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Joining a dental support organization (DSO) is a career-defining decision with lasting implications. DSOs offer administrative support, group purchasing power, and reduced management responsibilities but can limit clinical autonomy and impose contractual restrictions. For some dentists, the stability and business relief make DSOs attractive. Others may find the trade-offs—such as less control over treatment decisions and financial terms—too restrictive.
Mar 24, 2025
What Is a DSO?
A dental service organization (DSO) contracts with dental practices to handle their non-clinical operations. DSOs manage the business operations so dentists can focus on patient care and clinical work.
DSOs typically manage:
Marketing and patient acquisition
Human resources and payroll
Financial operations and accounting
Compliance and regulatory affairs
IT infrastructure and support
Office maintenance and equipment
Billing and insurance processing
Supply chain management
Types of DSO Models
Not all DSOs operate the same way. Their structure affects clinical autonomy, earnings, and long-term growth.
Corporate-backed DSOs are funded by private equity firms or large corporations. They acquire practices and handle business operations while dentists remain as employees or contractors. This setup offers financial stability and administrative relief but limits ownership and decision-making.
Dentist-owned DSOs are formed by dentists who share administrative resources and leverage collective bargaining power. Unlike corporate models, they retain ownership while benefiting from economies of scale.
These differences also highlight how DSOs compare to Dental Partnership Organizations (DPOs), which offer business support while preserving clinical autonomy. Understanding these structures helps you determine the best fit for your career goals.
Pros of Joining a DSO
Partnering with a DSO streamlines operations and provides financial stability, allowing dentists to focus on patient care.
1. Administrative Support and Reduced Burden
Running a practice involves billing, HR, payroll, insurance claims, and compliance. DSOs handle these tasks, freeing you from administrative burdens and ensuring operational efficiency. Their standardized operating procedures and staffing support help maintain workflows, reducing errors and delays.
2. Access to Advanced Technology and Equipment
Joining a DSO provides access to cutting-edge technology without the financial strain of solo ownership. By leveraging collective buying power, DSOs secure better pricing on AI-powered diagnostics, CBCT scanners, digital impressions, and chairside milling units, cutting down appointment times and improving patient care.
Many DSOs invest in cloud-based practice management software to upgrade scheduling, billing, and records. Some acquire certified pre-owned equipment for high-ticket items like extraoral imaging devices and 3D printers to further cut costs.
3. Financial Stability and Competitive Compensation
Earnings in private practice can fluctuate, but DSOs offer structured payroll, steady salaries, and reliable benefits.
In addition to base pay, many DSOs provide performance-based incentives, loan repayment assistance, and tax benefits. Equipment purchases often qualify for Section 179 tax deductions, lowering taxable income. With streamlined insurance negotiations and billing, DSOs ensure faster reimbursements and reduced revenue loss.
4. Professional Development and Career Growth
DSOs provide a clear path for professional growth through mentorship, continuing education, and leadership opportunities. DSOs invest in formal programs, hands-on workshops, and exposure to advanced techniques, keeping dentists at the forefront of industry advancements.
DSOs also emphasize practice management training, preparing dentists for leadership roles. Many offer promotion pathways to lead dentist or regional management positions, creating career growth beyond chairside work. Working alongside a network of colleagues and specialists fosters skill development that could take years to gain in private practice.
5. Improved Work-Life Balance
Solo practice ownership often means long hours, emergency calls, and after-hours administrative tasks, leading to burnout. DSOs offer set schedules, predictable hours, and reduced on-call duties, allowing for a more structured work-life balance.
With emergency cases shared among providers and administrative tasks handled externally, dentists can focus on patient care without the burden of business management. This freedom allows for more time with family, personal interests, and professional growth.
Cons of Joining a DSO
Before signing a contract, consider whether a DSO aligns with your professional values and long-term goals. While DSOs offer benefits, some trade-offs can impact your daily practice and overall job satisfaction.
One of the biggest concerns for dentists is the loss of clinical autonomy. The extent of this depends on the type of affiliation. If you sell 100% of your practice, you become an employee, following DSO policies on treatment protocols, production goals, and administrative procedures. This setup is common in DSO 1.0 and 2.0 models and means less control over patient care decisions and practice operations.
A partnership model, where you sell a percentage of your practice (often around 60%), allows for more flexibility. You may keep influence over clinical decisions and office culture, but external oversight still affects how the practice runs.
Many DSOs enforce standardized treatment protocols to control costs. While this can improve operations, it may limit your ability to customize care for individual patients.
Are you comfortable following set guidelines, or do you prefer making independent clinical decisions? Understanding these trade-offs will help you make the right choice for your career and patient care philosophy.
1. Potential for Lower Earnings Compared to Private Practice
The initial payout from selling to a DSO might look great, but the long-term financial picture often differs from owning your practice:
You'll typically make a smaller portion of profits compared to ownership
Revenue-sharing models can result in decreased ongoing income
Fixed salaries and benefits often don't reflect individual contributions
There's less opportunity to benefit financially from higher-margin services
2. Cultural and Philosophical Misalignment
Corporate dentistry often prioritizes profitability over individualized patient care, creating tension for dentists accustomed to independent decision-making. Many private equity-backed DSOs focus on maximizing enterprise value, which can shift priorities toward production goals and standardized protocols rather than personalized treatment.
This emphasis on business metrics may pressure dentists to increase patient volume, follow rigid treatment plans, or meet performance targets that conflict with their care philosophy. Those who value patient-centered care may find corporate policies frustrating, especially when efficiency quotas or upselling take precedence.
Understanding the nuances of corporate dentistry vs private practice can help you assess potential cultural and philosophical misalignments.
3. High Staff Turnover and Workplace Stability Issues
The workplace culture within DSOs can contribute to stability challenges:
Employees commonly report feeling overworked, micromanaged, and underappreciated
Dentists in DSO-affiliated practices tend to have more emotionally taxing experiences that negatively impact their perception of the profession
Associates may compete with one another for high-value procedures, creating a less collaborative environment
Management styles that prioritize business objectives may leave little room for positive employee influence
4. Long-Term Contract Obligations and Restrictions
Read the fine print carefully in DSO contracts, as contractual restrictions could limit your professional options even if your circumstances or goals change.
Multi-year commitments may lock you into arrangements that become undesirable over time.
Restrictive covenants often limit your ability to practice within a certain geographical radius after leaving the DSO.
Complex contractual terms may include obligations that limit your future career flexibility.
Non-compete clauses can stifle your options if the DSO relationship doesn't work out.
Key Considerations When Making Your Choice
Factor | DSO (Dental Support Organization) | Private Practice |
Financial Stability | Provides a stable salary, often marketed as a solution for student debt | Higher income potential, especially with ownership |
Earnings Potential | Typically lower earnings. | Owners can earn nearly double for the same production level |
Practice Ownership | No ownership or equity in the practice | Full control over practice decisions and profits |
In-House Dental Plans | Typically not available for associates | Can be implemented to attract and retain patients |
Workplace Culture | Varies widely; research reputation and employee satisfaction | Self-determined, but comes with management responsibilities |
Management & Admin Burden | Handled by DSO, allowing focus on patient care | Requires handling administration and operations |
Ethical Standards | Governed by ADSO Code of Ethics, but implementation varies | Set by owner, ensuring direct control over policies |
Compensation Package | Includes salary, benefits, CE allowances, and structured schedules | May include higher profits but requires self-management |
Career Advancement | Potential for leadership roles within the DSO | Advancement depends on practice growth and ownership |
Flexibility & Autonomy | Limited autonomy—decisions are influenced by corporate policies | Full autonomy over clinical and business decisions |
Alternatives to DSOs: Choosing the Right Career Path
For dentists seeking autonomy, financial opportunity, or professional growth, several alternatives to DSOs offer advantages. Whether in private practice, group settings, temporary work, or academia, the best path depends on your goals and risk tolerance.
Private Practice: Full Control, Full Responsibility
Owning a practice means complete autonomy but requires business expertise and financial management. Dentists handle staffing, overhead, and investments while maintaining control over patient care. Although startup costs are high, strategic investments increase practice value and long-term returns.
Group Practice: Shared Costs, Independent Decisions
Group practices offer clinical autonomy with reduced financial risk. Dentists share overhead and administrative duties, easing the burden of practice ownership. These settings also provide mentorship and collaboration, particularly valuable for early-career dentists refining their skills.
Locum Tenens & Temporary Work: Maximum Flexibility
Locum tenens roles allow dentists to work on their terms, choosing when and where they practice. This career path offers exposure to diverse patient populations and practice models without long-term commitments.
Academia & Research: Advancing the Profession
Academic dentistry offers mentorship opportunities and research involvement for those drawn to teaching and discovery. Educators shape future dentists while often maintaining clinical work, and research positions contribute to scientific advancements, publications, and industry recognition.
Make the Right Choice for Your Dental Career
Deciding whether to join a DSO is a highly personal choice that depends on your career goals, financial priorities, and preferred work environment. While DSOs offer administrative support and access to advanced technology, they also come with trade-offs in autonomy, earning potential, and workplace culture.
If you're looking for flexibility and control over your career without committing to long-term contracts or restrictive employment agreements, alternative paths are worth exploring. Locum tenens/temporary work provides an excellent way to experience different practice environments while maintaining work-life balance and financial stability.
With Teero, you can easily find the right hygienists for your practice. Call or email Teero today to learn more about hiring the best team for your business.