Dentists in private practice don’t necessarily need to compete with or copy dental service organizations; they need to provide a different, more intimate experience for patients.
Private practices have to lean into the relationship-building side of the business, building trust and continuity. Alongside creating long-term relationships, independent offices have to continue offering top-quality clinical services.
These eight dentists recently connected with Becker’s to share how private practices and dentists can continue providing value and succeeding in the current DSO-dominated dental landscape.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: How can the independent practice model remain competitive against DSOs in 2026 and beyond?
Robert Baskies, DMD. Dentist of Zufall Health (Phillipsburg, N.J.): If a dentist can secure financing, it is very easy. DSOs survive with young dentists who have limited skill sets. They work in DSOs for a short time as if the DSO was a residency. That is why Heartland and Aspen are always recruiting. To succeed, dentists have to seek an underserved area and set up. The dentist has to be social media savvy. And more importantly the dentist has to become a trusted member of their community. The days of DSOs getting better deals for prosthetics and dental supplies are basically gone. In fact, the DSO nets a smaller percentage than a private practice because they have corporate overhead and investors that want a return on their investment.
Christopher Freeman, DMD. Owner of Freeman Orthodontics (Fort Lauderdale, Fla.): Honestly, I think the question has a flawed assumption baked into it. I don’t think independent practices need to compete with DSOs by trying to become smaller versions of those organizations. DSOs may be able to compete on price, scale, marketing or convenience. Maybe they can offer extended hours or use their size to create efficiencies. But I don’t think that is where the real comparison lies. A great independent practice is not a commodity. It is a service business, a relationship business and in many ways a hospitality business. Patients and parents want to feel known, heard and cared for. They want consistency. They want to know who is responsible for their care. That is very hard to duplicate in a large corporate model.
I also think there is a long-term issue with the DSO model that people do not discuss enough. Early on, DSOs may attract some very talented doctors who are ready to exit, especially during the initial growth phase. But over time, as debt service, investor expectations, management layers and profit requirements become more significant, I think the model naturally creates pressure that can affect both the quality of care and the quality of the patient experience. I am already seeing this personally. We are getting referrals from what were arguably great offices before they sold to DSOs, because patients and parents no longer like the experience. Some are even leaving mid-treatment because of it. I think that will only magnify over time. It is hard to imagine that, as these models mature, there will be less pressure to extract revenue or exert control.
My expectation is that, over time, there will be more stratification in the profession. The best independent doctors who value their own services, want clinical autonomy and know how to create a great patient experience will continue to build strong private practices. Meanwhile, corporate models may increasingly have to rely on doctors who do not want to run their own practice, cannot run their own practice or are willing to work within a system where the business structure has more influence over the patient experience. Orthodontic Centers of America is a good historical example of how that type of model can play out.
So for independent practices, I don’t think the answer is to chase DSOs on price. The answer is to lean into what makes private practice different: excellent care, personal accountability, hospitality, trust and a consistent patient experience. As the DSO model matures, I think the difference between a true private practice experience and a corporate dental experience may become more obvious, not less, and the comparison will not even be close.
Richard Heinl, DDS. Owner of Heinl Dentistry (Orlando, Fla.): There is a great divide coming in dentistry and in many areas it is already here. We as a field have lost our position as the most trusted medical profession for many reasons and people in many cases today are reflexively abandoning or seeking alternatives to the corporation-based care they are familiar with. The corporations even know this and show it with the lengths they are going through to hide the fact that a location is a chain office; sub-brands, different names, etc. Patients have seen what DSOs have to offer and they don’t like it. The structure of a DSO always adds a layer of debt weight over the conventional practice and when that weight gets heavy, as it has now, the dentists get pressured to sell and produce, capital expenditures decrease and required office upkeep is not done. I’ve been in chain offices with broken curing lights, expired composite and handpieces from the 1970s in the last year.
Patients go in and are informed that they have X number of fillings and cracks and are exposed to high-pressure sales tactics; that this will be a nuclear bomb in their mouth unless they get it fixed today. And as the patient does not usually have some arbitrary high amount of money they don’t get it done. Then no bomb explodes anyway, or should they get the work done it fails in a faster than desired timeframe.
This is where the private practice provider has an opportunity: to step into the trust vacuum and resume our place as a trusted medical provider. A provider of a high quality and valued service. Life is difficult, the economy is tight, patients can’t afford what they used to and insurance is paying less than they ever have. We need to meet patients there. We as smaller offices have the ability to be flexible and move more rapidly as market trends shift. Today, that will be a flexible production chain and create a lower entry to deliver the care these patients need at costs they afford. The delivering of comprehensive care, implants, root canals and orthodontics all in a single location. Flexible, all-encompassing, ethical dental care.
A step beyond this however is the fact that we as a profession are under-utilizing one of the greatest advantages we have to re-establish trust, video and photography. In today’s digital age where everything else is video taped or digitized or shared, dentistry as a whole is a bit slow on the uptake. We are one of the few medical fields that can efficiently and easily show exactly what we are fixing. Few others in the medical industry can do that with the same ease with which we can.
Dentistry can get its trust back but only if we start meeting people in their need and then educating them in these matters. Returning to the Latin root of doctor, docēre, with the meaning of to show or to teach. And with this re-establishment of trust, of patients valuing what dentists have to offer, we also are able to return to better compensation for us little guys.
Phillip Isaacman, DDS. Owner of Bluff City Dental (Memphis, Tenn.): A private, independent practice will always beat a DSO office. De novo offices are fun to build. It’s your own ship that you can take in any direction you choose. Forget the money, a young dentist opening her own office in a good spot is way better off than one applying at McDentals. We encourage young dentists to be careful as they go from school-life to real-life and to understand that now people are going to want their money. As a private practice owner you’re able to navigate and learn along the way. As long as people have teeth, your own office will be much more lucrative and satisfying than someone else’s.
Barry Lyon, DDS. Director of Provider Recruiting and Onboarding of Dental Care Alliance (Sarasota, Fla.): With state-of-the-art analytics, complex marketing strategies and the ability to receive huge infusions of financial support from their investors, DSOs hold financial and business dominance over private practices. Nonetheless, independent practices can continue to thrive as successful participants in America’s healthcare.
As long as patients value continuity of care, cherish long-term trust and receive sound clinical treatment, private practices will maintain a respected place for those seeking more personalized experiences. However, these offices must not remain complacent. Private practices must evolve and mirror the strategies that have resulted in the tremendous growth of DSOs. By utilizing the latest technologies, employing digital workflows, incorporating automated communication, and refining revenue cycle optimizations, private practices will continue to be valued and respected oral healthcare partners.
Robert McNeill, DDS, MD. Managing Partner of The Dental Specialists (Garland, Texas): Independent practices can remain competitive by leaning into their natural advantages: being nimble, making decisions quickly, maintaining long-term patient relationships and being truly patient-centered operationally, not just in messaging. Patients notice stability and they value seeing the same doctor and team over time. Many patients are increasingly wary of being upsold or moved through a system that feels transactional. Independent practices have a real opportunity to build trust through continuity, transparency and clinical judgment that patients can see and feel.
At the same time, independent dentists cannot rely on nostalgia or the assumption that clinical quality alone will be enough. The strongest independent practices will need to modernize their operations, use technology wisely, understand their numbers, develop strong teams and become more sophisticated business leaders. That may mean an MBA for some, but it can also mean executive education, mentorship, focused continuing education or simply becoming more intentional about leadership, finance, operations and strategy.
I do not view the future as independent practice versus DSOs. I think the real divide will be between well-run, patient-centered practices and poorly run practices, regardless of ownership model. Independent practices that modernize their operations while preserving trust, clinical autonomy and community connection will continue to have a very strong place in dentistry.
Thomas Sarna, DDS. Oral and Maxillofacial Surgeon of Half Moon Oral Maxillofacial And Implant Surgery (Fayetteville, Ark.): Independent practice model doesn’t hold a candle to DSOs in 2026, as margins keep getting thinner. I took my payday after building a $6 million practice over the past 10 years and sold out to Paradigm in December 2025.
Robert Trager, DDS. Owner of Dentists for Airport Employees (New York City): The solo practitioner will always be sought after by most patients thanks to the way the medical profession conducts its practice today. Patients today in the medical profession never spend as much time with their primary care physician or specialists as they did years ago. Today, most patients spend as much time if not more with physician assistants, nurse practitioners and other medical auxiliaries. They do not have the personal relationships that we provide in solo practices.
The DSOs are now imitating the medical profession where there are large institutions of dentists and dental specialists providing care to the public seeking their services. At these DSOs you may not see the same provider every time or experience the personal relationships that you receive with a solo practitioner. With all the modern techniques such as AI and scanning, patients do not spend as much time with their provider. As a solo practitioner I believe in the four C’s: convenience, caring, concern and comfort. This is what the patients are seeking today and can only receive from a solo practitioner. I have been a solo practitioner five days a week providing these services to my patients. Most of my patients are asking that I not retire because they cannot find a practitioner that provides them with these traits.
My staff and I go out our way to know each patient’s culture, background, ethnicity and language spoken during their office visit. We provide them with a phone number that they can contact us personally rather than a phone service. At the age of 86, I enjoy spending quality time with my patients, and they appreciate hands-on time. When patients retire and move away they come back to us. Most patients today want to experience the personal/interpersonal relationship with their provider. Many of my patients have retired, moved away and experienced a DSO provider realize the difference.
At the Becker's 5th Annual Future of Dentistry Roundtable, taking place September 14-15 in Chicago, dental leaders and executives will gain insights into emerging technologies, practice growth strategies and the evolving landscape of dental care delivery, with a focus on innovation, patient experience and operational excellence. Apply for complimentary registration now.
