Chapter 23: Beware of Selling to a DSO

The Downside of DSOs: A Recipe for Disaster

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.