To join, or not to join, a DSO

Whether or not to affiliate their practice with a DSO is one of the biggest decisions a dentist can make in their career, especially as industry pressures like rising costs and staff shortages mount. 

Thirteen percent of dentists are now affiliated with a DSO, according to data from the American Dental Association. Some dentists are reluctant to join a DSO due to fears of losing autonomy or their staff, according to Barry Lyon, DDS, a chief dental officer for the division of orthodontics and pediatric dentistry at Sarasota, Fla.-based Dental Care Alliance. 

Dr. Lyon added that losing clinical autonomy is one of the most common misconceptions about DSOs.

"Dentists considering affiliating with a DSO may fear the character of their practices and their clinical autonomy would be altered by the supporting DSO," Dr. Lyon told Becker's. "When a DSO affiliates with a successful practice, tinkering with what has brought success for years makes no business sense. Dentists may also fear a DSO would come in and make wholesale changes to the office staff. Again, this is something a DSO would not do, especially in today’s business climate when finding skilled staff members is challenging. Besides, why break up a successful team? DSOs want the transition from private practice to supported practice to be as transparent as possible."

Dr. Lyon said some of the benefits to DSO affiliation include obtaining a positive work-life balance and being able to focus on patient care while the DSO handles the business tasks. DSOs also have additional resources to acquire new technology and offer mentorship and marketing services.

"If I were starting practice today I would start practicing with a DSO," Michael Perpich, DDS, told Becker's. "This way I could work on my clinical skills and not worry at all about the business side of the practice. This includes both working on government regulations, payroll, and staff recruitment and retention. I would hope the DSO would provide me the mentorship which I would need to improve my clinical skills as a dentist. In the eight years I worked for a DSO, I took great pride in providing clinical leadership to my new dentists."

Despite the benefits that could be offered by DSOs and the pressures that come with private practice, some dentists still refuse to affiliate. 

"I've talked to some friends who've done that and everyone initially is like, 'They said they're not going to change anything. You get to do exactly what you want to do.' They don't do it right away because they don't want to freak you out and they don't want everyone to leave, but they do it gradually," Huzefa Kapadia, DDS, told Becker's in June. "I don't want somebody dictating which lab I use, what my supplies are or who my staff is. You have no real say after a while because it's a bunch of corporate entities worried about the bottom line constantly and they want to flip that DSO to a private equity group in five years. I like my autonomy. I like the culture we have and I feel all that will be gone once the DSO takes over."

Andrew Horowitz, DMD, MD, who recently affiliated his practice with Max Surgical Specialty Management, called DSO affiliation the "million dollar question" for dentists. He advised dentists to speak with other industry professionals for advice to help inform their decision.  

"You're not going to get the answer right away. You need to get the background before you can make the decision," he said. "I spoke to an oral surgeon recently and this is his first foray into should he sell or should he not sell or join a group? And he didn't even understand the language. He didn't even understand the concepts, how things are evaluated and the benefits. You just have to talk to people."

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