2019 Recap & 2020 Predictions from 18 Dental Support Industry Thought-Leaders

Read the COVID UPDATE that was provide in September – HERE

2019 was one of the most active and exciting years in the DSO segment of the dental industry. The dental support model cannot be ignored any longer. We saw some large transactions and acquisitions and a plethora of emerging dental groups surface. Retail became a logical point of access for dental care with Aspen Dental’s partnership with Walgreens, Smile Direct Club’s creation of SmileShops in CVS stores, and the opening of the first Walmart Health location in Dallas, GA.

Group Dentistry Now reached out to several DSO thought leaders for their insights on 2019 and, more importantly, what they think the future has in store for the dental industry and the DSO model. Below are their thoughts.

Roshan Parikh, DDS, Head of Dentistry at Walmart

DSO transactions and subsequent consolidation continue.  Mid-Atlantic Dental Partners started 2019 at 16 locations and ended the year at 300+, unreal.  North American Dental Group’s transaction with European capital coming into the US market to form the first trans-Atlantic DSO is neat to see as well. 4Q 2019, SmileBrands, American Dental Partners, amongst others, are on the market for recapitalization.  Dental Care Alliance should be next to the market soon.

2020 – many of the 2014 and 2015 DSO private-equity investments, combined with as much dry powder as private-equity funds have waiting on sidelines, seems to suggest that there will be a significant number of DSO transactions in 2020, whether that is a first investment in or a recapitalization of older investment capital.  2019 saw an overall drop in healthcare investment transactions and in today’s era, with fewer publicly traded companies than ever as well as more privately held companies, with all of the mega-funds raised, and a bullish end of 2019 of the stock market, it seems like a perfect storm coming to a head here as 2020 begins.

Walmart Health opened our first location in September 2019 and just opened our second location in January 2020.  As much as retailers have spoken and/or have been rumored to be thinking about entering the realm of healthcare, Walmart became the first big-box retailer to enter the murky complex waters of US healthcare.  Not only offering convenient hours (open 7 days a week), but also offering multi-modality healthcare by having medicine, dentistry, hearing, vision, labs, mental/behavioral health, all with transparent pricing that follows Walmart’s mantra of Everyday Low Prices (EDLP) can really revolutionize healthcare and convenience, the way we think of it today.

Overall, dental continues to not only consolidate but also continues to generate more and more eyes from all walks of healthcare.  Kaiser Permanente and Walmart both speak about how dental patient volume actually drives medicine versus the other way around.  Combine that with all of the oral/systemic correlations that are continuing to be deepened in terms of understanding, makes dentistry more and more common dinner table and water cooler conversation.

Mark Hodge, DMD, Clear Aligner Consultant & KOL / Keynote Speaker & Dental Educator / Founder & Director, Alignerology.com

2019 was pretty much “business as usual”: the big got bigger; and the pond, middle level of DSOs grew broader.  Digital scanning technology transitioned from the category of innovative to mainstay. In the business world:

  • Increase in variety of dental delivery systems: DTC, retail (Walgreens, CVS, WalMart); tele-dentistry (Dental Monitoring, MouthWatch); non-traditional (TEND, FlossBar, Henry, SwankySmiles). Some DSOs dabbled in the arena of alternative delivery systems, but no one making any big bets just yet.
  • 3D printing continues to make rapid inroads in various manufacturing and healthcare sectors with Carbon 3D at the forefront.
  • Private equity is struggling to find places to park cash as their appetite for cash-burning IPOs focused on growth over profit wains.
2020 “Predictions”:
  • DSO marketplace has talked for years about being “ripe for roll up”; but cultural differences among DSOs introduce costly inefficiencies and hidden costs.  Perhaps the roll up opportunity is not within enterprise level DSOs, but cross-sector roll ups (similar to CVS/Aetna).  The glut of PE money looking for a new home could be a catalyst to this, if a key player as both strategy and track record.
  • Mid-level providers (dental therapists) progress slowly in gaining regulatory acceptance.  Who will be the first DSO to incorporate dental therapists into their strategic planning?
  • If FDA approves NIR technology for scanners, I predict non-traditional dental models (DTC & retail) will be more nimble and the earliest adopters will scale.
  • 3D printing will begin to scale beyond in-office technology.

David Branch, Principal at Viper Equity Partners

The year of 2019 was again another interesting time for the dental consolidation market. It marked the first time since 1995 that new smaller DSOs showed more growth than the industry staples like Heartland and Aspen Dental in terms of acquisitions. Competition has become fierce and the sellers are more educated in terms of deal structure. This paved the way for DSOs that are willing to pay multiples in the five-seven times range while offering ownership and attainable earn outs to easily “win” deals away from companies not willing to evolve.

Another interesting change was the age of the dentists joining DSOs. 2019 saw a younger seller market take shape throughout the year with doctors from the mid 30s to late 40s becoming a huge part of the sales. A key factor here was the ability for a younger seller to stay with the DSO longer, thus having a potentially huge exit payoff when they liquidate their stock. However, many of today’s DSOs are bloated with dentist partners in their upper management, which is very interesting to many sellers looking to come out from behind the chair and grow within the organization. A true win win for all parties.

This coming year will see the same trends from 2019 with one area really taking shape, practice roll-ups. Investment bankers have identified this area as a huge opportunity for all parties. Putting together 10-15 offices with between 5 and 10 million dollars in EBITDA makes a lot of sense. Depending on whether the group is integrated, and to what level, will determine the boost in value the group would get from the buyer.

Another big change will be a push further away from Medicaid offices. The risk factors and lack of understanding of that market has just become unattractive with private equity backed DSOs. The real action will be in the regional DSOs backed by family office money and the “one specialty” buyers. The deal flexibility allowed by family office money and the low competition in specialty buyers will pave way to huge wins for those operators.

Lastly this will be an important year for recap events as the market will need to see strong numbers across the board.

Gary J Pickard, Senior Director, Government & Industry Affairs, Pacific Dental Services

2019 was a banner year for PDS. I expect more of the same for 2020. We’ll continue our practice of service, giving back to communities, and our growth and expansion is most likely to accelerate, opening as many as 100 de novo locations, and adding roughly as many new owner dentists to our family. This year we’ll also be cementing our position as a leader in medical dental integration with the implementation of Epic’s dental practice management system into our ecosystem. I expect more dentists and patients to integrate, and a greater expectation by patients of such integration. The link between oral health and overall health is undeniable. We’ve seen several other organizations move in this direction as well so we’re likely to see massive progress over the next twelve months.

It’s hard to say if this is why there’s been so much discussion nationally about dentistry, but I think we’ve played a part. Our Founder & CEO, Stephen Thorne, has supported a broad coalition encouraging the addition of medically necessary dental care to Medicare. The United States House of Representatives passed a bill last year approving the addition of dental. If the American public interest is great enough and they convince their Senator of its importance, it could become a reality, increasing access to millions of seniors.

This year could very well be the year of disruptors. New delivery care models appear to have been embraced by the masses, spurring new and unique partnerships. I think there will be greater experimentation and early adopters following a few key leaders. Technological advances are helping to drive this change, improving patient experience, transparency, and ultimately patient access and care.

Steven Jones, Co-Founder & Chief Development Officer at CORDENTAL

Last year brought an acceleration of change in the dental industry and I foresee 2020 continuing that momentum.  From an industry consolidation perspective, the pace seemed to increase significantly in 2019 compared to prior years.  There were more privately-owned practices joining forces to form small group practices within local communities.  Not only does this provide more leverage and exposure within the local marketplace, but also creates more value for the owners as they look for a future transition.  There was also significant consolidation within DSOs in 2019.  We acquired AppleWhite Dental Partners and profoundly changed the face of our company, solidifying our position as a strong competitor within the DSO arena.  North American Dental Group joined forces to become the first transatlantic dental group, Mid-Atlantic Dental Partners acquired DentalOne Partners to create one of the largest U.S. DSOs, and Smile Brands made a significant investment in DecisionOne Dental Partners to become the first DSO to act as private equity for another DSO.  I believe the pace for consolidation will continue in 2020 and the competitive activity will be greater than ever.

Another trend in 2019 that didn’t come as a big surprise to me was the entry of Walmart into the dental space with the introduction of comprehensive dental clinics at Walmart Health.  Coming from a background in both the pharmacy and medicine industries, I navigated consolidation in those spaces for years.  Eventually the large companies such as Walgreens and CVS became the primary consolidators.  Not only did they acquire the “mom and pop” retail pharmacies, but also became diversified by opening some of the first walk-in clinics and became large players in the pharmacy benefit management space.  Walmart is following that trend in dentistry and I wouldn’t be surprised to see other large players following closely behind.

I believe the focus on the patient experience, as well as expansion of products and services to create a one-stop shop, will be key in 2020.  Consumers are becoming more demanding regarding what they want from providers and overall experience and ease of delivery will be imperative.  Continuing to adapt to the ever-changing social media marketing efforts will be very important, as well as better management of the online review process.  We have entered a new decade and to be a key player in the dental industry we need to remain diligent in our efforts to provide the highest quality of care to our patients in a way that supports the fast-paced environment in which we all live today.

Brian A. Colao, Member & Director of the Dental Service Organizations Industry Group at Dykema

The year 2019 was a very busy and important year for the DSO Industry and the Dykema DSO Industry Group.  Some key highlights are:

1)  The conventional DSO model has gained nationwide acceptance and the evolution and consolidation of dentist operated single and group practices into DSOs has continued at an explosive pace all across North America with hundreds of transactions closing in 2019 and many others expected to close in 2020;

2) DSO investors are becoming increasingly more sophisticated and selective with a clear preference for regulatory compliant organizations with efficient operations and  a strong culture.  Sellers that struggled with compliance, operations or culture received much lower returns;

3) 2019 was also the year of the alternative DSO as many alternative models to conventional DSOs made their mark with innovative  technology platforms, the use of teledentistry and direct to consumer marketing models designed to tap into the 60% of the population that doesn’t go to the dentist.

The things to watch closely in 2020 are 1) whether the threat of recession will impact the explosive M&A market; 2) whether alternative DSOs will continue their growth; 3) whether the emerging Canadian DSO market will continue its fast paced growth; and 4) new innovations and developments in the fast growing direct to consumer marketplace.

Darin Acopan, EVP/Partner at DEO: The Dentist Entrepreneur Organization

2019 was a year of continued consolidation in the dental marketplace, with ample opportunities for all involved in the DSO/emerging group practice space. Not only are more and more solo practitioners making the expansion leap to becoming a group practice, large group DSOs hit record numbers last year.

The financial marketplace and economy will guide the strategies of group practice owners for 2020. Group practices will have to look towards building excellent long term businesses rather than quick flips. The days of investors overpaying high multiples for somewhat fragmented platforms is gone. Further, a downturn in the economy will actually be beneficial for dental groups as they are currently struggling to find quality team members to staff their growth. Higher unemployment rates will improve the labor pool.

More solo-location owners will realize that it makes sense to build a group. The economies of scale and having an associate or at least partner-driven group is superior to going it alone. This will fuel a need for additional education and leadership that teaches owners the dos and don’ts of scaling a group practice. To be a successful and competitive DSO/group practice, now more than ever you have to continue to invest in learning and development for yourself and your key team members.

Attending live events, webinars, and being part of peer-to-peer support communities are essential to sharpen your skill set and learn from others as to what works and what doesn’t. There is no playbook for scaling a dental group so you become the average of the people and communities you spend the most time with.

John Reaves Whitaker SHRM -SCP, ATM, STA, SVP and Chief People Officer at Sage Dental

The age of innovation kicked off in earnest in 2019 and I don’t expect the brakes to be tapped any time soon. Increased use and application of laser technology, 3D impressions, improved practice management software, multiple orthodontic treatment plans and, of course – the continued trend toward group practice models. There’s no shortage of advancements in the craft; the caution is assuming too many initiatives simultaneously.

But before we get too fat & sassy, there’s a challenge we all continue to face– no matter the new toys and technology, it’s still about the people – and the people are getting more difficult to find. 2019 was a landmark year in the availability of talent and 2020 promises to be the same. With unemployment at a generational low point, open positions outnumber available talent. I know wewe are re-assessing our branding message, our offering, the candidate experience and the employee experience.

In an industry that ultimately relies on patient care, there can be no bigger priority than finding the right people and locking them down.

Heidi Arndt, Chief Operating Officer at Strive Dental Management

The DSO space continues to be a very hot space within dentistry.  In the past 12 months, I have seen a rapid increase of “new” investors.  Most of these investors are private equity, and most of them are new to dentistry.  These investors are getting more and more aggressive, and often doing cold outreach to find a partner within the dental space.  Most of these new investors will enter into partnerships with emerging or mid-size groups.

Amalgamated or “duct tape DSOs” will continue to pop up rapidly all across the country. My definition of this is a DSO that accumulates locations to increase their EBITDA, with little focus on creating infrastructure to support organic growth, limited consistency and typically one doctor owner that may or may not be involved in the day to day operations of the organization.  They are buying EBITDA instead of focusing on organic or same store growth.

I do not see these amalgamated groups as sustainable organizations and many will most likely fail.

I believe we will continue to see the elite (large) DSOs flourish.  These DSOs have the leadership, the infrastructure and “know how” to drive organic growth and to sustain any volatility in the market.  I also predict you will see these large DSOs acquire some of the strong mid-market and emerging groups that exist today.

In my 18 years of DSO experience, I believe that dentist led organizations are the most likely to succeed.  Doctor led does not mean that a doctor needs to be the CEO or the COO, but rather requires a doctor to actively lead and direct the doctor group or PLLC.; and have an active seat/role at the management level.

Why?  The groups that are losing value and struggling to grow are the ones that have leadership that is predominately led by non-clinical leaders.

In summary, 2020 will have a lot of movement just like the past few years.  However, I do believe you will start to see more and more DSOs struggling and some that ultimately fail.

Aziza Abed, Founder & CEO at PURE Health Dental

2019 – what a year for some of the larger DSOs!  Positive transformations across the board! 2019 was the first full year for PURE Health Dental and I am happy to report a much successful one. We have centralized services and established platforms to set us up for continued organized growth in 2020!

In 2019 many of the smaller to mid-size groups most likely were approached by PE or larger DSOs for acquisition.  I think the ones wanting to sell, may have done so already or are in midst of negotiations.  The groups wanting to create a legacy, able to maintain a positive profitably and are passionate about what they have built are not looking to sell, rather maybe looking to expand with other groups sharing similar philosophies and values. I think we will see more of those types of consolidations in 2020.

I believe 2020 will be a challenging year for doctor recruitment.  Many of the larger DSOs are offering hefty sign on bonuses as well as large ($200,000+) annual guaranteed salaries with additional production bonuses.  The industry has become extremely competitive in that respect.  Unfortunately, doctors are typically going with the highest bid versus looking at the overall picture, which is creating a struggle for the smaller DSOs.

Chris McClure, Chief Operating Officer, Aligned Dental Partners

2019 was another big growth year.  Research estimates 22% of dentists are part of a dental group practice or DSO and from our experience that number continues to grow.  That number has doubled since 2010.  With this increased trend, there has been an increased awareness and acceptance by dentists of DSOs and group practices.  Most dentists we talk to have a positive outlook on being associated with a group or DSO. This mindset has shifted over the past five years.  While there are three categories of dentists today:  solo, group practice and DSO we clearly see distinctions being made between the large top twenty “corporate” DSOs and the rest.  The DSOs of ten plus years ago are now well established within their models and are generally looked at as “corporates.”  Being part of a group practice or DSO is now the new shiny trinket and the “cool” place to be for entrepreneurial dentists today.

With the rapid increase, groups and DSOs are now experiencing increased challenges with recruitment for high quality doctors, motivated clinical and operational staff, and experienced business professionals.

More and more groups are turning to outside advisors to recruit key employees or provide training to develop the organization.  Additionally, there has been a large increase in professional services firms which specialize in supporting group practices and DSOs.  There has also been a large increase in legal and accounting firms that cater to this segment of the market.

2019 saw a heightened level of interest from new PE firms pursuing investments in the DSO space. Expectations of sellers has become inflated with many groups posing substantial risk for an investor.  There has been an increase in the number of brokers pushing to create transactions and exits with PE firms.  2019 transactions have shown that investors are most attracted to Groups and DSOs with strong infrastructure and stability prior to making an investment.

2020 is poised to be another growth year with the continuation of these trends.  The key trend to watch will be the state of the economy and the likelihood of moving towards a recession.  Should that occur, businesses that are not well capitalized will see challenges in continuing their growth.  If the lending environment tightens, groups will need to have increased focused on initiatives to maximize organic growth.

Mike White, CPA, Principal, Health Care, CLA (CliftonLarsonAllen LLP)

As we reflect on 2019 and the exciting year that it was I am more excited about 2020 and the flurry of activity that is already starting off the year.  I believe this year is going to be a bigger year with merger and acquisition activity and we will continue to see further consolidation amongst the industry.  I believe we are in the early to middle phase of the five to seven year run on consolidations that has been discussed at the conferences each year.  Although there are no firm stats in the marketplace today, I think we will crest the 20% consolidated mark if we haven’t already in the next 12 to 18 months.  With financing rates continuing to drive good valuations we are seeing existing platforms continue to expand their footprint and new investors that are still seeking to get into the market place.  Further I am seeing more activity in the specialty area as the GP practices look for an encompassing practice experience and individual group consolidations of specialty come to market place. Each year we are getting more requests to help sellers prepare their books and records to reflect the best story possible for potential suitors.

With so many options in the marketplace to expand footprints we are seeing a focus on same store growth amongst existing practices and ensuring replicability amongst the DSO group as to what is driving higher valuations.  This has been a critical discussion point amongst the leaders in the industry that are seeing the growth of EBITDA through only acquisitions as one that is hindering valuations a bit.

Neil Krugman and Eric Scalzo, Waller Lansden Dortch & Davis, LLP

The DSO industry kept growing in 2019, and we expect the momentum to continue in 2020, as more private equity firms become involved.   As larger existing platforms will require bigger deals to move their acquisition needle, we will likely see an increase in larger-sized acquisitions (ten+ offices) by strategic investors.  We are also seeing an increase in loosely-affiliated groups coming  to market and expect that trend to continue.

On the regulatory front, state dental boards continue to take an interest in the operations of DSOs.  In 2019, we met with the ADA’s Commission on Practice Ownership to discuss issues we are seeing related to dental practice ownership as well as their efforts to develop model legislation for non-dentist ownership, which is currently allowed in a handful of states. We expect ADA guidance on that topic shortly.

The DSO model can also be an effective support structure for teledental products (like direct to consumer aligners), ‘smart’ dental products (like smart toothbrushes) and retail dental concepts (like dental offices located in big box stores, on one end of the spectrum, or built to blend in to upscale shopping and business districts, on the other end).  All of these concepts  attracted significant interest and investment in 2019, and we expect the trends to continue to propel DSOs into new spaces in 2020 and beyond.

Jeromy Dixson, CEO at The DSO Project LLC

In 2020, I expect to see the following expansion of characteristics in the DSO market:

  • The continued emergence of specialty DSOs. I expect that trend to continue into 2020 and beyond as investors search for “blue oceans” with less competition for rapid expansion than is found in the more competitive “red ocean” general dental space.
  • Accelerating consolidation:  Mid-market (2-25 locations) and Large (25+ locations) practice segments will see increasing consolidation, not just in 2020, but through the early half of this decade. Mid-market size is estimated at about 13% of the current dental market, and that number is expected to double over the next five years alone.  Mid-market revenue growth is expected to lead the industry as well.  (Source: Coker Capital Advisors)
  • Ongoing interest from PE investors:  With consolidation into DSOs and groups estimated at only 20%+ of the market by leading experts, the runway for significant investor returns based on expanding valuation multiples with scale, appears solid for the foreseeable future.  Dentistry is seen as a stable, profitable, recession resistant industry that continues to be highly fragmented.  This mix is exactly what investors are seeking as they explore healthcare verticals for investment.
  • Large DSOs competing with PE for acquisitions:  Based on my conversations and experiences this year, I expect to see an expansion of large DSOs competing with PE for mid-market opportunities.  Many of the large DSOs are PE-backed with significant growth mandates.  Due to the multiple arbitrage available for large DSOs (carrying a 10X-12X+ EBITDA valuation) purchasing mid-market DSOs (carrying mid to high single digit EBITDA multiple valuations), large DSOs have an opportunity to immediately add value to their existing organization when purchasing smaller DSOs.

Maria G. Melone, Managing Partner, MORR Dental Transitions

There is no doubt that we are working in a seller’s market. But the dental practice acquisition landscape is becoming exponentially more competitive: DSOs/PE firms have fully functioning development teams pounding the pavement, in addition to engaging the services of buy-side representatives; there is an increasing number of emerging group practices looking for acquisitions; the market activity has attracted new “brokers” to the space; and, there are new investor types, and investment models, looking to move into the space almost daily.

A few of the emerging, and interesting, trends I’d alert you to include more creative structures intended to attract and entice younger sellers to partner with DSOs or PE firms directly; an increase in the prevalence of DSOs offering some equity or equity-like relationship; and PE firms starting DSOs from scratch. I also expect that we will see even more vertical integration, following Guardian Insurance’s movement into and out of the DSO space, while Walmart and others are now introducing dental services within their retail settings.

Jon Fidler, Presidnet/CEO, Fidler and Associates

The continuously evolving DSO space had no signs of slowing down in 2019 and that was reflected in our searches and placements. As the large groups continue to grow their footprints and acquisitions, so too are the emerging and mid-market groups.

  • Emerging and mid-market groups are paying more attention to building a formal executive team. We believe this is due to proper advice from consulting firms, larger DSOs looking to acquire and PE firms noting that this makes the group more attractive for acquisition/investment.
  • We noted that more private equity groups with portfolios outside of dentistry (typically involved in some form of healthcare) are interested in the dental segment for investment.
  • We have seen an increase in new roles developed that are more focused on analytics in performance and budgeting.
  • And of course, the introduction of Walmart into the DSO/multi-location group practice landscape has the potential to evolve the segment.
  • We also experienced an increase of placements and searches within the specialty focused groups (oral surgery, endodontics, ortho, etc)

With the expectation of a continuously strong economy and groups having to battle for top talent, we foresee plenty of executive movement and opportunities for 2020.  This should encompass sourcing for executives from outside of the traditional dental/DSO segment taking on leadership roles as well as opportunities for high performing mid-level managers to take on more senior roles.

  • With an influx of “outside dental experience” and due to similarities in the organizational and vertical structure, we expect to see some DSOs expanding their services and interests into other aspects of healthcare (family practice, chiropractic, dermatology, veterinary, etc).
  • Accompanying the outside influence of leadership teams many more aspects and services will inevitably follow. For instance, we predict more options for emerging and mid-level groups to grow privately with financial support from banks and other lending services.

With a strong economy, continuous growth in the demand for dentistry, an increase in the number of dental offices/groups and the always increasing pressure to offer services we see that offices will continue to evolve into a “one-stop shop” for all dental/healthcare needs and integrate specialties that they may not offer as of yet.

Jake Meadows, VP of Sales, Multisite, Henry Schein Dental

Looking at the year ahead, there are few key trends we are confident will reshape the DSO industry: DSOs will continue to look for new ways to engage patients and focus heavily on enhancing digital work flows with 3D imaging and scanning. Larger affiliations will continue to grow as we are seeing both regional and national DSOs with 20 or more locations focus on the acquisition of already established, or tightly run, local DSOs with three or more locations. Recognizing procedural expansion and specialization of DSOs, Henry Schein is focused on deepening our penetration in the clear aligner, endodontic, implant and orthodontic markets.

Jerry Lanier, DDS, Founder of EntrepreneurDentist.com, MKTGdocs.com & Kids Dental Kare

My 2020 predictions:
I try to focus mostly on what affects me directly so that I can see what’s coming at me and plan accordingly. Almost everything we deal with has some political guidance or affected directly by politics.

My area of expertise is in Medicaid services for kids. This is an area where Democrats have a much stronger advocacy than Republicans. As the 2018 mid-terms showed “healthcare issues” dominated, allowing Dems to sweep ballots and these issues are still top of voters minds. I expect the Democrats to do extremely well in 2020 elections and that healthcare for the poor and middle class to get significant traction. If I were a betting man I’d bet on Medicaid expansion. Since I’m an investor I’ll just invest in Medicaid expansion and growth and expect to win big!

Vin Cardillo, Founder & CEO at Maeva Dental Advisors

In 2019, the DSO space continued to see a sharp focus on consolidation. The urge to merge continues to be enthusiastically high — the highest I have seen in my 25 years of service to our industry. Based on current movement, we believe that at least 50% of dentists will be working for a group with at least two locations within ten years. From our perspective, however, the enthusiasm to grow through acquisition must be measured and business-driven rather than simply propelled by the market’s momentum. We think of every deal as unique and every market as local: buying and selling events ought to be based on the business life cycle of both the DSO and the practice.

We believe that in many cases dental practices would be best served by growing their existing offices and their infrastructure rather than adding additional locations prematurely. Same-store growth is an excellent utilization of untapped opportunity while simultaneously providing capital for future acquisitions. Knowing when to grow organically and when to sell or buy is an empirical process if your KPIs, systems and infrastructure are established and managed appropriately. So, while the numbers may tell the story, understanding market dynamics and risk are crucial parts of this puzzle.

We see continued consolidation in the DSO industry in 2020 and for a number of years to come, but we hope that the industry will conduct smart deals based on metrics and projections rather than scale for scale’s sake.

Read the COVID UPDATE that was provide in September – HERE

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