Evaluating company culture, the amount of clinical autonomy and compensation structures are just three of the factors to consider when thinking about joining a dental service organization.
The leaders featured in this article are speaking at Becker's 2024 Fall Future of Dentistry Roundtable, set for Oct. 30 to Nov. 1 at the Hyatt Regency in Chicago.
If you work at a DSO or dental practice and would like to be considered as a speaker, please contact Randi Haseman at rhaseman@beckershealthcare.com.
Note: Responses were lightly edited for clarity and length.
Question: What factors should dental professionals consider before joining a DSO?
Kathryn Alderman, DDS. CEO of Nebraska Family Dentistry (Lincoln): When thinking about joining a DSO, here's what I recommend you consider. Clinical control: Will you have the autonomy to treat patients your way, or will there be corporate policies you have to follow? Compensation: Make sure the pay structure is clear and fair. Some DSOs tie compensation to production, so you need to understand how you'll get paid. Work-life balance: DSOs can offer great support on the admin side, but check how flexible the work hours are and what kind of schedule they expect from you. Career growth: Does the DSO offer mentorship, continuing education and leadership opportunities? Your career development matters. Company culture: Does the DSOs values align with yours? You want to work in a place where you feel comfortable and supported. Reputation: Do some research on what's the DSO's reputation in the dental community? Are they financially stable? Joining a DSO can be a great move, especially if you want more support from the business side. Just make sure to do your homework and find the right fit for you.
Jason Auerbach, DDS. Co-CEO of Max Surgical Specialty Management (Hackensack, N.J.): Here are the two main points: First is the people you partner with. Align yourself with a group of individuals that share your values, vision and commitment to delivery of care. Assess the leadership team, support staff and clinician relationships to ensure a culturally compatible and supportive environment. Second is your life post-deal. Carefully consider how joining a support platform will impact your professional and personal life. Evaluate factors such as clinical autonomy and decision-making authority, financial expectations and incentive structures, work-life balance and non-clinical responsibilities, growth opportunities and continued education, and culture.
Sibera Brannon, DDS. Dentist and Owner of Affordable Dentures and Implants (Sun City, Ariz.): The key factors for me for joining a DSO would be these: Specifically, regarding tuition reimbursement, clinical and admin training, clinical mentorship opportunities and potential ownership or equity positions within the group for doctors.
Bradley Dykstra, DDS. Founder, CEO and Clinical Director of MI Smiles Dental Group (Hudsonville, Mich.): The No. 1 factor is to have a very clear "why" you need to form a DSO. Is it just because it's the "in" thing to do, or do you believe it is necessary to grow? The important consideration is what type of legal structure is best for you now and in the future. In most states, if you want non-dentist owners to have ownership interest, it is necessary.
Alexander Einbinder, DDS. Dentist of Caterpillar Dental (West Babylon, N.Y.): Dental professionals should consider the organization's culture and work environment. DSOs can vary widely in how they treat employees and foster teamwork. This includes work-life balance, growth opportunities, compensation, future options to partner, clinical decisions, etc. Make sure it's a company where you feel supported and aligned with the broader vision.
Christy Englehart. COO of PepperPointe Partnerships (Lexington, Ky.): When considering joining a DSO I would suggest evaluating several factors: Alignment of values and mission, clinical autonomy, administrative and clinical support in the practice, marketing capabilities, clinical practice standards, compensation structure, work-life balance, collaboration opportunities with other dentists within the DSO, continuing education opportunities, dentist retention and the DSO's reputation and track record with patient care.
Greig Davis. CFO of Flossophy Dental Management (Dallas): When a dentist considers joining a DSO, several critical factors must be evaluated. Financial strength is essential to ensure the DSO's stability, growth potential and the ability to provide quality, patient-centered care. The leadership team's experience and strategic plans for scaling the organization are also crucial, as they influence future opportunities and impact culture. Additionally, assessing the DSO's valuation and ownership classes helps determine the financial benefits of joining. Are you buying in or earning equity at a fair valuation? How will profits be allocated upon a recapitalization? How close is the organization to a recap and will your roll-in equity/investment appreciate the way you understand it? Balancing these factors is vital for making an informed decision.
Kendra Flowers. Vice President of Clinical Operations for Smile America Partners (Farmington Hills, Mich.): Before committing to a DSO, take the time to research their values and mission to ensure they align with your own. Speak with current and former employees to learn about their experiences, including what they appreciated and any challenges they faced. Additionally, review feedback on job websites to gain insights into the company culture. Working for an organization that conflicts with your principles can be difficult, but when your values align with those of your employer, your experience is likely to be more fulfilling for both you and the company.
Andrew Goldsmith, DDS. Owner of Northshore Dental (Houston): Dentists are an independent lot. I have often said that building an organization of dentists is like herding cats. If you are independent and want to be your own boss, then a DSO is potentially not for you. Having said that, not all DSOs are the same and there are many hybrid models that now offer equity in your clinic or in the group. If you are tired of making the big decisions, tired of sleepless nights worrying about staff issues, business issues and income flow, and really want to just focus on dentistry, then a DSO is for you. Within a DSO, you can build your own practice within a practice that includes a support structure that wants you to be empowered and successful. Ultimately it comes down to whether you want all the responsibility and privileges of practice ownership. Make sure you do your homework because there are many hybrid versions of traditional DSOs and not all DSOs are created equal.
Tara Good-Young. CEO of PDI Surgery Center (Windsor, Calif.): Before entering into a DSO relationship or joining a DSO-run practice, I recommend performing careful opportunity and financial cost-benefit analyses. While proposed improved economies of scale, increased capital investment supply with resulting eased access to advanced technology and reduced time spent buried in administrative and insurance paperwork are all attractive, there are tradeoffs. Some of the opportunity costs to be considered include the potential loss of autonomy within one's practice, often including that of what quality products and staff to utilize, reduction of individual branding/reputation recognition of the individual dentist, as well as time and ethics conflicts over quantity versus quality of appointments to be achieved daily. These are significant points to discuss when entertaining a DSO partnership, one needs to determine what cost-to-benefit risk ratio makes sense for them and the vision they have for their practice and patients, not to mention the future reputation of our dental healthcare industry.
Mark Greenstein. Executive Vice President and Chief Growth Officer of Heartland Dental (Effingham, Ill.): Everyone's path is unique. It's important for dental professionals to reflect on what is most important to them and ensure their DSO can provide the support they desire. At Heartland Dental, our culture, mission, vision and core values typically set us apart. When combined with the largest clinical, operational and leadership training infrastructure, new patient acquisition, and supply and lab capabilities at prices that reflect our No. 1 scale and 30 years of success, these factors are among the driving considerations for becoming and remaining a long-term Heartland-supported clinician.
Brain Hamilton. Chief Development Officer of Allied OMS (Southlake, Texas): How DSOs operate can have a big impact on how you practice. Two important questions to ask before choosing the right one are both related to autonomy and excellence in patient care: Will you be able to practice the way you want in terms of continuing to offer a full scope of services, and retaining important autonomy in your clinical decision-making? Do they offer mentorship or training programs for you and your staff, and initiatives to help attract and retain top surgeons and doctors to your practice and the platform? Allied OMS and Phase 1 Equity are both built on a doctor-centric model, keeping doctors in control of how they practice, and benefiting from working with like-minded doctors to advance the specialty and develop the next generation of talent.
Haim Haviv. Founder and CEO of Hudson Dental (New York City): Before joining a DSO, dental professionals should carefully evaluate several key factors. First, ensure that the compensation and benefits package is competitive. For those paid based on a percentage, it's important to not only focus on the percentage itself but to understand what it truly means for your earnings, consider how full your schedule is, as a high percentage of minimal production is still not much. It's also wise to think ahead about your five-year plan: Is there potential for profit sharing, ownership opportunities, bonuses or avenues for professional growth? Second, make sure you align with the organization's culture and values, as this is critical for long-term satisfaction. Lastly, assess the level of clinical autonomy the DSO offers. You should feel confident that you will have the freedom to make decisions that are in the best interest of your patients without undue interference.
Gabriela Hricko, DDS. Partner Orthodontist of Great Expressions Dental Centers (Southfield, Mich.): They need to consider what their professional goals are for the future and if those align with the DSO. They also need to ask: Does the DSO have a culture and leadership team that the dental professional is excited to be a part of and grow with? How much clinical autonomy do the dental professionals have and are they comfortable to practice within these guidelines? There are many different DSOs and they all offer different things. It is imperative that a dental professional knows what he/she wants out of the experience to make it long lasting and successful.
Dawn Johanknecht. CFO of Szmanda Dental Center (Wausau, Wis.): There are so many factors to consider. This is like a marriage. Do you fit culturally into the DSO? What kind of support and services do they offer? Many dental owners are looking for management help so they can step away from the office only to find out they still need to handle the local management. On the flip side, some dental owners don't want local management "interference" so it's important to understand the details related to what happens after the sale. It's also important to have a good tax advisor working with you during the negotiations. The numbers may look good in the letter of intent but you need to understand the tax ramifications and how much cash flow you can expect in the future.
Alan Law, DDS, PhD. President of the Dental Specialists (Woodbury, Minn.): Before joining a DSO, dentists should consider the level of clinical autonomy and how it aligns with their practice philosophy, as well as the compensation structure and benefits offered. It's also important to assess the ability to provide direction to the dental team, understand turnover rates among doctors and staff, assess patient satisfaction, doctor involvement in management and governance, and gather feedback from current doctors and team members about job satisfaction within the organization. These factors can significantly impact both professional fulfillment and patient care quality.
Emily Letran, DDS. CEO of Sea Breeze Dental (Huntington Beach, Calif.): Joining a DSO to learn the business model and taking advantage of a team approach may be a good experience for a new doctor. A lot of DSO's are set up as group practices, where a new doctor can work with a managing doctor and have a full staff supporting all the administrative work. This can be advantageous if the new doctor is willing to observe all phases of the business, ask questions to learn, and seek to understand the business structure of a group practice. If a doctor is considering selling/joining a DSO, it would be recommended to really study the model, understand the deliverables from the DSO, and make sure that the values align.
Tia Meyer. Clinical Director of NBD Partnerships (Sioux Falls, S.D.): Here are 10 important considerations: Clinical autonomy: It's essential to understand how much control they will retain over their clinical decisions. Compensation structure: Dentists should carefully review how compensation is structured, including salary, bonuses and incentives. Work-life balance: DSOs often offer fixed schedules, which can provide better work-life balance. However, the work pace can vary, so dentists should inquire about expected patient load, hours and flexibility. Ownership opportunities: Some DSOs offer partnership or ownership opportunities after some time, while others may not. Career development and continuing education: Many DSOs provide access to continuing education and training programs, which can be a significant advantage for career growth. Support staff and resources: The level of administrative support, such as patient management, billing, and HR, can vary. Corporate culture: The overall culture of the DSO should align with a dentist's values. Understanding the organization's philosophy on patient care, ethics and collaboration is critical for long-term satisfaction. Contract terms: Dentists should thoroughly review the terms of any contract before joining a DSO, paying attention to non-compete clauses, buy-out options, and the length of the contract. Reputation of the DSO: Research the DSO's reputation within the industry and among other professionals. Geographical flexibility: DSOs may have multiple locations, which can offer flexibility for relocation. However, this can also mean being assigned to a different office than initially expected. Understanding how assignments and location transfers work is essential.
Bond Ortiz. Revenue Cycle Strategist and Consultant of Bond Orthodontic Partners (Frisco, Texas): Dental professionals should carefully evaluate several critical factors when considering joining a DSO. Key points to consider include the DSO's financial stability, growth potential and access to modern technology and resources. It is also essential to evaluate the quality of support services offered, as these can significantly enhance the focus on patient care. By thoroughly analyzing these elements, dental professionals can make informed decisions that align with their career objectives and values.
Nimesh Patel, DMD. COO of Brite Dental Partners (Briarcliff Manor, N.Y.): If you are a dentist selling to a DSO, ask yourself the following questions: What is your retirement window? Does it line up with the typical work-back requirement offered by a DSO? What is the total compensation paid by the DSO over the work-back period and how does that compare with working for that period of time and doing a walk-away sale to another doctor? What is the value of your DSO equity, and how likely is that valuation to come to fruition? Has your DSO had a recapitalization event? If so, when is the next one? If you are going to be employed by a DSO, ask: What role does the parent organization play in the day-to-day operations of the office? What opportunities do I have for equity? How much clinical autonomy is the doctor given?
Viren Patel, DMD. CEO and Owner of Smile Obsession (Chicago): When evaluating employment opportunities, associate dentists should carefully consider the distinction between joining a DSO and working for a privately owned practice. The absence of investors in our model means that our associate dentists are not burdened by the pressure of meeting strict production quotas, financial targets or other performance metrics. At Smile Obsession, we prioritize patient care and employee well-being above profit margins, fostering a less stressful and more supportive environment for our team. For those considering a position with a PE [private equity]-backed DSO, the most critical factor to evaluate is the organizational culture. In addition, understanding the reporting structure is essential. Many DSOs place associate dentists under the supervision of operational managers or regional directors. This can result in a disconnect between clinical practice and corporate management, leading to potential friction, as dental professionals are focused on patient care and clinical outcomes, while non-dental executives are often driven by production goals and profitability. Lastly, the reputation and financial stability of the DSO should not be overlooked.
Demias Pegues. CEO of MyOrthodontist (Chapel Hill, N.C.): I would encourage any dental professional to ask themselves the following question before joining a DSO: Does the DSO have a history of strong organic, or same store, revenue growth? Sustained, strong organic growth is likely an indication that the DSO has the ability to assist the teams in the practices with consistently growing the topline, which is key for the overall viability of the DSO. If the DSO is experiencing declining same-store revenue over a significant period of time, then this may be a sign of dysfunction in the DSO, which, if not addressed, could lead to staffing changes, including job eliminations. In short, join a DSO with a solid foundation and you will have a rewarding career for years to come.
Ronald Perry, DMD. Professor at Tufts University School of Dental Medicine (Boston): Before joining a DSO, dental professionals should evaluate several key factors. Consider how much clinical autonomy you'll have versus corporate influence, as well as the compensation structure, including salary, bonuses and benefits. It's also important to assess work-life balance, the flexibility of the schedule, and opportunities for professional growth, mentorship and career advancement. Research the DSO's culture and reputation to ensure it aligns with your values, and review the contract terms carefully, especially non-compete clauses and exit conditions. Lastly, assess the quality of the technology and support staff, as these can impact both patient care and job satisfaction.
Shilpi Priyadarshini. Regional Managing Director of Jefferson Dental & Orthodontics (Dallas): DSOs can offer great support to new and experienced doctors. Some things to consider would be mentorship, AI-driven technology, clinical support and operational framework. All these, along with others, play a significant role in the success of a clinician. Another important factor to review is the systems in place in case of a complication following a procedure, is your organization prepared to help you handle something unexpected? Can you expect to experience the "dental camaraderie" that is invaluable after graduation?
Peter Rivoli, DDS. Owner of Rivoli Dental (Spencerport, N.Y.): I believe there are three distinct groups that consider joining a DSO. First is the new graduate. This person must consider stability. After years of debt and struggle, the thought of adding more years of debt and struggle is the first thought. This can be separated into those graduates that are married and those that are not. I believe the married graduate is more likely to choose the DSO for its guarantee of employment and thus a secure future for their family. The single graduate may be more likely to choose the risk of associateship for a faster path to ownership and money. Second is the old dentist. Most of these doctors haven't secured enough income to retire and thus are forced to work, they desire the security of a paycheck. Third is the doctor looking to monetize his practice. With that, he gains the security of his payment, a guarantee that a new graduate can't provide. The doctor trades future earnings for the security of payment. For this security, they all trade their autonomy. In summary, it is simple: the only factor is whether a doctor is willing to subjugate their autonomy for security.
Ronald Saffar, DDS. Owner and Founder of My Orthodontist (Bayonne, N.J.): Dental professionals who are considering joining a DSO should consider the following before joining. Cultural fit and alignment with vision and values: Dental professionals should develop a good understanding of the vision, mission and core values of the organization they are joining and ensure these align with their values and vision for the future. Work-life balance and flexibility: A major benefit of joining a DSO can be administrative support. However it is important to assess the workload and scheduling and overall work-life balance. Financial structure and incentives: Understand the compensation structure and clarify the details on base salary, bonuses or equity opportunities. Mentorship and growth opportunities: Look for DSOs with strong structured mentorship programs and pathways to career growth. Clinical autonomy: Are there standardized treatment protocols? If so, are they compatible with your treatment philosophies? How much control will you retain over your clinical practice?
Hoss Said. CEO of Massoumi Dental Corporation (Chula Vista, Calif.): Many seasoned dental professionals understand how challenging it is to manage an office while maintaining clinical hours. It can be difficult to focus on patient care while also overseeing the business operations. DSOs were fundamentally created to handle the administrative and business affairs of a dental office, allowing doctors to concentrate on providing high-quality patient care. Given these circumstances, ambitious doctors have an excellent opportunity to enhance their careers by partnering with a DSO. This structure enables them to be business owners while still focusing on patient care. This is especially beneficial for young professionals who may lack experience as business owners but are eager to learn in a formalized way, all while delivering top-notch patient care. Partnering with a reputable DSO can put dental professionals in a better position to promote themselves both in the clinical arena and in the business aspect of dentistry, providing growth opportunities in both areas. Dental professionals should also consider factors such as: autonomy, compensation structure, work-life balance, support services, reputation of the DSO and long-term career growth.
David Sopp. Senior Vice President of Corporate Development of First Choice Dental (Madison, Wis.): The most critical factor that dental professionals should consider before joining a DSO is cultural alignment. Do the parties share common goals, values and visions? A DSO/dental professional partnership is a long-term relationship, and for it to be successful, all involved must have similar priorities and motivations. If that initial step is passed, then the dental professional should consider how the DSO can help them achieve their vision. If the professional desires administrative support, how strong are those services offered by the DSO or if access to best practices is sought, what resources and network of like minded professionals are available and how are they accessed?
Jeff Staser. CFO of Straine Dental Management (Sacramento, Calif.): Dental professionals should consider several key factors before joining a DSO. First, is the organization capable of providing the necessary support and resources to enhance the quality of care in the practice? Additionally, will they foster an environment that prioritizes access to care and facilitate a smooth transition for both the team and the practice owner when it's time to reduce time commitment at the chair? Finally, can the DSO help create and generate an economic opportunity that enables the practice owner to fund their retirement in the most efficient timeframes? At Straine Dental Management, we have a world-class organization that provides these solutions to dental professionals, supporting them with the tools and expertise needed to improve practice operations, ensure seamless transitions, and achieve financial goals, including retirement planning.
Jeffrey Tomcsik. CEO of Grand Dental Group (Aurora, Ill.): If you are a near retirement practice owner looking to join a DSO through the sale of your practice, this can be a great exit strategy that may even lengthen the time you are willing to continue practicing as many of the non-clinical burdens may be taken off your plate. If you plan to practice for many more years, you need to consider other factors. For instance, do you like to be the sole decisionmaker? Are you highly independent? Do you hate having to answer to others? How do you feel about practice scrutinization and change? Depending on the group you sell to or partner with, these become real concerns, and some of them will certainly be out of your control. That said, you might find that an arrangement with a DSO might give you back free time. It may take away financial anxiety. You may find that the professionals at the DSO have a better ability to efficiently and effectively manage the non-clinical aspects of your practice, making you, your staff and patients happier. The key to making the decisions that are right for you starts with you being truly objective and honest with yourself about who you are and what you want. Then do the research. This should be a very slow and careful decision. There aren't bad DSOs, but not every DSO is a good fit for you.
Candace VanCamp. Director of Payer Strategy of MB2 Dental (Dallas): Understand all DSOs are structured and operate differently. Get a feel for the culture before you join. Visit the home office and get to know some of the key leadership members before you sign your practice. Know your strengths and limitations in business and the industry. Make certain the DSO can cover or support where you lack experience. Consider how your current staff will react to the change. This could make or undermine the experience.
James Willis, DDS. CEO of Willis and Associates Family Dentistry (Fisherville, Va.): Before joining a DSO, dental professionals should consider the opportunity for equity and ownership. In large corporate-owned DSOs, frequent private equity turnovers often limit clinicians' ability to build real equity, reducing their long-term financial stake. In contrast, self-funded regional groups like mine offer doctors founder shares, allowing them to have true ownership and influence within the practice. Dentists should also evaluate whether they want to be employees or partners in shaping the future of their practice. Choosing a group with a culture of ownership directly impacts both professional growth and long-term financial success.