Dental Support Organizations (DSOs)—What Are They and Are They Right For You?

As a dental attorney for the last 22 years, I work with individual dentists, dental practices, DSOs, and many other businesses and vendors that support the dental industry. It is such a wonderful industry and group of individuals. And I really enjoy talking and writing about the dental industry on a frequent basis. So, as part of this blog, I am going to write a series of posts about the impact of DSOs and the continued experience I have had personally with DSOs. I may end up writing five posts in the series, or I may end up writing 15 posts. Who knows? It just depends on what pops into my head and what I think would be valuable to those that want to understand more about DSOs.

What are DSOs?

Let’s start with a practical description/definition of a DSO, otherwise referred to as a dental support organization. Although the concept of a DSO is relatively new, medical professionals have been working with support organizations, commonly referred to as management services organizations (MSOs), for a very long time. In fact, medical doctors have been working with and operating MSOs longer than I have been practicing (and that is a long time). Arguably, a hospital itself is a form of management services organization.

So, what is a DSO? It is simply a business that focuses on managing the administrative side of operating one or more dental practices so the clinical staff, including the dentists, can focus on caring for their patients.

Really, it is that simple. And, knowing many dentists, what I know about them personally is this: They absolutely—100%—care about their patients. Now, what is not as easy to answer is: How is a DSO structured and operated, and who owns it? I say that because there are as many variations and structures as there are opinions. The only limitation on the structure, operation, and ownership of a DSO is the creativity of the founders involved in the formation of that particular DSO. In other words, the limitations are scarce, and the models of DSOs are vast.

Do dentists like DSOs?

As many different types of DSOs that may exist, there are even more opinions from dentists about what they think about DSOs. I do not plan to try to impact any individual dentist’s opinion in this post, whether that opinion is a positive one, negative one, neutral one, or no opinion at all. Why? Because over the years I have learned that individuals do not form, change, or allow their opinions to be impacted by what someone else may write or say. They are impacted by their experiences, and I will leave it at that.

All I will say is this: I firmly believe that competition, change, and remaining challenged by outside forces is a good thing. It is good for us personally, it is good for us professionally, it is good for business and, indirectly, it is good for those around us, including those we may serve. Without competition, change, or challenge, we are left with complacency. And we all know what that means from sayings like, “Complacency is the enemy of progress [or success].” I’m not sure who came up with this or a similar quote, but we all understand it, and I personally agree with it.

What are some questions that may arise about DSOs?

If you are considering forming a DSO, contracting with a DSO, or selling to a DSO, what are some things you should consider? Well, to me, it all comes back to due diligence and making an informed decision. Let’s focus in on the potential of selling to a DSO, as an example.

  1. If you choose to sell to a DSO, what will your life look like with the DSO post-closing?
  2. Where do you see yourself one year from now, five years from now, and thereafter?
  3. There are many different types and structures of DSOs. Some DSOs are hands off and allow you to do your thing, and others are intimately involved in the operations. What are you looking for?
  4. Now, no matter what the management style may be, you must also understand that in exchange for the substantial buyout of your dental practice(s) assets, you give up a certain amount of control and autonomy. This is not a bad thing or a good thing. It is what it is. You just need to understand it, and answer the question: Can you survive with giving up the control and a certain level of autonomy?
  5. Here are some additional questions:
    1. What role does the DSO see itself playing in the dental practice?
    2. What role do you see yourself playing in the dental practice, and for how long?
    3. Are there other business opportunities involved for you in the DSO business itself?
    4. Will the DSO place a specific executive within the dental practice as part of its operations?
    5. What are your reporting obligations to the DSO?
    6. Who will you meet with on the DSO side and how often?
    7. What experience and resources will the DSO deploy?
    8. Does the DSO have a track record?
    9. Can you talk with other dentists that have sold to that particular DSO?
    10. How many other practices are owned by the DSO?
    11. And many more…

Now, those are a lot of questions. But do not cut yourself short—ask more questions. The good DSOs, and there are many out there, will answer them. They will spend time with you to ensure that you are making an informed decision, and they will not want to do the deal if it is not good for all involved, including you. To quote leadership author, speaker and pastor, Andy Stanley, “The decisions we make, not our intentions or desires, will determine our final destination.” So, take your time and do the due diligence to ensure that you are making an informed decision.

I think I will cover some of the common business terms in the next post. We will see.

Vince Nardone is a partner in the Benesch Healthcare+ Practice Group with a specific focus in the dental industry, where he is a thought leader and regular speaker. He may be reached at (614) 223-9326 or