The dental support organization industry is going through its hardest stretch in a decade. By some estimates, roughly 80% of DSOs are in some form of financial difficulty. Several well-known groups have restructured debt, paused acquisitions, or wound down entirely. Even the largest players in the space are describing low single-digit growth as an industry-leading result.
None of this happened overnight. In the years before and during COVID, private equity raised enormous amounts of capital at near-zero interest rates. Cheap debt and stable practice profitability created a simple thesis: buy as many dental offices as possible, as fast as possible. Groups paid historically high multiples because the math worked when debt cost almost nothing, and many operated on the assumption that practices didn’t need to be integrated, just owned.
That model depended on two things staying the same. Neither did. Interest rates went from effectively 0% to over 5% in roughly 18 months, and post-COVID inflation drove up labor, supplies, and real estate costs across the board. Practices that were marginally profitable became unprofitable, and groups that borrowed aggressively found themselves servicing double-digit interest on debt taken out under very different conditions.
A different result
Against that backdrop, Elevate Dental Partners, a founder-owned doctor partnership organization posted numbers that stand apart from the industry.
Becker’s Dental + DSO Review named Elevate the fastest-growing DSO of 2026, with 136% revenue growth, the highest of any organization on the list. The company also earned spots on the Inc. 5000 National and Rocky Mountain Regionals lists, was named a Longhorn 100 winner, and saw its leadership recognized as an EY Entrepreneur of the Year finalist, all in a year when much of the industry’s growth stalled.
The operating results tell the same story. Elevate’s partner practices are growing profitability at more than 20% year over year, while the industry average is flat. GP practices that have been with Elevate for more than a year show over 80% pre- to post-partnership growth. Across more than 80 doctors and 35 locations, the company reports zero regrettable partner-doctor turnover and an average partner satisfaction score of 9.4. In an industry where DSO leaders consistently cite doctor satisfaction, retention, and profitability as their top challenges, those numbers matter.
Why the model holds
Elevate attributes the performance to three things working together.
First, aligned incentives. Partner doctors hold equity that grows as Elevate grows, so the organization and its clinicians win or lose together.
Second, selective partnership. Elevate partners with roughly 3% of the doctors it talks to, prioritizing fit over volume.
Third, operational infrastructure. The systems, tools, and support teams that let practices run better after partnership than before it.
The company’s view is that any one of these alone isn’t enough. The combination is what produced growth through a downturn.
The opportunity ahead
Elevate sees the current environment less as a crisis and more as an opening. There are groups across the country with strong underlying assets, established patient relationships, and good clinical teams sitting inside ownership structures that aren’t working. Elevate’s plan is to keep doing what it has always done, disciplined single-practice acquisitions, while adding a second engine: select group acquisitions at valuations that reflect today’s market.
The infrastructure to do both at once is already built. The strategy is to stay the course and compound.
The past two years have tested every operating model in dental. The organizations coming out of this period strongest won’t be the ones that bought the most practices at the peak. They’ll be the ones that built something doctors actually want to be part of. Elevate‘s numbers suggest it’s one of them.
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.