Here’s the One Trait That Can Predict a Successful DSO Leader

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When everything is done right, the synergy between
effective treatment and organizational efficiency
fosters a thriving practice — and community trust.
By: Dr. Eric Roman

Here’s the really cool thing about leading a DSO: if we do our jobs well, we bring our patients happiness, benefit our profession, and secure a successful business. 

This kind of alignment is rare.

When everything is done right, the synergy between effective treatment and organizational efficiency fosters a thriving practice — and community trust.

In one of the dental groups I built, we initially served 1,000 people per year, then 5,000, then 10,000, and eventually over 100,000 annually. We innovated the customer experience in a way that our patients enjoyed and extended these innovations across a multi-location platform, introducing something new to the market.

But the best feelings from the journey came from an unexpected source: serving my own team. This is a huge part of building a DSO and isn’t talked about enough. In fact, those who don’t enjoy serving their “internal customers” — their team members, other practitioners, or partners — often find the journey extremely draining.

Many tap out.

I’ve coached DSOs worth billions of dollars and noticed a key differentiator among those DSO leaders who succeed and those who don’t.

Those who thrive generally enjoy interactions with internal teams. As they grow and scale their business, the focus quickly shifts to other people and leaders, significantly changing their role from that at a single location.

These leaders discard preconceived notions about success. Namely, they rid themselves of the notion that success is defined by what they do with their hands. It’s like a high-level athlete moving from the playing field to the front office. A good day’s work is no longer defined the same way, and that can take some getting used to.

Like many early-stage practitioners, I initially believed my success came from the care quality I delivered. This was everything to me. But as we grew, the predictors of my success shifted: I recognized that success now depended on my ability to empower and develop others.

If you cling to your old definitions of success, you obstruct yourself. You’ll fail to develop other doctor leaders, strong mid-level management, and elevate successful executives.

Your company might grow to a point, but it will always rely on a single individual. This isn’t sustainable.

It’s possible for leaders to make this shift if it doesn’t come innately. But they need to be honest with themselves.

Do they genuinely desire to make the necessary changes for growth — to go from high-level athlete to high-level front office executive?

In this self-reflective stage, I encounter three types of leaders. There are those who realize they don’t want to change, those who say they want to but deep down don’t, and those who genuinely want to change and are intentional about doing so.

For those in the first category, a solution is to bring in someone who does like interacting with others. This can be challenging, as the new person often holds significant authority in developing others, which can bruise the ego of the original leader. However, I’ve seen clients manage this fit.

It’s not as easy for those who fall into the second group. The DSO journey is littered with leaders who expressed a desire to help others develop, but couldn’t get out of their original comfort zone.

The key takeaway here: be honest with yourself from the jump.

Equity is a powerful tool to fuel growth, but it can also be the downfall of your company if not handled correctly.

The equity model I created aimed to offer my partners the benefits of ownership without the loneliness and risks. We leveraged brainpower and support from others, so if someone had an unexpected life issue and couldn’t contribute as much, others would pick up the slack.

My model turned my partners into multimillionaires, which was more satisfying to me than my own earnings. It helped my business grow in ways that, without it, wouldn’t have been possible. It also provided growth and opportunities for managers, executives, and leaders who weren’t dentists, which was life-changing for them.

But equity also comes with risks. Building a model for it is only part of the challenge; operating it successfully is what really matters. I’ve seen many cases where someone put an equity model in place, only to find out later that they can’t transact as they intended.

I recommend this guide by Pulse Equity to understand the table stakes. Pulse is an equity management platform focused on dental and medical practices. It streamlines the equity process and makes it transparent — this is crucial when you’re trying to grow your business with integrity.

Everyone needs to come into the equity process with their eyes open. When that happens, we can serve patients, grow our business the right way, and serve our “internal customer” — our team members, other practitioners, and partners.

For many of us, that’s what makes working in this field worthwhile.


Written by Dr. Eric Roman.Dr. Roman is the quintessential “dentist entrepreneur”.   He has lived the “DSO life” and juggled every conceivable role along his journey building and exiting two wildly different dental groups.  He used that expertise to build several unique coaching ventures, train a community generating over $3B per year through the Dentist Entrepreneur Organization, and serve dozens of software and support organizations as a key opinion leader.  His current ventures focus on helping our leaders and teams experience the life satisfaction they’ve always wanted but have found difficult to balance against their exceptional work performance.  From founding through exit and every operational modality in between, Eric has uncanny wisdom and a unique approach to offer our industry.  Find out more at and