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A recent LinkedIn post by Bill Neumann of Group Dentistry Now has reignited the conversation around Dental Service Organizations (DSOs) and their growing influence in the industry. He shared a private message he had received from a dentist expressing strong anti-DSO sentiments, highlighting the persistent divide within the profession regarding corporate dental models. The post read:
“I recently received a private message on Facebook from a dentist I don’t know. I liked a comment she made on a post in one of the dental Facebook groups, though I honestly don’t recall the topic or her comment. Unfortunately, I can’t go back to check—she blocked me immediately after sending me the messages below.
I felt compelled to share it here with my LinkedIn network to highlight something important: there’s still a vocal segment of the dental community that remains strongly anti-DSO.
I’d really appreciate hearing your thoughts on this—especially from those of you working in, with, or around DSOs.”
With more than 90,000 impressions and over 150 comments, the post quickly became a flashpoint for discussion, showcasing a wide spectrum of perspectives from dental professionals across the country.
This type of thinking was thought to be in the rearview mirror. Yet, the feedback on this post makes it clear that many in the industry still hold deep reservations about the DSO model. Whether those concerns are right, wrong, or somewhere in between, there’s no denying that, in some cases, the model has left clinicians feeling burned.
The conversation sparked by the post highlights just how nuanced and complex the DSO debate remains. Below is a selection of comments that capture the wide range of perspectives shared. For the full post, click HERE.
Real Stories from the Frontlines: Pain and Disillusionment
“As a dental hygienist who has worked at 4 DSOs (two of the largest in the country and two small and local, both on the east coast and the west coast) I can say that only one of them was better than private practice. My opinion is based on patient outcomes, safety, and frontline worker conditions. The problem with many DSOs is that they require us to sign contracts that forbid us from speaking negatively about them on social media. It is unlikely you will hear any of the real frontline stories of the worst DSOs on a public forum such as this. Also, most litigation between DSOs and employees occurs under binding arbitration so it is difficult to find publicly available documents. I have many DSO stories but all I can say is that those stories are why I am now in law school. Feel free to read between the lines.”
“I agree with her. My story is probably the nightmare of DSOs. Could not find a buyer for my very successful practice and ultimately had to sell to a DSO which pained me greatly. Was led to believe all would be wonderful for the three years they required me to work (I was 69 at the time and the thought of killing myself trying to meet the INCREASING production metrics for that time frame was not something to be taken lightly. And I was already producing 1.4M/ year as a solo practitioner). Was promised help and associates for the entire time but finished as a solo. My DSO literally went bankrupt and we were placed with a ‘rescue bank’ as the equity partners ran like rats off a sinking ship. Then came the gutting of my staff and all supply purchases were scrutinized with a fine tooth(sic) comb. All in the name of making us saleable again. I was forced to place two different implant platforms other than my usual and it took another year to get a guided surgery kit like I HAD BEFORE! Needless to say, making the production increases was something I could or would not do at my age. Finished last September and my contract bonuses were not paid on time. Just ran out of characters allowed but much more to story.”
“I remain skeptical about DSOs, largely because of a negative experience I had. That said, I don’t dwell on it — I moved on, removed those five years from my resume, and focused on growing and trusting my instincts more quickly in the future. What’s difficult to accept is recognizing the potential DSOs have, only to see that potential consistently undermined at the corporate level. The idea itself has merit, but poor execution and greed often ruin it. Unfortunately, I am one of many who have been badly hurt by a DSO.”
“Well sure there will be dentists that won’t support DSOs. Independent dentists want to be just that – independent. Why do these comments above surprise you in any way? We work daily with dentists that feel similar – maybe not that DSOs are corrupt – but that they are a threat to their livelihood.”
“The majority of our clients feel that way. But it’s really segmented. The older they are, the stronger those feelings. The younger ones are much more open.”
The Sales Perspective: Challenges in Serving DSOs
“Interestingly, we recently sponsored a smaller event but were asked to not come as our firm name [which includes the acronym DSO], but as one of our other sister-company, because ‘the word DSO is a swear word around here.’ “
“I’ve had verbal tomatoes thrown at me in a trade booth before for repping a DSO, who shall remain nameless, more than once. It all boiled down to a misinterpretation on practice philosophies. Luckily, I’m a people person with catlike reflexes.”
“I agree. From the point of dental sales my experience discussing the DSO factor is one of disappointment for patients. The dental environment is changing with regards to the associate hiring and retention. The lack of succession plans by the DSO’s leadership is a major threat. Young graduates or the dentists that want to purchase and grow their own business is increasingly diminished. The business model is anti-excellence due to turnover; product ordering and team education is fundamentally lacking. It’s an opportunity, not a negative. My small circle of friends and relatives have left their now DSO managed practices despite decades of loyalty. Just two cents from the outside. The discounting required to achieve the preferred partnership makes servicing them non-profitable or near. The requirements for support and service are not financially viable for a long term.”
“Blanket statements are never helpful on any topic. From the over 100 DSOs I have worked with over the last 17 year’s, there are countless examples of excellent patient care, upstanding ethics, and investment into technology that helps benefit patient care and experience. Yes, they make a profit when they are successful, that is what a business is supposed to do. There is a reason many of us have built our careers in this space.”
Motivations for Independence: Dentists Choosing Their Own Path
“In my experience, every dentist working at a DSO will not dive into the experience. Those who have opened their own practice in the last 5 years cite working with a DSO as their primary motivation to do so, and to put additional care and attention into their staffing, material, and patient base. This could be a selection bias—those who were motivated to be solo practitioners would never have adapted to the DSO environment, but dentists are in the middle of a Venn diagram of doctors and artists; no wonder they value independence over sheer employment.”
“Sadly, it sounds like someone needed a scapegoat for when things aren’t working out for her or her practice.”
“Let’s talk about the hidden elephant in the room! Money, and profit. Let’s just get real. Both DSO and private practices have that in common. It’s okay to make money, no problem with that at all. Here is the difference, and I call it Forced management. When you deal with a DSO, you are forced to deal with their manager, some are awesome and leaders, while others have no clue in how to manage, it is these managers that create all the frustration. How can you tell if you have a good manager? It’s really simple. Ask them to name every team member in their biggest office, and what they do, and what they enjoy doing in their spare time. In a private office, most have culture, and the doctor usually knows the role of the employee and their name, it’s called respect.”
A Model with Momentum
“The future is DSOs. Denying the future, holding onto the past, never works… The U.S. dental service organization market size was estimated at USD 26.9 billion and is projected to grow… potentially reaching up to 70% of the industry by 2050.”
“The future cannot be stopped. Make them better, don’t make them wrong.”
“Some DSOs deliver excellent clinical care… Others do not… Now in truth—some private practices deliver excellent care—and others do not.”
“There is good dentistry and bad dentistry, good business operators and poor business operators. Neither are defined by being a private practice dentist or DSO supported dentist.”
“This reminds me of the early days representing DSOs, when ‘traditional’ dentists tried their best to outlaw DSOs making the same bogus claims… The genie is out of the bottle.”
“I predict she will be back. I have noted that many anti-DSO folks come around later when they find the model useful… It’s not right for everyone at every phase, perhaps, but it’s not going away as a viable construct.”
Defending DSOs: Perception vs Reality
“I heard Dr. Rick Workman once say to the doubters of DSOs ‘dogs bark at things they don’t understand.’”
“I talk to our clients every single day of every week. That is the prevailing sentiment among them. Right or wrong doesn’t matter. It’s the perception that counts. DSOs have an image problem.”
“So much irony here. If this doctor has a beef with DSO dentistry, they should speak to their peers about it as DSOs do not exist unless clinicians choose to work in a DSO supported environment. Secondly, many dentists restrict payer types, offer limited hour and do not want to practice in all communities where care is needed. There is good dentistry and bad dentistry, good business operators and poor business operators. Neither are defined by being a private practice dentist or DSO supported dentist. The facts remain, DSO supported dentistry continues to grow, which to me, means the value proposition DSOs offer is one that appeals to a great number of dentists that have choices about where they work.”
“It is very unfortunate that there is still a fairly small but highly vocal segment in dentistry that continues to spread a false narrative about DSOs. This is why it is critical that we all continue to educate the dental industry until these kinds of false narratives become eliminated and I appreciate everything GDN does to help educate the industry on the many benefits of DSOs.”
“I don’t believe DSOs are the problem, they are just an expected outcome of dental insurance in the country, while less and less independent Dentist take insurances it creates a vacuum for DSOs to take that market share. I have a hard time thinking that dentist come out of dental school with the dream of being a DSO dentist, however some find a home there and thrive.”
Lessons Beyond Dentistry
“We have the same issue in plastic surgery. The plastic surgeons did not protect the ‘brand’ of plastic surgery, and it quickly got commoditized. It became the best marketer wins as the prices for procedures remained the same or plummeted. The corporate entities bought the smaller practices, and the complaints from the plastic surgeons blaming ‘corporate’ persist. But the plastic surgeons are not blameless. If you don’t protect your industry brand as a whole, you can expect that your value (everything you worked to create) will be eaten up and considered ‘ordinary’ (anybody can do it), and then the corporations swoop in. For them it makes sense. For the plastic surgeon and patients… not so much.”
“It’s just a sign of the times. Everybody’s so quick to label something ‘good’ or ‘bad.’ ”
A Vision of the Future: DSOs’ Growth and Evolution
“The future is DSOs. Denying the future, holding onto the past, never works. According to all philosophies, religions, and science, the law of impermanence exists. It is a cosmic, immutable law. Nothing lasts and is always replaced by what is next. Impermanence is due to everything changing – change is the constant.”
“Given the future is AI, robotics, supply chain cost management, hiring, recruiting, deep analytics, and the rising debt of new dentists, solo practice as a segment struggle will only increase. Business costs are increasing, and in the ‘tariff era,’ they will accelerate even faster, and cost management cannot be done effectively by solo practice.”
“This reminds me of the early days representing DSOs, when “traditional” dentists tried their best to outlaw DSOs making the same bogus claims. Many state dental boards, legislatures and courts made laws to prohibit or discourage DSOs to protect traditional dentists, but they couldn’t put the genie back in the bottle given the overwhelming benefits of DSOs for patients and dentists. I met with the ADA board about their concerns about DSOs and many board members privately asked me how they could affiliate with a DSO. The profession and patients are so much better off with the great quality of care, cost-effectiveness and innovation that DSO aligned dentists provide.”
“I predict she will be back. I have noted that many anti-DSO folks come around later when they find the model useful (e.g. for strength in numbers, exit point, division of labor, etc.). It’s not right for everyone at every phase, perhaps, but it’s not going away as a viable construct. Keep on with your pathway. We appreciate you and what you and Kim do. Cheers!”
As the dental industry continues to evolve, it’s clear that DSOs will play a significant role. Whether viewed as a threat or an opportunity, their impact on the profession is profound and warrants ongoing discussion.
