While several dentists predict a continued decline in solo dentistry, some say the industry could switch away from DSOs and group practices in the future as people realize the benefits of a solo practice.
A recent report from the Association of DSOs found that the majority of dentists now work in a group practice, with only 36% of dentists working at a solo practice. Thirteen percent of dentists are now affiliated with a DSO.
Eleven dentists recently spoke with Becker's to discuss what is driving this trend and the impact it could have on the industry.
Editor's note: Responses were lightly edited for clarity and length.
Corey Anderson, DDS. Affordable Dentures & Implants (Bridgeport, W.V.): If the number of solo dentists declines, DSOs will initially thrive. However, the cost of buying existing solo practices or smaller DSOs will eventually increase due to scarcity to the point that DSO growth will require DSOs to open new offices to grow instead of purchasing existing practices/smaller DSOs. Consolidation among the mid-size DSO groups could be a consequence.
Omer Anisso, DDS. Espire Dental Encinitas (Calif.): Dentistry is following in the footsteps of the medical field 25 years ago. The only difference is that the dental DSOs have had the opportunity to study the successes and failures of our medical DSOs. What we are seeing is smarter and more patient-friendly organizations coming into the limelight for dentistry. Dentists today have better choices to partner with first class DSOs and are also more educated to not partner with the DSOs that don't have the same plans and culture. I partnered with an outstanding DSO called Espire. The organization is extremely smart, organized and the culture goes hand in hand with my personal feelings that you can have a "win-win" relationship with the organization along with continuing to serve your patients exactly the way you feel best doing so. I agree that the solo dentist will continue to decline but the positive is that the dentists that do partner with DSOs in the future, as I did successfully one year ago, can also do so with like-minded organizations and can continue to have a prosperous career that may actually take away much of the behind the scenes stresses that so many dentists would welcome.
Joshua Austin, DDS. Joshua Austin, DDS & Associates (San Antonio): I think dentists combining forces makes a lot of sense from a cost and overhead perspective. Whether that be with a traditional DSO model or the smaller, local dentist collaborative-type DSO, we are going to see these markets grow. I do not think we will ever see the total elimination of solo practices, though. There will always be a market for a traditional solo model-type practice. I think back to my teenage years in the mid 90s. It seemed like chain restaurants were taking over everything. There were far more Chili’s and Outback Steakhouses than there were locally owned trattorias or bistros. Now it seems like it has swung back the other way. I can’t remember the last time I ate at a Chili’s, but I can name 10 great, locally owned spots around town that we dine at multiple times a year. There is space for both in the market.
Raul Escalante, DDS (San Marcos, Calif.): Owning a dental practice is not like it used to be. It has become more and more expensive to maintain the practice and you can only raise your prices so much. Even if you were able to keep raising your prices, insurances will only pay you what their fee schedule dictates. Recent graduates are coming out of dental school with large amounts of student loans, so for them to start a solo practice is virtually impossible. They need to work and group practices are the answer for them. I believe these are the main reasons solo practitioners are a dying breed.
I feel like most solo practitioners are like myself and have owned their practice for decades. I honestly don't see how a young dentist can start a practice in these times. The cost is just too high. As a recent grad, you can start working right now at a group practice or you can build your own practice and hope that you can stay busy enough to pay your overhead plus have an income for you and your family. You have to deal with all of the regulations and pay all of the permits, hire your own staff, negotiate pay, set up payroll, pay your own taxes, the list goes on and on. On the other hand, you can be an employee for a group practice and not worry about any of that. I honestly believe that in time a solo practice will be talked about like vinyl records, a thing of the past.
Jacob Ferris, DDS. Twin Ports Dental (Superior, Wis.): If the trend of diminishing solo dentists persists, the field of dentistry is poised to witness a surge in dentists seeking stable positions within DSOs, particularly among those burdened with hefty student loan debts. The weight of educational loans prompts many dental graduates to prioritize the stability and support offered by DSOs over the risks associated with independent practice ownership. While both options, solo ownership and affiliation with a DSO, have their advantages and drawbacks, there will always be a demand for dentists capable of delivering personalized, high-quality care. However, achieving comparable income levels may prove challenging amid stagnant insurance reimbursement rates and escalating operational expenses, necessitating dentists to carefully weigh their options in the evolving landscape of dental practice.
Lawrence Hale, DDS. Total Dentistry (Englewood, Fla.): I have been a solo dentist for 38 years now. I think large DSOs and group practices have a better negotiation ability for supplies and insurance reimbursement. Costs are rising due to inflation along with payrolls. Solo practice will continue to shrink.
Daniel Lingenfelter, DDS. Fitch Mountain Dental (Healdsburg, Calif.): Group practice is great for dentistry. I was a partner in a five-doctor practice for many years. Now, I own a practice with my wife, Dr. Krista Kappus. I think working with other dentists is a good thing for a few reasons:
1. Shared ownership responsibilities. I do more of the accounting in the office and she is more involved in human resources.
2. Shared learning and experience. It is really nice to get another set of eyes on any case and another perspective in treatment planning.
3. More skillset to accommodate patients. I do all of our implants, something I received extensive training with in my previous office, and Dr. Kappus does all of our orthodontics. Instead of each doing several treatments with less experience, we have been able to specialize within our practice.
4. Shared costs. To compete with DSOs or even to take most insurances these days, it is very helpful to have some economy of scale. I can't imagine the stress of buying a CBCT scanner or CEREC system being a solo doctor.
I think what this translates to is better patient care, less burnout and the ability to keep some level of autonomy in dentistry.
John Lucia, DDS. Lucia Family Dentistry (Rochester, N.Y.): I am currently in a [private] practice with my wife, who is also a dentist. I have seen local practices acquired by DSOs and I am, quite honestly, disturbed by the treatment plans patients are being presented. I have seen a number of patients seeking second opinions where they have been told they needed multiple restorations in addition to crowns. Sadly, there was no clinical reason for the treatment beyond generating revenue for the practices from which they came. As much as DSOs may present themselves as a strategic way to practice dentistry without the headache of administration, many place pressure on their providers to produce income, resulting in substandard patient care with treatment plans that are inflated and unethical.
Will solo practices like mine continue to decline? For the short term, perhaps, but as patients begin to question many of these unnecessary treatments and case acceptance declines, private equity will see their investment is a diminishing return, and move out of dentistry. This will take some time, but I believe we will have a multi-tiered dental practice model. Group practices associated with DSOs will seek volume and revenue, and the solo practitioners will continue to provide quality care to patients with whom they have established relationships. Dental practice is built upon relationship building and not merely trying to propose the highest income-generating treatment plans. Patients will get wise to this, and the movement for dentists to gain their independence back will take hold. I am a true believer that the decline of the solo practitioner is happening but will reverse itself once the DSO ecosystem self-destructs, and private equity looks elsewhere for its next best return on investment.
Michael Perpich, DDS. Northland Smiles (Deerwood and Little Falls, Minn.): I think dentistry will continue to be an excellent profession. In my opinion, the number of solo dentists will continue to decline because solo practitioners can’t compete with buying the technology needed to be a state-of-the-art practice, i.e., CBCT and artificial intelligence. As dentistry incorporates more medical [services], it will be difficult for solo practitioners to compete with DSOs.
Rani Shina, DDS. Rolling Hills Family Dentistry (Poway, Calif.): The number of solo dentists will continue to decline. The cost of delivering care and the low insurance reimbursement make it very difficult to stay competitive. By joining the right corporation, we have better buying power and reduced overhead. I predict in the next 10 years most dental offices will be affiliated with some sort of corporate model.
Owen Waldman, DMD. Waldman Dental Group (Scottsdale, Ariz.): If the number of solo dentists continues to decline, dentistry will continue to look more and more like medicine, kind of how it's already started to — big groups, less personal, more corporate structure — but solo private practices will still continue to exist and thrive. Dentistry is a personal business and in the way that there are "concierge" medical offices that patients seek out, this is what solo dental offices will continue to be. For those dentists who always strive to go the extra mile for their patients and give that outstanding individualized quality care, there will always be patients seeking out that type of care in a more personal setting.