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By Joel Idelson, Chief Executive Officer, Image Specialty Partners
When I joined Advanced Dental Brands back in 2019, the organization was still called Advanced Dental Management. That name told me everything I needed to know and signaled that a fundamental shift was needed…not just in how we operated, but in our entire philosophy.
The first thing we did? Drop “Management” from the name. Not because it sounded too corporate, but because it represented a top-down, command-and-control culture that was choking the very practices we were supposed to be supporting. If we were going to build something scalable and meaningful, we had to shift from dictating at practices to collaborating with them.
Which brings me to the “S” in DSO.
It stands for Support, not Strangle. Not Suppress. And definitely not Suck the soul out of your practice and replace it with spreadsheets and flavorless corporate policy. Yet, too many Dental Support Organizations have conveniently started acting like DMO’s (Dental Management Organizations).
Why?
Because they don’t understand the difference between supporting a practice and managing one. Or worse, they do understand it…and just don’t care. Because control is easier than collaboration, and top-down decision-making is faster than actually listening. But trusting and empowering offices requires letting go, at least of the kind of control that kills initiative.
When you provide the right oversight, the right support, the right data, the right team, and the right relationship, grounded in knowledge and discipline, good things happen. Practices thrive. People take ownership. And instead of managing results, you’re watching them grow.
Support ≠ Management
Management, in the worst sense, is about taking over for the sake of control. It’s implementing systems just because “that’s how we do it at corporate.” It’s changing processes with no regard for why they worked in the first place. It’s trying to mold every practice into the same lifeless template, regardless of the people, the patients, or the culture that made it thrive in the first place.
Instead of empowering office managers and staff to think, lead, and make decisions, management turns them into order takers. They lose autonomy. They stop innovating. They start waiting to be told what to do because that’s what the “home office” expects. And just like that, you’ve stripped away their ownership, their pride, and the very spirit that made them valuable in the first place.
Too many DSOs approach integration like a hostile takeover: change all the vendors, all the systems, and all the processes just because “that’s part of the integration plan”. A good support organization may recommend new vendors or better systems, but only when they enhance what the practice already does best: deliver great dentistry in a culture where patients feel cared for and teams feel empowered. The difference is in the how and the why. One forces change. The other earns trust.
Oversight Isn’t Control
One of the most misunderstood words in this space is “oversight”. Let’s be clear: oversight isn’t about control or micromanagement.
Oversight means making sure teams have the tools, data, structure, and clarity they need to succeed. It’s about eliminating bottlenecks, offering strategic guidance, and keeping an eye on the big picture, without getting in the way of local leadership doing what they do best.
You don’t improve performance by removing the brain from the operation. You improve performance by enabling smart, capable people to make smart, capable decisions…with the right support behind them.
Support Means Empowerment, Communication, and Collaboration
Support is about empowerment. It’s asking, “What do you need to succeed?” and then delivering the resources, infrastructure, and guardrails to make it happen…and sometimes on their terms. It’s enabling, not enforcing. Partnering, not policing.
But support also requires something a lot of DSOs forget: healthy communication. That means being transparent about why new initiatives matter and taking the time to explain them. It means collaborating with doctors and office teams before rolling things out. Not as a courtesy, but as a necessity. Because when people understand the “why,” they’re more likely to buy into the “how.”And if you take a minute to actually listen to the people doing the work, you might just hear something that makes your idea better, or realize your idea wasn’t that great to begin with.
Support isn’t about dropping mandates from a glass tower. It’s about rolling up your sleeves and co-creating success with the people who live it every day.
You’re Not Scaling Systems – You’re Scaling Culture
When a DSO acquires a high-performing practice, the goal should never be to “fix” what works. The question should be: “How do we amplify what’s already great here?”
The best practices you acquire aren’t just assets, they’re playbooks. You should be learning from them, not replacing them. Let their approach to team culture, patient relationships, and operational excellence infect the platform. Let them raise the bar for the rest of the organization.
Because here’s the truth: you can’t scale a culture you don’t respect. And if you’re not protecting the culture that made a practice successful in the first place, then all the infrastructure in the world won’t save you from mediocrity.
Be the Backbone, Not the Boss
I’ve seen what happens when DSOs get it right, and what happens when they don’t.
The great ones? They empower leaders, not suppress them. They invest in culture, not just cost savings. They support without suffocating. They build real trust with their doctors and teams, and that trust becomes their competitive advantage.
The bad ones? They treat every practice like a branch office of a faceless corporation. They replace pride with policy. And they wonder why performance drops and turnover spikes.
You can’t dictate your way to greatness. But you can support your way there.
It’s Time to Rethink the “S”
If you’re running a DSO like it’s a DMV with scripts, call centers, and top-down mandates…don’t act surprised when the soul of your platform starts to rot. If you’re running it like a hospital system with “providers” instead of passionate clinicians, expect mediocrity.
The “S” in DSO is the most important letter. It’s the value you bring. It’s your entire reason for existing. Get it wrong, and you’re just a bloated holding company with a customer service hotline.
Get it right, and you’re a rocket booster for growth, helping already great practices reach even greater heights.
So stop managing.
Start supporting.
It’s right there in the name.
J
oel Idelson is the Chief Executive Officer of Image Specialty Partners, headquartered in California, ISP is a specialty dental platform backed by ONCAP (Onex). Known for his ability to lead through complexity, Joel specializes in building and scaling multi-site healthcare platforms, particularly in fast-paced, private equity-backed environments where the stakes are high and the path isn’t always clear.
Joel thrives in moments that require operational clarity, cultural reset, and bold decision-making. He simplifies the complex, resolves tough challenges, and drives performance without compromising culture. His philosophy is rooted in empowerment: give teams the tools to focus on care, equip office staff to lead with confidence, and build smart systems that support both without getting in the way.
At Image Specialty Partners, Joel is focused on delivering measurable impact, tightening operations, improving clinical, financial, and business performance, and creating environments where great talent sticks around because they feel heard, supported, and proud of the work they do.
Before ISP, Joel served as CEO of Advanced Dental Brands, leading the company through a period of rapid expansion and ultimately a successful private equity exit. He also founded and scaled Flossed, a high-growth, on-site dental brand. Earlier in his career, Joel held executive roles at several leading consulting firms.
