In the past five years, the dental industry has experienced a seismic shift: the rise of DSOs (Dental Support Organizations). With promises of top-dollar offers, operational relief, and growth potential, DSOs are aggressively courting private practices—especially those nearing $1M in annual collections.
But is selling to a DSO the right move for every dentist?
As someone who works with practices nationwide to increase profitability and decrease stress, I’ve seen both sides of this decision up close. And with insights from Ryan Isaac of Dentist Advisors, we’ve broken down the real considerations every doctor should explore before signing a Letter of Intent.
What is a DSO, and Why Are They Everywhere?
A DSO is a corporate-backed organization that buys dental practices, manages the business side (HR, billing, marketing, etc.), and allows the doctor to remain as a provider under a new ownership model. Some DSOs offer cash, others offer equity in their larger group. On paper, it can sound like a dream.
But here's the reality:
- 1 in 3 DSOs is currently in some form of financial receivership.
- Equity payouts are far from guaranteed.
- You're front-loading income—and possibly giving up long-term security.
What Really Happens After the Sale?
Here’s what we’re seeing in real client case studies:
- Dentists receive ~50% of their practice value in cash up front.
- The remaining “value” is often tied up in equity or earn-outs over 3–5 years.
- If the DSO defaults, files bankruptcy, or is acquired by another group, you may lose your equity, lose your practice, and still owe taxes and have limited recourse.
We’re watching it happen today. Top-producing doctors who built thriving businesses are now burned out, back to square one, or locked into associate roles under drastically different cultures.
Why the Industry Is Changing
- 65–70% of dental practices are projected to be DSO-affiliated within 5–10 years.
- Private equity sees dental as stable, profitable, and ripe for consolidation.
- And with student debt high and burnout rising, many young dentists see DSOs as the “easy button.”
But easy isn't always best.
The Alternatives: Can You Grow, Profit, and Exit Without a DSO?
Yes, if you plan early and optimize your practice like an asset.
Strategies to consider:
- Get a valuation early (even if you’re not ready to sell).
- Build a high EBITDA practice that attracts multiple types of buyers.
- Train your team and systems to run without you.
- Consider a partner buy-in or selling to an associate over time.
With the right guidance, you can still cash out without sacrificing control, culture, or your legacy.
What Will Dentistry Look Like in 10 Years?
If corporate consolidation continues unchecked, dentistry risks becoming just another cog in the healthcare machine. Productivity quotas, cookie-cutter protocols, and profit-first decisions may become the norm.
But if private owners unite, building profitable, ethical, patient-centered practices—we can preserve the integrity of the profession.
The choice is yours. Just make sure you have the full picture before you sell.
Looking to maximize profitability before you sell?
At the Dental A Team, we help dentists like you build streamlined, profitable, and sellable practices.
Let’s chat: TheDentalATeam.com.
Don't forget to check out our podcast for more tips!
Last updated: June 2025
Author: Jacintha Ham, Dental A Team