“Dear DSO, We Need to Talk” – A Candid Letter from a Dental Student

Midwestern Arizona class of 2020 students enjoying a cultural diversity event

Dear DSO,

We need to talk. While you’ve been courting dental students with free lunch and sponsored events, they’ve been talking behind your back. The question you should be asking yourself is if what they’re saying is true.

Are your office managers approving and denying treatment plans? Are you sure? Do your regional managers encourage dentists to hit production goals or risk losing their job? Is your marketing team hard at work cooking up ways to attract new patients while existing patients leave for greener pastures?

Dental students have a running list of the “good” and the “bad” DSOs. Our young adjunct faculty are only too eager to share their experiences with us. We study past litigation against various DSOs in our ethics classes and we hear from recent graduates at our schools about what it’s like to work in your offices.

The good news is, it’s not all bad news. In fact, many of us plan to work for a DSO as soon as we graduate. But most of us have a good idea of which companies we will avoid when we hit the interview circuit. Much of what we care about centers around the following:

  • Autonomy
  • Patient care
  • Continuing education
  • Professional working environment
  • Financial incentives


Many of us chose to become dentists because we want to be in control of our professional practice. We don’t want someone else telling us what to do. After all, we went to dental school and spent countless hours learning to treatment plan so that we could provide the best possible care for our patients.

DSOs that empower dentists to practice in accordance with their own professional judgment will see less turnover, and higher quality applicants. I’m sure recent graduates are cheaper to employ, but they also tend to be slower, with less clinical judgment. It seems to me that many DSOs could benefit from keeping more senior dentists in the office.

There are plenty of dental students who would rather leave the task of running a business to a DSO so they can focus on dentistry. But these young dentists have options, and they won’t stay with a DSO they feel curtails their professional growth and development. Give your dentists some breathing room and you’ll likely see a better ROI than if you pressure them to perform.

Patient Care

Ask most dental students why they wanted to become dentists and they will tell you it’s because they want to help people. Human interaction is the name of the game in dentistry, and most of us want to go home feeling like we improved our patients’ lives.

DSOs that allow dentists the autonomy to treat their patients will see a tremendous return on their investment. We want to do great work, and we really do want to be productive for you. Allow us the freedom to figure out how to do both without compromising our values.

Continuing Education

Many new dentists have great aspirations for learning more advanced dentistry after they graduate. Some of us plan to focus on one treatment modality or another in practice; whether it’s root canals or implants, many dental students plan to pursue continuing education.

I have heard from many recent graduates, and those looking for jobs currently, that they refuse to work at a DSO that won’t allow them to perform a certain procedure. They have spent the last two years cultivating a skill, and they don’t want to forget everything they’ve learned by working somewhere that doesn’t allow them to grow.

Some DSOs offer great continuing education courses. I know that many of my colleagues are excited by the possibility of working for one of these companies. We all aspire to be great dentists someday, and the thought that our employer may foster that ambition makes it seem like we are both working towards the same goal.

Professional Working Environment

I have heard of office managers who denied treatment plans from dentists. A good friend of mine once complained that her assistant denied her request to attend a wedding the following month. Another young dentist I know once griped that her office manager refused to order most of her preferred dental materials.

We hear these stories as dental students, and it scares us. Many of us went into dentistry to avoid exactly these kinds of horror stories. When our colleagues tell us about the low morale at the office they worked in, we naturally avoid applying there.

I have no doubt that there are plenty of recent graduates applying every year for virtually every DSO. But, the best candidates are those who are informed, in the loop, and passionate about their future. They also tend to have plenty of options. If you aren’t on the good list, then you may be attracting all the bad applicants. Cultivating your image in the dental student community could be a huge boon for your bottom line.

Financial Incentives

We graduate today with more debt than any generation in history. Moreover, dentistry is the most expensive degree program in the nation. Dental graduates are encumbered with a tremendous debt burden, and they are often desperate to find work.

When people are desperate, they do things they might later regret, like taking a job that doesn’t pay well or offer decent benefits. Regretful dentists soon become resentful dentists, and this can ultimately create baggage in the office. Do you think a dentist who feels shortchanged will work as hard for you as one who feels they got a fair deal?

I submit that the majority of dentists who are happy with their pay and bonus structure won’t need anyone eyeing their productivity data. A grateful dentist will be more inclined to show their appreciation by working harder. Even better perhaps, a dentist with some skin in the game and the ability to win will almost certainly give it everything they’ve got. We tend to be high achievers, so give us something to work towards and a real possibility of success.

Room for Improvement

Good or bad, you can always improve. Dental students largely see DSOs as a place of temporary employment for training and development. As DSOs occupy a larger share of the market however, more dentists will find themselves employed in a corporate office.

I always compare the dental profession the restaurant industry. Many restaurants are corporate franchises. Some are still owned and operated by a single person or family. There is room for both, but both cater to different needs.

That said, most people don’t aspire to work at McDonalds. However, many corporations do aspire to be like McDonalds. Clearly, the wants and needs of the employees may not line up perfectly with those of the company.

If your company doesn’t mind being the training ground for recent dental graduates, then there’s likely nothing I can say here that will change your mind. In fact, I’m not sure there is any reason that I should try to. You are already likely aware of the additional costs associated with legislative oversight of our profession and the threat of litigation that brings.

If, on the other hand, you want to attract the best candidates to work in your offices, then you have to think like your dentists. When dentists are happy, so too are the patients. When patients and dentists are happy, then so are the support staff. When people are happy, they work harder and complain less.

A Tale of Two Retailers

A 2006 article in Harvard Business Review article compared Costco employees to their Sam’s Club counterparts. They found that although Costco pays employees more, Costco paid only $3,628 per employee turnover compared to $5,274 at Sam’s Club. With a 44% turnover rate at Sam’s Club versus just 17% at Costco, HBR calculated that Costco spent $244 million annually while Sam’s Club spent $612 million.

Diving deeper into the numbers, we find that Costco has one of the lowest rates of employee theft in the retail industry. Furthermore, Costco generated nearly as much revenue ($37 billion) as Sam’s ($43 billion) with 38% fewer employees. In fact, Costco generated roughly $21,805 in operating profit per hourly employee while Sam’s generated just $11,615.

If your employee dentists see you as one of the good DSOs, then you are likely performing better on all metrics than one of the bad ones. It isn’t just about making dentists and support staff feel good, it’s about your bottom line. A company that has a good reputation will attract higher quality applicants who consistently provide better results.

About the author:

Richard Dawson is a 3rd year dental student
at Midwestern University in Glendale, Arizona.
He runs a website for current and future dental
students at www.dentalschooldigest.com.


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