Staffing challenges, reimbursement rates, network growth and technology are some of the biggest issues that are top of mind for DSO leaders in 2026.
Barry Lyon, DDS, the director of provider recruiting and onboarding at Dental Care Alliance, recently spoke with Becker’s about the biggest challenges facing DSOs this year.
Editor’s note: This Q&A is part of a weekly series featuring Dr. Lyon focused on topics in the dental industry and DSO field. The views expressed are those of Dr. Lyon and do not necessarily reflect those of Dental Care Alliance.
This response was lightly edited for clarity and length.
Dr. Barry Lyon: To be a leader of a DSO means to be alert 24/7. Important business issues are like horses on a merry-go-round. They may change in color, but they are sure to eventually return. While interest rates and financing decisions once warranted much notice, it’s now execution that requires leaders’ attention. Hiring and retaining providers, ensuring same-store growth, updating reimbursement rates, studying the latest technology and enhancing cybersecurity have captured the consideration of DSO leaders. According to the American Dental Association’s Health Policy Institute, staffing shortages and insurance reimbursement remain the top concerns for dentists nationwide, underscoring the operational challenges facing DSOs as they continue to grow.
Recruiting and retaining dentists, hygienists, dental assistants and specialists have become an industry focus. While a DSO may have the capital to grow through expansion, it may fall short with bringing providers into a new office. Pediatric dentists, oral surgeons and endodontists remain particularly difficult to recruit. At the same time, younger clinicians increasingly prioritize mentorship, autonomy, work-life balance and organizational culture alongside compensation, making retention just as critical as recruitment.
For DSO leaders, financial concerns are ever-present. There is unease over the prospect of Medicaid reimbursement rates declining and the stubborn refusal of insurance reimbursements to keep pace with increasing operational costs. Rising wages for hygienists and support staff have compressed margins, forcing organizations to focus on operational excellence rather than relying solely on acquisitions to generate enterprise value.
Healthcare organizations continue to be on the government’s radar. Billing compliance, quality reporting, data privacy and corporate governance are all blips on the screen. CMS Administrator Mehmet Oz, MD, is leading a major Trump administration anti-fraud campaign targeting Medicare, Medicaid and hospice care. As for state dental boards, DSOs have always been on their radar screens. Having a capable compliance department is critical for every DSO leader.
These are the issues DSO leaders are zeroed in on until the next horse comes by on the merry-go-round.
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.