What is a DSO anyway?

By: Natalie Lucken, Account Manager

Most of us are already familiar with the acronym DSO, which stands for Dental Service Organization. But what do they do and why would a dentist want to join? Here’s a quick definition: Dental Service Organizations (DSOs) contract with dental practices to provide critical business management and support including non-clinical operations. The creation of DSOs have allowed dentists to maximize their dental practice with the support of professional office management. These are organizations who provide management, human resources, and buying power,  which allows the dentists to invest in better technology upgrades, CAD/CAM systems (for one-appointment crowns, for example), implants, or digital radiography. All of these enhance the patient’s experience of going to the dentist, and increase the accuracy of diagnoses. The dentist can focus on meeting patient needs and by organizing into local/regional groups, the members are able to fortify their collective voices towards healthcare reform. There are conferences held for members, as well as access to track the latest regulatory and legislative movements.

The ADA reported this year that on average, “7.4% of US dentists are affiliated with DSOs” now, with that number rising to 16.3% for younger dentists, aged 21-34. There is a higher number of female dentists in these organizations, and pedodontists had the highest numbers by specialty. The overall impression is that DSOs are helpful overall because they are increasing access to care for the general public, and allowing younger dentists to overcome their anxiety about starting their own practice right away after graduation, staring down an ever increasing mound of student loan debt.

The cost of membership can be steep–$9,000-$12,000 per year to join the national group, and the group actually purchases the non-clinical aspects of the practice. There is a signed agreement where they will take over operations for a period of 40-50 years, typically. The doctor, hygienist, and assistants are paid a salary, and sometimes the practice will retain its original name. This makes it a little more difficult to tell that an office is owned by a corporation, and it’s estimated that the number of dentists who practice in this type of group will double or even triple in the next 20 years. Do you remember when people used to go to the local optometrist office for their vision care, versus nowadays running into Target/Walmart/CVS to have an eye exam after you get milk and frozen lasagne for dinner?

As a former dental assistant, I can tell you there is a big difference for the other members of the clinical team between working for a private practice and a corporate one. I have personally worked in 2 of the largest corporate chain dental offices, both as a permanent employee and as a temporary one. I thought that the corporate one would be more likely to make sure that we got our scheduled (and mandated by labor laws)  breaks, and that we would be more likely to get time off when we needed it, since there were more people to cover for a person who was out of the office at any time. I could not have been more wrong! Time and again, I worked 10 or 11 hours straight with no break between patients, and regularly had to grab my sandwich and eat it in the bathroom while I was….”multitasking”. There was simply no time. And, taking time off was almost unheard of in the first year of working for any practice, because the schedules were so tight that it was always, “we need all hands on deck” every day from start to finish.

Not everyone likes the idea of a DSO coming into their state. Last year, Texas, Wisconsin, and North Carolina saw bills introduced that eventually became defeated attempts to limit the ability of dentists to choose to associate for this purpose. In Wisconsin, the dental board sought to expand its regulatory powers to block DSOs from getting a foothold. A similar scenario played out in Washington, though many have argued that DSOs can rein in the ever-climbing costs of Medicaid. So, it begs the question, are the dental boards just trying to block the competition for patients, and chase profits?

In the end, a dentist has to choose which option will offer more of the lifestyle they envisioned before they started dental school: private practice or the corporate type? Surprisingly, many dentists decide right away that they don’t care for hiring/firing people, managing patient scheduling issues, working more than 40 hours per week, having their income fluctuating from month to month, and the financial liabilities that come with being the owner/co-owner/CEO of a healthcare facility. The possibility of a higher income reminds me of those who play the stock market and those who choose a more steady source of income. Some may not be willing to ride the roller coaster of the stock market, even if the payout may eventually be higher. Personally, I would choose the one with more life balance options and less stress!



eAssist Helpful News and Billing Tips; Edition #118


  • I think that it’s important to note that all DSOs are not created equal. Your corporate experience of eating a sandwich in the bathroom may give readers with minimal DSO experience an extremely negative impression. I would have to think that is an isolated situation.

  • The DSO is little more than a corporate entity owning a dental practice. The language is smoothed over to give the appearance of great autonomy for the dentist, but the reality is when investors pump huge sums of money into the equity of your practice, you can rest assured they will expect it to be run in a particular manner. Whether that is good or bad depends on the ethics and philosophy of management. Just as there can be good or bad ethics in private practice , so there can be the same in the corporate or DSO world. I question the claim of improved access to care…it is an argument made but I have not seen evidence to support it. What dentists need to realize is that you can achieve the same level of freedom from the management issues in a private practice IF you take the time to set things up properly from the beginning. There is nothing a DSO can provide you that you cannot do yourself with some up-front effort. That being said, the DSO is a great model for some…but this article does oversell its virtues.

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