A dental service organization approached me about eight or nine years before I actually sold my practice. They wanted to buy in as a partner, purchase a portion and work alongside me. I turned them down. I had built Mountain Springs Dental from the ground up, starting in a single rented treatment room from my childhood dentist. I liked owning my own business. I wasn’t ready to share it with anyone.

Fast forward to when I was finally ready to retire. My plan had always been to sell to my associate. He was a good dentist, the patients liked him, and it felt like a clean handoff. But when the time came, he couldn’t put together an offer. That door closed, and I had to figure out what came next.

I remembered the guys from the DSO. I had run into them a few times over the years and always liked them. So I reached out.

How the deal actually worked

I had an acquaintance from a business group negotiate the sale on my behalf. That turned out to be a smart move. He got a significantly better offer than I could have negotiated on my own. The DSO purchased 60% of my practice. I retained 40% and stayed on as the doctor-owner.

Their standard model was for the selling doctor to stay on for three years while they brought in a second doctor to learn the practice and eventually buy out the remaining share. I knew going in that I wanted out sooner than three years. We negotiated six months, contingent on them finding two doctors to replace me.

That contingency ended up stretching my timeline considerably.

My associate chose not to stay. He had worked for a DSO in another state before joining me and it had been a bad experience, so he wasn’t willing to take that chance again. I totally understood. But without him, the DSO needed to recruit from scratch.

The first doctor they found was excellent. Patients took to her right away. Then her husband got transferred and she had to leave. The second took longer to find. The third, the one who finally completed the two-doctor requirement, took longer still. I left the day before he started. My six-month plan stretched well beyond that.

What changed after the DSO took over

Some things got better. Some things got harder. Most of it was somewhere in between.

The relief of getting out of the business side was real. Before the DSO, I was handling payroll, authorizing purchases, managing billing, dealing with insurance contracts. After the sale that was all gone. They took care of it. That freed up a surprising amount of mental energy I hadn’t realized I was spending.

Insurance reimbursement improved. The DSO negotiated better contracts with insurance companies than I ever could have on my own. That was a genuine benefit to the practice.

The specialists were a mixed bag. The DSO rotated their own specialists through our office; periodontists, oral surgeons, endodontists. For patients, that meant they could stay in a familiar office for more complex work instead of being referred out. The downside was that some of those specialists didn’t take insurance, which meant patients who expected normal coverage ended up paying out of pocket. That was a hard conversation to have.

My pay looked different on paper. Under the DSO, I was paid 30% of my own production. Before the sale, I had been paying myself about 20% of the total practice production. On the surface that looks like a raise, but I was no longer collecting on the entire practice, just my chairs. The math is something every dentist needs to work through carefully before signing.

The supply situation took adjustment. We were given a supply budget that was tighter than what we had been used to spending. They had negotiated better pricing with a specific supply company, which helped offset it. But there were moments when I wanted to order a brand I had used for years and was told to substitute something else because it cost more. That took some getting used to. We also had to order everything from the same supplier that they had the contract with. We had been using two or three different suppliers.

Losing team members was the hardest part. When the DSO came in, every member of my staff had the option to stay, but they had to sign new contracts as DSO employees. Several of them didn’t want to do that and chose to leave. We had built something good together over a lot of years. Watching that team split apart was genuinely painful. Several stayed too, which I was grateful for. But it was never quite the same as we missed our friends.

As time went on, I also lost some of my say in hiring. Early in the transition I could interview candidates and give input. That naturally faded as it became clear I was on my way out. I understood why; I was a short-timer at that point, but it was still a reminder of how much had changed.

What I’d tell any dentist considering a DSO

Go in with your eyes open. That’s the short version.

The longer version:

Read the contract carefully. Every word. Don’t skim it and don’t assume anything is standard. If something doesn’t sit right with you, negotiate it. You have more leverage before you sign than you will ever have again.

Get an attorney involved. Have someone who does healthcare contracts specifically review it and explain anything you don’t fully understand. This is not the place to save money on professional advice.

Talk to other dentists who have been through it. The more conversations you have before you sign, the better. Everyone’s experience is different, but patterns show up. Ask the uncomfortable questions.

Build a real relationship with the DSO leadership. The contract is just paper. The relationship is what determines how things actually go when something unexpected comes up, and something unexpected will come up. If you can call someone and have a direct, honest conversation, a lot of problems get solved that would otherwise fester.

Plan earlier than you think you need to. I should have been thinking about this years before I actually started the process. The timeline is rarely what you expect. My associate situation, the doctor transitions, the extended stay — none of that was in my original plan. The earlier you start thinking about your exit, the more options you have.

For me, it worked out. I got out, I got paid, and I drove to Florida with LoriAnn on my last day. But I went into it later and less prepared than I should have. If I had started earlier and planned more intentionally, the whole thing would have been smoother, and probably more profitable.

If you’re a dentist starting to think about your exit, don’t wait until the door closes on your first option the way it closed on mine. Start now. Get informed. And go into whatever you sign with both eyes open.

Have you been approached by a DSO, or are you in the middle of a practice transition? I’d genuinely like to hear what you’re navigating. Leave a comment below or share this with a colleague who might need it.

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