Many of you will end up working for a dental support organization at some point in your career. Practicing with a DSO may likely be your first job opportunity right out of dental school.
You may know other’s perceptions of DSOs and some general information about DSOs, but do you know what a DSO really is? Are you fully equipped with the knowledge to choose the right DSO for you?
In this article we will discuss dental support organizations and what you need to know to make an informed decision on whether to choose a DSO career path or not, and if so, how to choose the best DSO for you.
What is a DSO?
DSO is an acronym which can stand for either dental support organization or dental service organization. Regardless of whether the ‘s’ stands for support or service, the meaning is the same.
A DSO is typically a stand-alone, legal entity, built specifically to handle the non-clinical functions of the dental offices which it manages. These non-clinical functions include human resources, accounting, legal, marketing, risk management, compliance, recruiting, payroll, IT, procurement, and several other non-clinical services.
When a dentist decides to work for a DSO, one of the major draws is the fact that the dentist can focus on the clinical side of dentistry while leaving the administrative side to a team of business experts. You go to dental school to change people’s lives through the art of dentistry, not necessarily become a CEO (chief everything officer.)
The right DSO can be a great place to start your dental career and fine tune your clinical skills without the sometimes-overwhelming distraction of figuring out and managing the business side of dentistry.(3)
Aren’t all DSOs the same?
No, in fact, every DSO is different. There is a saying in the DSO industry, “When you’ve seen one DSO, you’ve seen one DSO.”(4) And it’s very true. Dental support organizations can vary in many ways, including:
- Geographic footprint
- Career path and opportunities
- DSO ownership structure
- Company culture
- Doctor compensation models – salary, pay for production, student loan repayment
- Potential ownership opportunities for dentists
- Mentorship and training programs
- Charitable causes
- Career opportunities beyond the chair
- The type of dentistry performed
- Payor – fee-for service, Medicaid, capitated, mix
- Business growth and exit strategies
Understanding all of your options
Much like each solo practice operates differently, each DSO also operates differently. There are hundreds of DSOs to choose from and their numbers are growing.
DSOs come in all shapes and sizes: emerging, mid-market, and large; all offering different cultures and support philosophies. It is important to understand how you, the soon-to-be dentist, align with their culture, philosophy, and value system.
Opportunities abound for you and you need to make sure that you choose the right DSO, and not necessarily the first DSO with whom you speak.
But why does any of this matter to you, the dental student?
According to the ADA Health Policy Institute, approximately 7.4% of US based dentists work in a supported setting. Broken down by gender 10.2% of all female dentists and 6.1% of all male dentists work for a dental support organization.
If we examine the report from an age perspective, we see that 16.3% of younger dentists (>34 years old) work in a DSO setting. It is also important to note that Arizona, Texas, Indiana, Georgia, Nevada, Oregon, Florida, Wisconsin, South Carolina and Arkansas have the highest percentage of dentists practicing in a DSO setting.(5) According to ADEA, 15.1% of graduates plan to work for a DSO.(6)
The ADA numbers above only represents the large DSOs in the US. There are at least 500 (or more) emerging and mid-market dental support organizations that have not been included in these statistics.
A rough estimate, with the inclusion of these emerging and mid-market DSOs, moves the percentage of dentists practicing in a DSO setting closer to the 15-20% mark, with younger dentists working in this setting being significantly greater than the 16.3% referenced in the ADA study.
Interview them and ask the tough questions
It is important to understand that there are many DSOs out there and they are not all equal. You may be more familiar with some of the larger DSOs since they tend to have more doctor recruiters who can attend and sponsor various campus functions.
It is valuable to attend these events and become familiar with the recruiters and their DSO’s culture. Talk to every DSO that comes to your campus. Go prepared and ask them the tough questions.
You also need to perform your due diligence online. Visit and join some of the many online closed groups for dentists. Use these groups to find other dentists that have worked for a DSO you may be considering and get their opinion and experience. Don’t just rely on one person’s opinion.
Gather information to make an informed decision. Research other smaller, emerging or mid-market DSOs that may be more regional in nature and offer unique benefits or opportunities in order to compete with the larger DSOs.
Online resources like the Association of Dental Support Organization’s website, as well as our websites, JoinDSO.com and GroupDentistryNow.com, can get help you navigate the abundance of opportunities and give you more information to help you make the best decision.
What are some important topics of discussion or key questions to ask a DSO?
- Student Debt Repayment opportunities
- How are patient treatment plans determined, managed, and executed?
- What is your DSOs business model and how does a new dentist fit into it?
- Do I have an opportunity to buy into the DSO or own a percentage of a practice or practices?
- What type of charitable work does your DSO do?
- What does the work / life balance look like?
- Are there advancement opportunities beyond the chair?
- What is your DSO’s growth strategy?
- Who owns the DSO and how does that influence how you operate?
- Why are you different than other DSOs?
- What type of training do you offer?
- Is there a mentorship program?
Two dentists who chose DSOs:
Asia Richardson, DMD, affiliated with a DSO because it allowed her to have the benefits of running her own practice without the financial and operational burden of starting and maintaining a business.
According to Richardson who currently owns five practices. “Had I opened a private practice, I would be responsible for the operational tasks of running a business while still balancing the load of treating patients.
Working with a DSO, all of the administrative hassles, from taxes to payroll, come off my plate, and I can dedicate my time to my true passion—patient care. The most significant element of this benefit is that I don’t lose my autonomy because I have a larger organization as my affiliate.
I can be as involved or uninvolved with the administrative duties as I’d like. I can form my own clinical team, set the hours for my practices, decide what type of products and services to provide, and determine the marketing I’d like to use to promote the practices.
If I decide to be completely hands off with operational functions, I still receive an itemized report of everything that is done and am ultimately the overarching decision maker on anything relating to my practices.”(1)
As with many graduating dental students, the responsibility of student loans was at the forefront of Dr. Andrew Zwers’ mind. This led him to explore a variety of career options, including joining a private group practice.
“It’s hard for students to come out of school with $300,000 or more in debt, and then immediately invest another $350,000+ into a practice.
For me, I didn’t want to take that extra level of risk. My wife and I also love to travel, so I wanted a career that would allow us to maintain a flexible schedule without being committed to getting a new practice up and running.
The group has allowed me to serve on several committees and develop strong leadership skills. Some students look at solo practice as the ultimate goal, and for some people, that may be the perfect fit.
However, an opportunity with a group practice can still provide you with a chance to be a practice owner, but without the extra overhead or administrative responsibilities. Each environment is different, and I’d encourage students to do their research on what kinds of opportunities are available to them before settling on one definitive career path.”(2)