The 5 top challenges DSOs are staring down

Macroeconomic conditions, succession planning of practices and keeping new affiliates happy are three of the toughest challenges that DSOs have to face today.

The leaders featured in this article are all speaking at Becker's 2024 dental conferences. This includes our Spring Future of Dentistry Roundtable, which is set for June 19-21 at the Swissotel in Chicago, and our Fall Future of Dentistry Roundtable, which is set for Oct. 30-Nov. 1 at the Hyatt Regency in Chicago.

If you work at a DSO or dental practice and would like to be considered as a speaker, contact Randi Haseman at

As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at our roundtables. The following are answers from our speakers at the events.

Note: Responses were lightly edited for clarity and length.

Question: What is the biggest challenge dentists, DSOs and/or dental practices are facing today?

Manu Chaudhry, DDS. President of Capitol Dental Care (Salem, Ore.): The biggest challenge facing dental providers and organizations is to differentiate into a blue ocean with strong financial acuity. As the reach of provider organizations grows, we must act beyond conventional practices of brick-and-mortar offices and sustainably disrupt our business. Further, true transformation elevates humanity through the quintuple aim.

Richard Hall. President and CEO of U.S. Oral Surgery Management (Irving, Texas): I think the biggest challenge facing DSOs and MSOs is the macroeconomic conditions with the cost of capital more than doubling over the last 18 to 24 months. Fortunately, we're not in this category, but many DSOs and MSOs are in a position where they just can't get the debt they need to continue to fund their growth. Another major challenge is staffing, which has been ongoing for a while but is subsiding to some degree.

Brian Hamilton. Chief Development Officer of Allied OMS (Southlake, Texas): There are two challenges that are interrelated: succession planning and recruitment. With the dental profession witnessing a significant number of practitioners reaching retirement age, succession planning has become critical to ensure a smooth transition and continuity of quality patient care. Many dental practices do not have a well-defined succession plan in place, leading to uncertainties and potential disruptions in the practice. At the same time, recruiting associates can be challenging, with many options in front of them. Newer surgeons often have different expectations regarding work-life balance, technology usage and workplace culture. Further, economic factors, including student loan debts for new associates and financial constraints for existing practices, can impact recruitment efforts. Differentiating your practice, maintaining a great culture and offering competitive compensation packages will go lengths in attracting and retaining talent.

Joe Malzone. COO of Select Dental Management (Florham Park, N.J.): DSOs are facing several key challenges today. Economic uncertainties have affected the cost of capital and have caused a slowdown in mergers and acquisitions across the industry, impacting growth strategies. The competition for talent, compounded by rising wages and material costs, have made organic growth an even bigger priority for many groups. Additionally, keeping up with technological advancements, including artificial intelligence, digital scanning, and 3D printing and data analytics, is crucial for maintaining efficiencies.

David Sopp. Senior Vice President of Corporate Development at First Choice Dental (Madison, Wis.): The biggest challenge DSOs face today is making sure that newly affiliated offices remain happy and productive after the partnership is formed. Aside from having proven processes for working with their new partners, DSOs have to allow the offices to retain their clinical autonomy and the unique cultures that initially attracted them to the affiliates. While it may be an oversimplification, dental offices are experts at improving patients' experiences and outcomes, and DSOs that appreciate that and offer support services to continue improving the experiences of staff and patients will be the most successful.

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