Why 1 dentist won't affiliate with a DSO

A Michigan dentist said he doesn't plan on affiliating with a DSO despite increased presence because he wants to retain his clinical autonomy and ability to decide how his practice operates. 

Huzefa Kapadia, DDS, owns Kapadia Dental Care in Waterford, Mich., and Detroit Sterling Dental. He recently spoke with Becker's about staffing shortages in the industry, increased DSO presence and how dental schools can better educate students.  

Editor's note: Responses were lightly edited for clarity and length.


Question: Have you experienced staffing shortages at your practices?

Dr. Huzefa Kapadia: Right now I have staff. I'm very fortunate and grateful for that. But other dentists I've talked to are saying they put out applications. They get somebody who replies over email, they set up the interview and then nobody shows up for the interview. [One dentist] has so many of these where people flake and don't show up and she's kind of scratching her head, like where are all these workers that supposedly need work?


There is a theory that maybe people are still living off of their COVID-19 money, but that money seems to be running out. You are seeing more applicants than before. It's still hard, but it's weird how people flake out. I've had other practices tell me they'll have somebody for a short time and then all of a sudden that person will come up with an excuse that there's some personal emergency in the family and they can't make it anymore. I think what's happening when they say that is they're finding another job that is maybe paying them more, so then they jump for that other job.


Q: Have you been feeling increased pressure from DSOs in your area?

HK: There are a lot [of practices] that are being bought out, like a lot of dentists who are retiring and start selling to DSOs. So we see that with specialist groups and with general dentistry groups. We will face more pricing pressure and marketing pressure. The only thing we can beat a DSO on is consistently having the same dentist there. What I've seen at DSOs is that it's kind of a revolving door. Dentists and hygienists leave soon after a DSO purchase, then they have a lot of different associates come in and out and there's no consistency there. Patients pick up on that, and they don't like it. They want to see the same person. They develop a relationship with that dentist.


Q: Is there anything that would make you consider affiliating with a DSO?

HK: Right now, I don't want to, even if they offer me a lot of money. The problem is they try to offer a lot of money and lure you with that, but 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. 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.


Q: What are the biggest challenges facing the dental industry today?

HK: One is, of course, DSOs. I'm not saying they're evil or horrible, but they're pros and cons. They might be able to run things efficiently in some places, but some don't. I think also quality control as well as patient satisfaction may start to diminish with DSOs. DSOs are definitely going to be taking a larger footprint in dentistry, especially with newer graduates who don't have the funds to buy a dental office. The other challenges [are] insurers cutting reimbursement and dentists dealing with the rising overhead costs.


Q: If you could change one thing about the dental industry, what would it be and why?

HK: I wish dental schools would teach procedures better. They give you a very limited amount of procedures to get through dental school and then when you get into private practice, most new grads are lost. They don't know how to do root canals or extractions very well, they get stuck and then they just don't want to do them at all. If dental students get better clinical experience in dental school, that would make a big difference.


Q: Many dentists think dental schools could also teach students more about the business side of dentistry. Do you agree?

HK: I definitely would agree with that. We don't know what to do when we buy a practice. We just learn from our mistakes and follow what the previous dentist did. You learn what works for you and what doesn't. But sometimes it's very frustrating. There are a lot of dentists who are very good clinicians but are horrible at business, managing staff and personality. Half of owning a practice is dealing with people.


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