Deciding Who to Work For: DSO vs. Private Practice


By Ryan Lindgren, VP Acquisitions and Development

Dentists come in all shapes and sizes. The same is true of their career paths – thanks, in part, to the ever changing dental industry landscape. This article reviews some of the advantages and disadvantages of working for a DSO (dental service organization) vs. working in a private practice. We cover arguments from both sides of the chair at each major stage in a dental professional’s career. Starting with young dental school graduates, through established mid-career dentists and finishing with seasoned dental professionals looking to sell their practice and enjoy retirement.

Early Career
As a recent graduate, you’re likely to focus your career search on a position that allows you to gain skill proficiency while earning enough money to pay off the student debt you’ve accumulated. Unfortunately, dental schools don’t teach dentists how to build or run dental practices. Remember, at its core – every dental practice is a small business. Dentists need to know how to be competent administrators of that business if they’re going to be profitable & successful.

DSO Advantages

  • Good DSOs know how to attract and keep patients in the chair leading to a steady income and increased proficiency.
  • Most DSOs also provide healthcare benefits and malpractice coverage.
  • Practices are busy and efficient. Great opportunity to learn the inside operations of a successful & profitable practice.

Private Practice Advantages

  • Good doctors will mentor you from a clinical & business perspective. Their mentorship and expertise is valuable.
  • There are far more private practices than DSOs, finding a practice in a location you desire to live should be easy.

DSO Disadvantages

  • Business models vary between DSOs, and as such, you will learn different skills from each.
  • Clinical support also varies by model. Know the dentist you want to become and don’t hesitate to ask questions.

Private Practice Disadvantages

  • New associates often start out with simple procedures and limited patients, impeding your proficiency.
  • Expect to earn less until you build a steady client base of your own. Most practices don’t offer healthcare benefits or malpractice coverage.

Mid Career
For established practice owners – your earnings have probably reached their full potential and you’re beginning to focus more on your work-life balance. It’s at this point when your practice has reached or is near reaching its highest value. Having pre-defined retirement goals and a succession plan in place can help you capitalize your investment. For long-term associates – your earning potential over the next few years will have a meaningful influence on your retirement picture.

DSO Advantages

  • Will buy practices at peak value. Don’t wait until revenues and profits are declining to sell.
  • Offers the flexibility of relocating to practice in other parts of the country or advance to other positions in your career.
  • By nature of their operations, DSO’s are less affected by changes in the dental industry and overall economy.

Private Practice Advantages

  • Long term associates have the advantage of an established patient base which will earn a steady dependable income.
  • Practice owners have the highest earning potential point in their career and should hold on to that as long as possible.

DSO Disadvantages

  • DSO supported practices are busy and you can expect a full schedule, whether you want it or not.
  • Lower overall earnings. Highly productive dentists have higher earning potential in private practice, but also take on the associated risks.

Private Practice Disadvantages

  • Your income is tied to the chair and declines when you aren’t working.
  • Private practices are rarely able to keep up with the growing cost and complexity of providing healthcare and insurance benefits.
  • Less opportunity for career advancement.

Late Career
You begin to realize there are procedures you no longer like to do. You have reduced your schedule 1-2 days a week and retirement is on the horizon. As a practice owner, time is running out and you’re faced with deciding what to do with your practice, staff and patients.

DSO Advantages

  • Ability to continue practicing after the sale. DSOs prefer selling dentists to stay in the practice as long as possible.
  • Many DSOs employ part-time and traveling dentists which provide you more options and flexibility to continue practicing.
  • Selling your practice to a DSO allows you to diversify your investment and reduce your overall long term risks.

Private Practice Advantages

  • You are the only one tied to your income. You have the option to cut back your days or slow down the pace.
  • If you’re in a stable practice and enjoying it, private practice gives you the least amount of change.
  • If you are ready to retire now, selling to another dentist will typically give you an immediate exit upon sale.

DSO Disadvantages

  • Selling dentist is typically required to work at the same pace they did prior to selling. You’ll need to plan ahead to allow time to ramp down.
  • Working with a DSO offers you the opportunity to show up, do dentistry, and leave. Essentially, it will feel like you’re “just an associate” again.

Private Practice Disadvantages

  • A buyer rarely wants the seller to stay because it takes income away from them.
  • If you decide to cut back your production, the value of your practice will immediately decline.
  • As the age of the practice increases so does the cost of maintenance and up-keep of technology.

Bottom Line
Knowing and prioritizing what is most important to you at each stage of your career is the first step toward making the right decision. We’ve uncovered many of the advantages and disadvantages that come from working with DSOs and private practices, but there are many more options available to you at each stage in your professional career.