Private practice was once the gold standard for dentists, and while it is still a goal for many entering the field, compounding challenges have made it harder to attain.
Nine dental industry professionals recently spoke with Becker’s to discuss the challenges facing new dentists and how the pathway to practice ownership has changed.
Note: Responses were lightly edited for clarity and length.
Question: Is private practice still attainable for new dentists? Why or why not?
Dee Fischer. CEO of Fischer Professional Group: Private practice is still attainable for the next generation. We just have to think out of the box. The current doctors and new grads must reshape how it is done though. For a successful private practice to occur, there must be planning and strategy involved. This looks like starting with financial planning, not necessarily the usual way, research other and creative options.
When dentists operate and have this vision for their practice, they will make it work. This will ultimately show up in their willingness to partner both strategically and financially with people who can help procure market advantages and look to bring wealth to them in multiple ways, all while respecting the calling and goodness of dental healthcare.
Doug Gray. Owner of Dental Business Solutions: Yes, but more importantly, it’s much more desirable. To categorize the biggest benefits:
Build wealth earlier
Starting ownership early lets compounding work for you. Each year of ownership builds equity, not just income. Student debt can be paid down faster through practice cash flow, and an owned practice can be refinanced, expanded or sold later, giving options. Dentists who delay ownership often earn well but miss out on years of asset growth they can never get back.
Faster skill development and career control
Early owners grow faster professionally. With the help of a consultant/coach, they learn business, leadership and clinical decision‑making sooner, they avoid being locked into associate roles with limited autonomy, and they shape their career path instead of waiting for “permission” to advance. Ownership accelerates confidence and competence. Many dentists say their biggest regret is waiting too long.
Design the practice around your life (Not the other way around)
Early ownership lets you build habits and systems once. Again, with the help of a proven consultant/coach you can set schedules, ergo your clinical pace, and culture early, hire and train a team that grows with you, and avoid adapting to someone else’s systems and values, which is a leading cause of burnout. Instead of inheriting a structure that doesn’t fit, you grow into a practice that evolves with your life — family, interests and goals included.
Bottom line for early‑career dentists: Ownership isn’t about being “ready enough.” It’s about starting early enough to maximize opportunity, flexibility and long‑term freedom.
Scott Kalniz, DDS. Chief Dental Officer and Vice President of Network Development at Beam Benefits: I do believe private practice is still attainable for new dentists, but the path to ownership has become more challenging than it was years ago. Between rising student debt, increasing overhead costs, staffing challenges and competition from larger group practices and DSOs, there is far less room for error early in a dentist’s career.
I do not think it is wise for a new graduate to immediately purchase or start a practice unless there is strong mentorship and support in place. Dental school teaches the fundamentals of clinical dentistry, but it does not fully prepare graduates for the realities of practicing in the real world. New dentists are still developing their clinical speed, diagnosis and treatment planning skills, and their ability to communicate treatment recommendations effectively to patients.
Working in a multi-doctor practice or a DSO environment can provide a valuable transition period. These settings often expose young dentists to a high volume of procedures, different practice systems and experienced mentors who can help accelerate both clinical and professional growth. In addition, if a dentist pays attention to how the business operates, they can gain critical insights into scheduling, staffing, collections, case acceptance, insurance management and overall practice operations.
Ultimately, understanding how to run a successful business is just as important as being clinically skilled. Private practice ownership is still very achievable, but today it requires stronger preparation, better business awareness and usually a more gradual path than in the past.
James Lipton, DDS, PhD. Adjunct Professor at the University of Pennsylvania School of Dental Medicine (Philadelphia): I believe that traditional private practice will diminish over the coming years for most new dentists. Healthcare is experiencing an exciting period of change as a result of scientific discoveries, technological advances and the translation of this knowledge to oral care. This will make practice rewarding for most new dentists, especially those who are curious and creative clinicians and keep current with developing innovations and breakthroughs. I believe the future structure of dental practice may become more group-oriented with an interprofessional emphasis that includes medicine, nursing, pharmacy, physical therapy and other health professions. Perhaps these will be known as MDSOs. This structure will stimulate many new dentists to strive for success and overcome potential financial issues. Most dentists will no longer desire to establish a traditional solo private practice.
Brion Long, DMD. Smileworks Children’s Dentistry and Orthodontics (Tallahassee, Fla.): Private practice is absolutely still attainable, but new dentists face real headwinds: student loan debt that often exceeds $400,000, the rising cost of clinical and digital technology required to compete, and a regulatory and compliance environment that grows more complex every year. Those barriers are why so many graduates default to DSO employment out of school.
What gives me real optimism for the next generation of owners is [artificial intelligence.] The two largest pain points in running a practice — administrative burden and staffing dependency — are exactly what AI is poised to ease. Treatment coordination, insurance verification, patient follow-up and scheduling are increasingly being handled by AI tools at a fraction of what those roles used to cost. For a new owner, that’s a meaningful equalizer against scale. The dentists who learn to leverage these tools early will have a real advantage over both slow-moving DSOs and peers who don’t adopt.
Roshan Parikh, DDS. Founder of DSO Strategy: Yes, but it depends a lot on where you want to practice and how creatively you’re willing to structure the deal.
In rural markets, solo ownership is absolutely still on the table. Lower cost of entry, less competition, and a new graduate can realistically step in and own outright.
In urban markets, I’m much more cautious. Between the student debt most new dentists carry, the cost of living in major cities and reimbursement rates that keep getting squeezed, solo ownership just doesn’t pencil out for most people coming out of school today. That’s part of why DSOs have become such an important part of the landscape — and frankly, many of them are excellent training grounds, with strong mentorship, real clinical volume and genuine paths to partnership or equity for dentists who want to grow with the organization.
For dentists who do want to own a private practice, though, I think the most underrated path is partnership — buying into an existing practice alongside the current owner, often with the seller carrying back part of the note to fill the gap traditional lenders won’t touch. It lets a new dentist build real equity over time, learn the business from someone who’s done it and grow into full ownership instead of trying to leap into it on day one.
So, yes, private practice is still attainable. For most new dentists today, though, it means partnership first, full ownership later.
Viren Patel, DMD. CEO of Smile Obsession (Oakbrook Terrace, Ill.): Private practice ownership is still attainable for new dentists, but the path is far more challenging than it was a decade ago. Rising student loan debt, increasing construction and equipment costs, staffing shortages and the growing complexity of running a healthcare business have all created significant barriers. Dental school prepares students clinically, but most graduates leave with limited exposure to leadership, operations, finance, marketing or team management. As a result, many young dentists are drawn toward larger organizations or DSOs that can offer financial stability, established systems and administrative support early in their careers.
That said, I do not believe private practice is disappearing, I believe it is evolving. The old model of a solo dentist trying to manage every aspect of the business alone is becoming increasingly difficult to sustain. The future of private practice will likely look more collaborative and operationally sophisticated, with dentist-owned groups leveraging centralized systems, technology, shared resources and economies of scale while still maintaining clinical autonomy and a strong patient-centered culture. My company, Smile Obsession, is a dentist-owned model that reflects this evolution.
I believe ownership is still one of the greatest opportunities in dentistry because it allows dentists to build long-term equity, shape their culture, and create meaningful patient relationships. However, success today requires a broader skill set than ever before. The dentists who will thrive in the future are the ones willing to think beyond dentistry itself, learning leadership, operations, technology and business strategy alongside clinical care. Private practice is still attainable, but it is no longer something that happens by default. It requires intentionality, adaptability and the willingness to evolve with the profession.
Matthew TeNyenhuis. Quality and Compliance Officer at Butte Native Wellness Center (Butte, Mont.): I have worked for a decade in both the federal FQHC and private environments. I have spent a lot of time in the Rocky Mountain Region between Colorado and Montana. Dentistry is near and dear to my heart.
Size, location, market and service area competition are key factors for any private practice owner or prospective entrepreneur. What is becoming increasingly more popular is the DSO model. There is at least one DSO chain in any metro-based location nationwide at this point. From a private industry perspective, the DSO model is taking all of their “in-network insurance” patients from practices.
The dental insurance industry is really the dividing line. Patients purchase it expecting it to cover everything. They then find out it pays pennies on the dollar of what it actually costs to produce care. In reality, nobody could survive if they just billed insurance and wrote off the adjustment after the insurance closes.
Private practices really can only survive if they go out of network for all insurances. However, they can bill patients’ insurance as a courtesy on the patient’s behalf. There are other neat ways of offering cash or check discounts to patients to incentivize patients from utilizing the credit card system, which absorbs merchandising fees. [I’m] uncertain of how attainable it is for a new doctor to buy into a private environment. Student loans from school, plus absorbing the debt, are huge. Younger doctors entering the field really could benefit from investing in a retirement opportunity with a hybrid transition in place.
Robert Trager, DDS. Dentist at JFK Airport (New York City): I [was recently] in Nashville, Tenn., celebrating my 60th class reunion at Meharry. Back then, my tuition was $850 in a trimester program, resulting in a tuition of $2,550 a year, compared to today’s tuition at most dental schools of $85,000 to more than $100,000. When I graduated, there were many opportunities for associateship and buying a practice with no worries about student debt. In today’s environment, most graduating students are in heavy debt, owing anywhere from $300,000 or more in student loans. Their only choice after graduating is associating with a DSO for immediate employment in order to pay off their student debt.
Most of the graduates today have no knowledge of business acumen, and will be swallowed up by the DSOs to be dental mercenaries. They will have no knowledge of how to run a dental private practice. They will not be taught how to manage and fire employees, how to accept or reject insurance plans, which supply houses to order dental supplies from and which dental laboratories to use. These dental mercenaries will be constrained to work for these DSOs without any incentive to open or associate with a dental practice. They do not want the responsibility of owning a private facility.
I recommend to most of these young practitioners to look at where they want to be 10 years from now. Do they want to remain an employee or an employer? Do they want to associate or buy their own practice? In today’s environment, there is more consolidation than ever, which means [more] DSOs and specialty groups. Insurance companies and private equity groups are controlling the future of dentistry. They will regulate all the parameters of fee structures, reimbursement and eligibility for most of their patients. Like medicine, dentistry is becoming a corporate entity that’s controlled by wealth management. There will be few choices if one does not plan ahead and realize what the future holds. Do you want to be independent or dependent? Time is not on your side. The choice is yours.
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.
