Should you join a DSO?

By Dr. Shilpy Bhandari 

A review of the current trends regarding Dental Service Organizations and the key factors to consider before joining.

Gaining popularity in the US, dental service organizations (DSOs) are professionally run companies that manage the non-clinical aspects of multiple dental practices. 

However, when considering joining a DSO, it’s imperative to make a fully informed choice on how a DSO would impact your practice. In this article, we’ll review recent developments in the industry and weigh the pros and cons of joining a DSO.

Responsibilities of DSOs

Services that DSOs provide include: common branding and marketing; quality assurance; human resource management; financial support, and centralized supply of materials. They also provide IT support, access to a legal team, risk management, recruitments, payrolls, tax services, and maintenance support. Since DSOs manage several dental clinics, their operations are streamlined, and administrative costs are pooled.

Rising popularity of DSOs

In the US, DSOs have been growing in popularity since the 1990s, causing a decline in solo dental practices. According to American Dental Association’s Health Policy Institute survey, the share of solo dental practitioners declined from 65% in 1999 to 50% in 2019.

DSOs can be a seemingly popular career choice for dentists, especially among recent graduates. This decision could be driven by student debt, limited knowledge of running a solo practice, and higher potential patient footfall (including from Medicaid patients).

Trends in the DSO Industry

  • Higher adoption of DSOs among females: According to the American Dental Association, 10.4% of US dentists were affiliated with DSOs in 2019. Female dentists were more likely to join DSOs at 13.3% of all female dentists, compared to 8.7% among male dentists.

  • Faster adoption of advanced technologies: DSOs are increasingly using new technologies to differentiate from solo clinics. For instance, DSO Dental Care Alliance recently entered an agreement with Biolase to expand laser adoption in dental offices across the US.

  • Agile management: During COVID-19, several dentists had to shut their clinics completely due to economic uncertainty and fear of the virus. DSOs quickly developed strategies and led the recovery process by the adoption of teledentistry, and effective deployment of support systems. With pooled marketing and IT support, they were effectively able to communicate their dentists’ availability and safety measures adopted in their clinics.

Consider This Before Joining a DSO

Things to consider before joining a DSO

  • Terms and policies: Dentists planning to join a DSO should evaluate the terms and policies of the DSO. These may include money collection procedures, turnaround time for scheduling and confirming of appointments, and metrics used by the DSO to track growth (e.g., patient footfall and overall utilization percent­age). Dentists should ask about the patient flow in their area, the process of assigning patients, the role of third-party payers, dental materials used and equipment available, choice of laboratory services, and incentives provided.

  • Dental team members: Dental team members comprise associate dentists, assistants, hygienists, and front office personnel. It’s important for dentists to know about their involvement in hiring of the team, previous work experience of team members, and trainings available for the team. 

  • Clinical roles and responsibilities: Before joining a DSO, dentists should understand their clinical roles and responsibilities. This may include aspects such as freedom in treatment planning and decision-making for patients.

A joining bonus may come in exchange for a long-term contract with the DSO. The terms and conditions of signing the bonus need to be understood clearly as they may include repayment clauses.

The dentist should also enquire about additional benefits offered by the DSO such as: health care; retirement; sick leave; maternity leave; relocation assistance; life insurance; daycare reimbursement; continuing education reimbursement; and disability insurance.


The Pros and Cons of DSOs


  • Efficient use of resources: Since DSOs manage several clinics, the administrative costs of running dental clinics are optimized, leaving dentists to concentrate on clinical aspects.

  • Reduced capital risk: DSOs provide capital investment and financing for the clinic, eliminating the need for the dentist to invest in the practice.

  • Adoption of advanced technologies: DSOs equip clinics with the latest dental technologies such as digital X-rays and cameras, intraoral cameras, CAD-CAM, laser, implants, cloud-based patient management software, and other software to manage patient appointments, insurance claims, and accounting. These improve the standards of patient care, and save time and effort.

  • Quality assurance: DSOs set high clinical auditing standards and hire third-party auditors. Regular quality audits prevent fraudulent activities and ensure consistency of service across clinics.

  • Affordable services for patients: DSOs benefit from economies of scale as they pool administrative costs and procure equipment and materials in bulk, effectively reducing the running cost of the clinic. This helps DSOs offer services at competitive prices.


  • Predatory pricing: As DSOs enjoy economies of scale and have pooled costs, they often offer lower rates of services compared to solo clinics. They are accused of driving down prices for the entire market.

  • Opportunity loss: The downside of associating with DSOs is that in the long run dentists may find it difficult to create a name for themselves.

As DSOs continue to expand, they’re likely to be omnipresent--either as partners or formidable opponents. Dentists should weigh their options and chalk out a clear strategy of using DSOs to their benefit. It’s best to do some homework before joining any DSO, so you don’t end up stuck in a bad contract. Know what you do and don’t want for the future of your practice and use that as the guide before making any decision on joining a Dental Service Organization.

About the Author: Dr. Shilpy Bhandari is an experienced dental surgeon, with a specialization in periodontics and implantology. She received her graduate and postgraduate education from Rajiv Gandhi University of Health Sciences in India. She is interested in evidence-based academic writing and has published several articles in international journals.

The information contained in this, or any case study post in Incisor, should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 3250 Airport Way S, Suite 701 | Seattle, WA 98134. Please print a copy of this posting and include it with your question or request.
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