To DSO or Not to DSO, That Is the Question

An illustration of a dental chair and dental equipment

DSOs continue to be a polarizing issue throughout the dental industry. People seem to believe they are either “destroying dentistry as we know it” or “the best possible way to practice dentistry,” with very little room in between.

Before we go any further, we all have to agree that there are some great corporate dental companies and some less-great corporate dental companies. Like anything else, that evaluation hinges on how you measure what makes a dental practice “great.” But we also have to acknowledge that there are great independent dentists and less-great independent dentists, just like there are great barbers and less-great barbers.

DSOs serve a market need

DSOs continue to grow because they offer a solution that meets the needs and preferences of some dentists and patients.

There are dentists who love the art and practice of dentistry and have no interest or inclination for running a small business. They don’t want to spend time and energy on marketing, or accounting, or hiring and firing. And they have even less interest in dealing with all the regulatory acronyms: OSHA, EPA, and IRS. An organization that offers efficient business service and regulatory expertise is ideal for a dentist who simply wants to be a dentist and not a business owner.

Likewise, some patients prioritize practices with convenient locations and hours (evenings and weekends) while taking all insurance packages. Large corporate dental organizations are often exactly what those patients are looking for.

A DSO isn’t the only way to achieve these goals, but the business model clearly resonates with those who see their needs served.

Research says…

When I served as the VP of Member & Client Services at the ADA, my team did research to understand the experience of dentists. Some of the qualitative research focused on understanding the experience of dentists working in DSOs to identify what they might need from the ADA.

As expected, some loved working in that model and some were eager to leave. But whether they liked or disliked the business model itself, there was commonality in what they did not like about the experience. When asked what they did not like about working as an employee in a corporate setting, the responses can be summarized in one word: control. The surveyed dentists wanted more control over the materials used, their own time, and, in some cases, the treatment plan.

I suspect the ADA would find the same experience if they surveyed associates in independent practices or even in a completely different non-dental setting. Some of those concerns stem from the very nature of being an employee. Any employee agrees to certain standards and business practices as part and parcel of working in an organization. As long as those practices are ethical and legal, the employee is choosing to agree to those conditions. Those who start their own business often do so because they want to control those standards and business practices.

How dentists’ career paths are changing

Increasing numbers of dentists go to corporate opportunities right out of dental school. According to ADEA, 18.1% of dentists intend to work in DSOs immediately after graduating, while the ADA Health Policy Institute reports that 10.4% of all dentists are affiliated with a DSO. But it also seems that some large corporate dental organization experience significant turnover of those dentists.

Anecdotally, we are now seeing more dentists enter DSOs at the end of their career. Tired of managing their own practice, dentists approaching retirement often desire to keep working in dentistry without the responsibility of running a small business. These options offer an attractive off-ramp as a dentist moves toward retirement.

Regardless of the reason, it’s up to the dentist to take the time to carefully evaluate their own needs and the office itself before signing on the dotted line. No matter what type of practice you might consider, the questions are the same:

  • What are the working conditions and schedule?
  • Are you comfortable with the quality of dentistry being delivered?
  • What procedure mix will you be responsible for?
  • What is kept in-house, and what is referred out?
  • Does the practice stay on schedule or consistently run over?
  • How does the office “fit” your personal style? (Do you like quiet or bustling? How do you prefer to work with the rest of the team?)

These questions point to finding the right “culture” or “philosophy of care,” which means the place where you can find career satisfaction. (See the Know Your Options eBooks, for owners or early-career dentists, to take a quiz on potential options for you.)

The Evolution of the DSO

“If you have seen one DSO, you have seen one DSO.”

We see that the corporate model is in a constant state of change. Today, there are DSOs with hundreds of locations across the country. Some of these function like well-oiled machines, with all offices sharing the same processes, branding, and layout. On the other hand, there are DSOs with 10-30 practices that allow the dentist to function as a solo practitioner, with full operational autonomy, while the corporate entity provides oversight, guidance, and economies of scale. (See: Should I Join a DSO?)

The reality is that every practice is unique, be it DSO, private practice, public health, or another modality. No matter what, you must take the time to fully understand the individual practice you are interested in joining.

Ultimately, in the current market, there is room for corporate-owned dental service organizations and private practice owners – as well as everything in between. Remember to carefully evaluate your personal and professional situation, review all your options, and make the decision that is right for you.

If you then take the time to ask the right questions and objectively evaluate the individual practice – you have a much higher chance of finding success as you pursue your dream career! 

This article was reviewed and updated in June 2023.