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By Cassie Tallon, CEO of The Fractional Match and COO in the Dental Industry
The DSO industry has no shortage of sharp suits, big titles, and high-level “mojo.” In boardrooms across the country, conversations center around EBITDA optimization, exit multiples, and market expansion strategies. Meanwhile, at the practice level, reality tells a starkly different story.
I’ve walked into practices where broken piezos sit untouched in storage closets while senior management demands more SRPs. I’ve seen dental assistants reuse and wipe down handpieces without proper sterilization—not out of negligence, but because there simply aren’t enough instruments to follow protocols. Sensors held together with duct tape are shared between three operatories like priceless relics. Team members work without bonus structures, wearing scrubs so worn they’re nearly transparent, while outdated equipment frustrates both staff and patients. Antiquated phone systems and PMS tie up more time in support calls than in welcoming new patients. Doctors face payroll delays caused by broken insurance systems and outdated RCM protocols.
Many private equity portfolios grow richer while the practices powering them run on fumes.
We’re missing the fundamental point.
The Leadership Disconnect
The DSO industry thrives on personal branding, executive presence, and boardroom swagger. LinkedIn feeds overflow with thought leadership and conference keynotes. Yet unless that senior-level “mojo” reflects what’s happening at the front desk and chairside, we’re failing the teams who actually drive organizational success.
True servant leadership demands we flip this equation. Instead of expecting practices to support executive ambitions, leaders must rise to support their teams. A rising tide lifts all boats—but only when we ensure every vessel in our fleet is seaworthy.
Four Pillars of Practice Excellence
As a fractional integrator and operator in the DSO space, I’ve learned that sustainable growth requires aligning leadership priorities with practice realities. This alignment centers on four critical areas:
Production Per Visit goes beyond pushing quotas from corporate headquarters. It means equipping teams with proper tools, comprehensive training, and the clinical freedom to maximize every appointment while maintaining authentic patient care. When a hygienist has functioning instruments and adequate time and training, production naturally follows.
Team Satisfaction directly correlates with patient experience and organizational longevity. Happy, supported teams stay longer, perform better, and treat patients like extended family. This requires functioning equipment, fair compensation structures, professional development opportunities, and a culture where respect flows in all directions—not just upward. This includes insurance reimbursements, when doctors are paid on time for the work they do, they naturally rise up as better leaders.
Schedule Integrity prevents the revenue hemorrhaging that occurs when appointments fall through. This demands better systems, intelligent automation, and proactive communication strategies that keep schedules full and revenue predictable. It’s about building resilience into daily operations, not just reacting to problems.
Technology & Integration means replacing patchwork fixes with unified, future-ready solutions. Stop duct-taping today’s challenges and start building tomorrow’s competitive advantages. Every technology decision should enhance both clinical outcomes and operational efficiency.
Rising Tides and Servant Leadership
The most successful DSOs understand a fundamental truth: when you elevate your practices, you elevate your entire organization. This isn’t charity—it’s strategic leadership. Servant leaders recognize that their primary responsibility is removing obstacles that prevent their teams from excelling.
I’ve witnessed the transformation that occurs when C-suite executives step out of boardrooms and into operatories. When leaders see the daily reality of duct-taped sensors and overworked team members, investment priorities shift dramatically. Suddenly, equipment upgrades aren’t expense line items—they’re competitive necessities.
The Courage to Act
The thing no one wants to say is this: if your executive brand looks flawless while your practice floors look broken, you’ve lost your way. No amount of personal “mojo” compensates for operational neglect.
The thing no one has been willing to do is harder: align leadership ambition with practice-level excellence. This requires courage to invest in foundational improvements that don’t immediately boost executive metrics but create sustainable competitive advantages.
It means choosing long-term practice health over short-term profit optimization. It means measuring success by team retention rates and patient satisfaction scores, not just EBITDA margins. It means recognizing that every broken handpiece represents a failure of leadership priority.
The Path Forward
Real transformation happens when leaders embrace servant leadership principles and commit to raising the operational tide across the entire organization. This means regular practice visits, honest conversations with frontline teams, and investment decisions that prioritize clinical excellence alongside financial performance.
The dental industry needs fewer executives focused on personal branding and more leaders committed to practice-level excellence. We need fewer boardroom strategies and more chairside solutions.
Because at the end of the day, sustainable success in the DSO space isn’t built on executive swagger—it’s built on the daily excellence of teams who feel supported, equipped, and empowered to deliver exceptional patient care.
The rising tide we create through servant leadership doesn’t just lift our boats—it transforms our entire industry.
It’s time to say the thing no one wants to say—and do the thing no one has been willing to do.
