DSO or private practice: what the data says about setting

Dentists who compare a DSO job with private practice often want one number: which pays more. This post shows what public data exist, and where they stop. It covers setting and career stage, what the ADA reports about autonomy, and questions to ask before signing. It does not take a side. It is general education, not career or legal advice.

How many dentists work in each setting?

A growing share work with a dental support organization (DSO), and a large share still work outside one. As of 2024, 16 percent of U.S. dentists were DSO-affiliated, according to the ADA Health Policy Institute (HPI). That leaves most dentists in other settings.

Career stage changes the picture a lot. HPI reports 2024 figures for early and late career dentists:

The early career DSO share was 24 percent in 2023. See how many dentists work with a DSO for the full series, and practice ownership trends for who owns.

What does the data say about pay by setting?

Nothing the sources here can support. None of the ADA, ADEA or peer-reviewed pages opened for this post compare dentist pay in a DSO with pay in private practice. HPI says it is still studying “whether there are differences across modalities in terms of career satisfaction, work-life balance, earnings and patient outcomes.”

Two reasons make a simple comparison hard:

1. Pay models can vary inside any setting, for example production-based pay or collections-based pay. See dental associate compensation models.
2. An owner’s pay and an employee’s pay are different things. An owner earns profit after expenses and carries risk. An employee earns a contract rate. Comparing the two takes care.

If you are comparing offers, compare the written terms, not averages. Dental associate contracts lists the terms to check.

Why is pay hard to compare?

Pay in any setting has several parts. It can include a base, a share of production or collections, bonuses and benefits. An owner’s income is what remains after expenses. Two offers with the same headline number can pay very different amounts once the formula, the schedule and the expenses are applied. This is why the ADA’s career guidance pushes dentists toward the individual practice and the written terms. When someone quotes a pay gap between DSOs and private practices, ask which source it comes from, which year it covers and who was counted.

What do dentists report about autonomy?

Control is the common theme. An ADA career article describes qualitative research with dentists working in DSOs, done while its author worked at the ADA. Some loved the model and some were eager to leave. The shared complaint was control: “The surveyed dentists wanted more control over the materials used, their own time, and, in some cases, the treatment plan.”

The same article adds a caution. It says the ADA would likely hear similar concerns from associates in independent practices, “or even in a completely different non-dental setting,” since some stem from being an employee. Those who start their own business “often do so because they want to control those standards and business practices.”

The article also says some dentists choose DSOs because they do not want to run marketing, accounting or hiring, and because the model offers regulatory support. A DSO is not the only way to reach those goals, it says, but “the business model clearly resonates with those who see their needs served.”

Does the DSO label tell you what the job is like?

Not by itself. The ADA article says some large DSOs run offices with shared processes, branding and layout, while DSOs of 10 to 30 practices may let a dentist work as a solo practitioner with full operational autonomy. It concludes: “The reality is that every practice is unique, be it DSO, private practice, public health, or another modality.”

The same applies on the independent side. Private practices differ in team culture, owner style and systems.

What does the career-stage split suggest?

The split suggests that new graduates choose group and DSO settings more often than older cohorts did. It does not say why. HPI’s ownership brief says young dentists “are practicing very differently than their predecessors,” and it lists possible factors without ranking them. See dental school debt numbers for one of those factors.

It also does not say that these dentists will stay in the same setting. HPI says it is studying how long dentists remain in a modality. The ADA article notes that some DSOs see significant dentist turnover, and that some dentists enter DSOs late in a career as an “attractive off-ramp.” Settings change over a career.

What should a dentist compare before signing?

Compare the specific office, not the category. The ADA article says to ask whether you are comfortable with the quality of dentistry delivered and how the office fits your style. This table adds contract points to check with an attorney.

The ADA article’s closing view is that “in the current market, there is room for corporate-owned dental service organizations and private practice owners,” and for everything in between. Read the DSOs and private practice guide for the models side by side.

Next step

Read the DSOs and private practice guide and the dental practice ownership guide. Contact Dr. Copeland about dental practice consulting.