Is Dentistry Becoming Medicine? What the Collapse of Physician Ownership Should Teach Every Dentist
For much of modern American medicine, becoming a doctor meant more than treating patients. It often meant owning the place where you treated them. That world is disappearing.
In 2012, 60.1% of physicians worked in private practices. By 2024 that figure had fallen to 42.2%. Hospital ownership moved in the opposite direction, and salary has increasingly become part of physician compensation. By 2024, 70.5% of physicians received at least some compensation through salary. The question for dentists is uncomfortable. Are we next?
How Medicine Lost the Independent Doctor
Medicine did not arrive here because physicians collectively decided they no longer valued independence. The transformation occurred one rational decision at a time.
The AMA has repeatedly asked physicians why practices are sold. The answers are revealing. Physicians cite the need for better reimbursement and negotiating leverage with payers, access to expensive resources, and relief from growing regulatory and administrative burdens.
Imagine the decision from the doctor’s perspective. You can remain independent and manage employees, technology, billing, prior authorization, compliance, facilities and capital while negotiating against enormous insurance companies. Or you can join a larger organization that handles much of it for you and deposits a predictable paycheck. For many physicians, employment became rational.
The 65 year old physician rationally sold. The 35 year old physician rationally accepted employment. The hospital rationally acquired practices. The insurer rationally negotiated aggressively. Nobody needed to conspire against private practice. The cumulative result was a fundamental change in the profession. That is medicine’s first warning to dentistry. Professional independence can disappear even when nearly everyone involved is making a reasonable decision.
Dentistry Is Consolidating, But It Is Not Medicine Yet
Dentistry is moving in the same direction, but we should resist the temptation to declare the ending before the evidence supports it. According to the ADA Health Policy Institute, approximately 73% of dentists were practice owners in 2023, down from 85% in 2005. DSO affiliation reached 16% in 2024 and is substantially higher among younger dentists. Among dentists less than 10 years out of dental school, 27% were affiliated with a DSO.
Those numbers clearly show consolidation. But the ADA discovered something important when it stopped comparing young dentists with older dentists at a single point in time and instead followed generations of dentists through comparable stages of their careers. Today’s dentists are becoming owners much later.
Among dentists graduating from 2016 through 2020, only 21% were owners at the earliest career stage measured. Among dentists graduating in 2010 or earlier, 63% to 70% were already owners at comparable stages. That looks ominous until we follow dentists further into their careers.
Among dentists graduating from 2006 through 2010, ownership reached 81% by 15 to 19 years after dental school. For the 1991 through 1995 cohort, it was 89%. That suggests something very different from the physician story. Dentistry may currently be experiencing delayed ownership rather than disappearing ownership. The distinction is enormous.
A dentist working for a DSO at 30 and buying a practice at 40 represents a changing career path. A dentist working for a DSO at 30 and remaining an employee at 50 represents a changing profession. We do not yet know which path today’s youngest dentists will follow because they simply have not been practicing long enough.
The Economic Warning Light Is Already Flashing
There is another number dentists should watch even more closely than DSO market share. The economics of ownership. The ADA describes an ongoing fiscal squeeze in dental practice. In 2025, average general dentist owner income was $215,320. Inflation adjusted income has declined over roughly the past 15 years. During the five year period highlighted by HPI, practice revenue increased 1.4% while expenses increased 4.9%. That should concern every practice owner.
Collections can rise while the owner becomes economically worse off. Payroll gets paid first. Then laboratories, supplies, rent, technology, insurance, equipment, financing and administration. The dentist receives what remains. This is where dentistry begins to resemble medicine.
The crucial question is not whether an owner earns more than an associate. It is whether the additional return from ownership adequately compensates the dentist for the capital, debt, financial risk, personnel management, administrative responsibility and sleepless nights that accompany owning the business.
If an associate can earn an attractive income without putting substantial capital at risk, while an owner earns only modestly more after assuming a million dollar acquisition loan and responsibility for 15 employees, ownership becomes harder to sell. No motivational speech about entrepreneurship can repeal arithmetic.
Why Dentistry Still Has an Advantage
Dentistry nevertheless possesses structural advantages that much of medicine has lost. A dental practice remains a remarkably self contained economic unit. The dentist can own the practice, equipment, goodwill and sometimes the real estate. Diagnosis and treatment frequently occur under one roof. Most dental procedures require no hospital. Dentists can influence their service mix, payer mix, scheduling, staffing, technology and patient experience to a degree many employed physicians cannot.
Dentistry also gets clinicians into practice earlier than many medical specialties. A dentist can begin producing income after dental school and potentially acquire equity relatively early in a career, while many physicians spend additional years in residency and fellowship. That is why I would still give dentistry an important advantage over medicine for a young person who values entrepreneurship.
Medicine may be the better career for someone fascinated by a particular medical specialty, hospital based care or areas of science unavailable in dentistry. Some medical specialties also remain remarkably entrepreneurial. Ophthalmology, for example, still had a 70.4% private practice rate in the AMA’s 2024 survey. There is no universal winner.
But dentistry still offers something increasingly unusual in American healthcare. A clinician can realistically own the enterprise where care is delivered, control the patient experience, build business equity and eventually sell an asset created over decades.
A physician earning $500,000 as an employee may substantially out earn a dentist taking home $250,000. But an owner dentist may simultaneously be practicing dentistry, building equity in a business and accumulating value in real estate. Salary comparisons alone miss that distinction.
Ownership Is Not Enough
Dentistry should also be careful about what it calls ownership. Owning 100% of a practice is not economically equivalent to owning a tiny minority interest in a 500 office organization. A dentist may technically possess equity while someone else controls staffing, schedules, payer contracts, capital expenditures, laboratories, supplies and production expectations.
The more important question may eventually become not who owns dentistry on paper, but who controls it. Who determines treatment? Who decides appointment length? Who controls staffing? Who chooses laboratories and supplies? Who negotiates reimbursement? Who owns the patient relationship and patient data? Who benefits economically when production increases?
This becomes especially important as insurers, private equity firms, DSOs, management organizations and other healthcare companies become increasingly intertwined. Clinical autonomy without economic control can be fragile. Economic ownership without meaningful control can be largely cosmetic. Dentistry should protect both.
Independence Does Not Have to Mean Going It Alone
There is another lesson from medicine that dentistry should learn before it is too late. Preserving independent dentistry does not require preserving the dental office of 1985. The future does not have to be a choice between a solo dentist and a 500 office DSO.
Dentist owned groups can share purchasing, recruiting, HR, billing, cybersecurity, marketing, analytics, technology and AI. Independent practices can form cooperatives and other shared service organizations. Associates can receive genuine pathways to equity. Older dentists can transition practices to younger dentists instead of assuming an institutional buyer is the only viable exit.
The objective should be to capture the economies of scale of corporate dentistry without automatically surrendering dentist ownership and control.
Technology could become particularly important. AI may eventually give a five office dentist owned group administrative capabilities that once required a corporate headquarters. Scheduling, insurance verification, claims management, call conversion, analytics, patient communication and other functions increasingly lend themselves to automation.
But technology cuts both ways. If large organizations adopt these tools faster than independent dentists, technology could widen the scale advantage instead of narrowing it. Independent dentistry cannot afford to become technologically conservative while its competitors automate.
What Dentistry Should Learn From Medicine
The lesson is not that DSOs are bad. Many provide capital, mentorship, technology, benefits, administrative support and attractive careers. For some dentists, employment will be exactly the right decision. The goal should not be forcing dentists into ownership. The goal should be preserving a genuine choice.
That requires keeping ownership economically rational. Dental schools should teach accounting, finance, leadership, insurance, practice acquisition and business strategy alongside clinical dentistry. Young dentists need realistic pathways from associate to owner. Financing for dentist owned acquisitions must remain accessible. Organized dentistry must continue addressing reimbursement and administrative burdens. Regulators should pay close attention when payers and providers become vertically integrated.
Most importantly, dentists should stop confusing independence with isolation. A profession consisting entirely of one dentist offices may not be capable of competing indefinitely against organizations with enormous advantages in capital, purchasing, recruiting, technology and administration.
Dentist ownership can evolve without disappearing. The future may belong to dentist owned groups of 5, 20 or 50 clinicians that operate with the sophistication of corporations while preserving meaningful dentist equity and clinical control.
The Number I Would Watch
DSO affiliation tells us where dentistry is today. It does not necessarily tell us where dentistry is going. The more revealing number will be the percentage of dentists who possess meaningful ownership 15 or 20 years after graduation. If today’s young dentists eventually approach the ownership rates of previous generations, then dentistry will have changed the timing and structure of ownership without abandoning it.
If successive generations reach their 40s and 50s and remain overwhelmingly employees, dentistry will have crossed a much more important threshold. Medicine shows us that once an entire economic infrastructure reorganizes around employment, reversing it becomes extraordinarily difficult. Dentistry still has time.
But telling young dentists that ownership is wonderful will not preserve independent practice. Ownership must provide enough autonomy, income, equity and wealth creation to justify the capital, responsibility and risk required to achieve it. If dentistry wants owners, dentistry has to make ownership worth owning. Will the dentists graduating today still own dentistry 20 years from now?
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