What is a dental support organization? DSO basics

A dental support organization, or DSO, is a business that manages some of the non-clinical work of dental practices. The term shows up in news, contracts and job offers, and it is used loosely. This post explains the definition used by the ADA Health Policy Institute (HPI), what DSOs handle, and how DSOs differ from each other. It is general education, with no view on whether any model is right for you.

What is a dental support organization?

HPI defines DSO affiliation by what an outside entity does. A practice is affiliated “if some outside entity manages some or all of its non-clinical functions such as billing, marketing, human resources, etc.” Non-clinical means work that is not diagnosing or treating patients.

Size does not decide it. The ADA’s chief economist, who also leads HPI, said that “DSO is not about the size of the practice, or the number of locations a practice has but rather about a particular type of business model.” A single-location practice with one dentist can be DSO-supported. See how many dentists work with a DSO for the share of dentists affiliated.

What other names does a DSO go by?

Sources use several names for similar models. The table lists the ones you will meet.

The glossary has entries for DSO, dental support organization, dental service organization and management services organization. Read group practice too, since size and DSO status are separate ideas.

What does a DSO handle for a practice?

A DSO usually takes on business tasks so the dentist can focus on care. A 2022 Journal of the American Dental Association paper on oral health in America describes the model this way: “DSOs provide centralized practice management and group-purchasing services to affiliated dentists.” HPI’s definition adds billing, marketing and human resources.

An ADA career article describes the pitch. Some dentists “love the art and practice of dentistry and have no interest or inclination for running a small business.” The article says an organization with efficient business and regulatory services suits a dentist who wants to be a dentist and not a business owner. It also says some patients prefer practices with convenient locations and hours.

A contract between a practice and a managing company may be called a management services agreement. An attorney should review any such contract.

How do DSOs differ from each other?

Widely. The same ADA article says the corporate model “is in a constant state of change.” It describes two ends of a range:

• Some DSOs with hundreds of locations run offices that share the same processes, branding and layout.
• Some DSOs with 10 to 30 practices let the dentist work as a solo practitioner with full operational autonomy while the corporate entity gives “oversight, guidance, and economies of scale.”

The article’s conclusion: “every practice is unique, be it DSO, private practice, public health, or another modality.” The word DSO tells you less than the contract and the office.

Why do DSOs exist, and why do they grow?

The ADA career article says “DSOs continue to grow because they offer a solution that meets the needs and preferences of some dentists and patients.” It names two groups. The first is dentists who want to practice without running marketing, accounting or hiring. The second is patients who prefer convenient locations, evening and weekend hours, and practices that take all insurance packages.

The article adds that more dentists enter DSOs at the start of a career, and that some dentists approaching retirement choose them to keep working without the burden of running a small business. It labels the end-of-career point as anecdotal. It also says DSOs can see significant turnover of dentists.

What are the common debates?

The ADA article opens by noting that DSOs are a “polarizing issue.” Some people see harm and others see a useful model. The sources here do not settle it, and neither does this post. Open questions that HPI says it is studying include career satisfaction, earnings and patient outcomes. For one part of the debate, see dental private equity: what the ADA found.

How does a DSO differ from a group practice?

A group practice is defined by size: more than one dentist, and sometimes many locations. A DSO is defined by function: it takes on non-clinical work. The two overlap but do not match. HPI tracks them as separate measures, practice size by number of locations and DSO status regardless of size.

Here is how that plays out. A group of five dentists in one town can run its own billing and marketing and have no DSO. A solo dentist can contract with a DSO for billing and human resources. A chain of 200 offices managed from one headquarters is both a large group and a DSO. Which label applies depends on who manages the business tasks.

What should a dentist ask about a DSO?

The ADA article says the questions are the same for any practice. It asks whether you are comfortable with the quality of dentistry delivered and whether the office fits your style of work. Add the points a contract review would cover:

1. Who makes decisions about materials, schedule and treatment plans?
2. What does the agreement say about clinical autonomy?
3. How is pay set, and what happens when the contract ends?
4. Who owns the patient records, and what restrictions apply after you leave?

For contract terms, read dentist employment agreement provisions. For the wider comparison, see the DSOs and private practice guide.

Next step

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