky roof, handling curb appeal, marketing, social media, equipment malfunctions, software, and employee benefits are just not things that many dentists want to deal with.

Instead of reinventing the wheel, a DSO gives dentists an outline to work from, which can be adapted to a dentist’s own style and preferences, thereby leading to a happy dentist who can grow the dental practice of their dreams.

Important Takeaways
Truth be told, most younger dentists will end up working for a DSO at some point in their careers. Before deciding on a DSO, it is important to investigate and talk to people who have experiences working in a DSO setting. Research your options as not all DSOs are the same. In fact, most DSOs are unique. Make sure you share a common philosophy and value system with the DSO.

Once you decide on a DSO, dedicate yourself to the organization, armed with a good attitude, looking at a future with them past the six-month guarantee. Don’t begin the relationship planning to leave. Have the intention of giving it everything you have. Build the relationship and grow within the DSO model to experience all that it has to offer.

Still Have Questions?
Are you a dental student, resident, or dentist and have a question(s) about DSOs? You can email your question(s) to us and we will provide answers in an upcoming Q&A article.  Please indicate in the email if you’d prefer to be anonymous. Submit your questions to

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