Selling your practice to a Dental Support Organization (DSO) might seem appealing at first—promises of financial security, administrative relief, and an easier workload. But in reality, it often leads to a frustrating and chaotic experience that can ruin everything you worked so hard to build.
Many orthodontists assume that DSOs have the expertise and infrastructure to scale a practice successfully, but the truth is, most struggle with profitability, operational efficiency, and maintaining a strong patient experience. In this chapter, I’ll break down why selling to a DSO is a decision I strongly advise against unless you’re at the very end of your career and ready to walk away completely.
The Downside of DSOs: A Recipe for Disaster
1. They Create a Mess of Your Office
Once a DSO takes over, the practice you built starts to feel unrecognizable.
They bring in their own management team, often with little to no experience in orthodontics.
Decisions that used to be made in minutes now take weeks or months because they have to go through layers of corporate approval.
Patient care and office culture suffer because the DSO focuses on cutting costs, not delivering great treatment.
2. Poor Management = Bad Employee Morale
DSOs operate with a high turnover rate in key positions, from office managers to regional directors. This creates an endless cycle of:
Inconsistent leadership—new managers come in with new ideas, then leave before they can execute.
Disengaged employees—staff members lose motivation when they feel like their concerns aren't heard or addressed.
Lower-quality patient care—when employees feel unsupported, patient experience declines, leading to negative reviews and lower referrals.
3. Financial Struggles & Broken Promises
Most DSOs today are not as financially stable as they appear.
Many borrowed heavily when interest rates were low and are now struggling to keep up with payments.
Because of rising interest rates, many DSOs are scaling back, restructuring, and even shutting down locations.
They often fail to reinvest in marketing, staff training, or patient experience, which directly impacts revenue and growth.
When you sell to a DSO, you’re often contracted and compensated based on growth metrics—but if they don’t pay the marketing bills, your growth stalls, and you never see the money you were promised.