DSOs and private practice: models, data and questions to ask

The choice between a DSO and private practice is one of the largest career and business decisions in dentistry. This guide explains how each model works, shows what ADA Health Policy Institute (HPI) data say, and lists questions to ask. It takes no side. Both models are common, and the right fit depends on the dentist.

What is the difference between a DSO and a private practice?

A private practice is owned and run by its dentist owner or owners. A dental support organization, or DSO, is a business model in which an outside entity handles part of the running of a practice.

ADA HPI gives a working definition. A practice is DSO-affiliated “if some outside entity manages some or all of its non-clinical functions such as billing, marketing, human resources, etc.” HPI also says DSO status is separate from practice size. In the words of HPI’s chief economist, “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.”

That means three things are easy to mix up:

• Practice size is the number of locations in a practice.
• Ownership is who holds the equity in the practice.
• DSO affiliation is whether an outside entity manages nonclinical work.

A single-location practice with one dentist can be DSO-affiliated. A multi-location group owned by dentists may not be. Related terms include group practice, solo practice and management services organization. For a plain-language overview, read what a dental support organization is.

How common are DSOs, and who is joining them?

DSO affiliation has more than doubled since 2015, and it is highest among dentists early in their careers. HPI reports that 16.1% of U.S. dentists were DSO-affiliated in 2024, up from 7.2% in 2015.

HPI’s 2025 workforce report adds detail by group. In 2024, 17.6% of female dentists and 14.8% of male dentists were DSO-affiliated. By career stage, the picture changes a great deal.

The same brief says 27% of dentists under 10 years out of school were DSO-affiliated in 2024, up from 24% in 2023. State patterns differ, too. HPI notes that Colorado and Oklahoma saw the highest increases from 2015 to 2024, and in those states more than 1 in 4 dentists up to 10 years out of school are DSO-affiliated.

Two cautions apply. First, HPI’s DSO count relies on its own method. It uses the membership list of the Association of Dental Support Organizations plus other entities judged to be DSOs through HPI primary research. Second, HPI has said it is still studying how long dentists stay in each model and whether career satisfaction, earnings and patient outcomes differ by model. Those open questions mean no one should read the trend as a verdict on quality.

How common is private practice ownership?

Most dentists still own their practices, but the share is falling, and HPI links part of the drop to ownership coming later in a career. HPI reports that 73% of dentists were practice owners in 2023, down from 85% in 2005.

HPI’s June 2025 brief says ownership appears “delayed” rather than “reduced.” It states that “practice ownership is the career ‘end game’ for most dentists,” but that the process is longer for newer generations. Solo practice is also changing. In 2024, about 1 in 3 dentists (34%) practiced in a single location with no other dentist. HPI found that 15% of dentists under 10 years out of school were in solo practice in 2024, against 48% of dentists at least 25 years out.

These numbers show a shift in the order of a career, not an end of ownership. Many dentists work as associates or in a DSO first and then buy in or buy a practice later. If you are weighing that path, see buying a dental practice and the practice ownership overview. For associate terms, see dental associate contracts.

HPI also reports that in 2024, employee (associate) dentists worked 5.2 fewer hours each week on average than owner dentists. That is a plain difference in hours, not a statement about income or satisfaction.

Where does private equity fit in?

Private equity is an investor type, not a practice model. A DSO or group practice may be backed by private equity, but DSO affiliation and private equity affiliation are separate measures. HPI researchers found that dentists affiliated with private equity rose from 6.6% in 2015 to 12.8% in 2021.

The same ADA HPI paper, reported by ADA News, found that:

• General practice dentists affiliated with private equity rose by 87%, from 6.8% in 2015 to 12.7% in 2021.
• Affiliation grew faster among specialists such as endodontists, oral surgeons, orthodontists, pediatric dentists and prosthodontists.
• Private equity affiliated practices had a higher rate of Medicaid participation, but the authors could not “rule out the influence of unobserved confounding factors.”
• The authors wrote that “these trends bear watching” and called for research on cost, access and quality of care.

For a deeper read, see ADA findings on private equity and the glossary entry on private equity in dentistry. The paper does not claim that private equity helps or harms care. It says the effects still need study.

Why do dentists choose a DSO?

ADA’s career guidance says DSOs grow because they meet the needs of some dentists and some patients. The ADA article explains the reasoning in plain terms.

• Some dentists want to practice dentistry and have little interest in marketing, accounting, hiring or regulatory work. An organization that handles those tasks can suit them.
• Some patients want convenient locations, evening or weekend hours, and acceptance of many insurance plans. The ADA article says large organizations are often what those patients seek.
• The ADA article also notes that some dentists near retirement join a DSO to keep working without running a business. It labels this observation anecdotal.

A research paper in the International Journal of Health Economics and Management points to another driver. It found that higher commercial dental insurance concentration was associated with a dentist’s decision not to own a practice. Its authors wrote that “dentists consolidate in response to increases in concentration among commercial dental insurers.” The data covered 2013 to 2015, so this is older evidence, and the paper found inconclusive results on DSO affiliation specifically.

Why do dentists choose private practice?

The ADA career article gives one clear reason from its research: control. When ADA staff asked dentists in DSOs what they did not like about working as an employee, the answers “can be summarized in one word: control.” Dentists wanted more say over materials, their own time and, in some cases, treatment plans.

The same article adds a balance point. It suspects associates in independent practices might report similar concerns, because some of them “stem from the very nature of being an employee.” It also says people who start their own business often do so to control standards and business practices.

Owners carry the other side of that control. They run payroll, compliance, marketing and finance themselves, or hire staff to do it. That workload is the same set of tasks a DSO takes on. A dentist who likes that work may prefer to keep it. A dentist who does not may prefer to hand it off. Neither choice is wrong.

How do the two models compare?

The table below sets out common differences in plain terms. It describes how the models are built, not how well they perform. Individual practices vary a great deal, and ADA notes that “if you have seen one DSO, you have seen one DSO.”

ADA’s career guidance describes the range inside the DSO category. Some DSOs have hundreds of locations with shared processes, branding and layout. Others have 10 to 30 practices and let a dentist work “as a solo practitioner, with full operational autonomy,” while the organization provides oversight and economies of scale.

What questions should a dentist ask before choosing?

Ask the same core questions of any practice. ADA’s career article says that “no matter what type of practice you might consider, the questions are the same.”

1. What are the working conditions and the schedule?
2. Are you comfortable with the quality of dentistry being delivered?
3. What procedure mix will you be responsible for?
4. What is kept in-house, and what is referred out?
5. Does the practice stay on schedule or consistently run over?
6. How does the office fit your personal style and the way you work with the team?

Add business and legal questions to that list. The ADA article does not cover these, so treat them as prompts for your own review.

• How is pay set, and how is it measured? See associate compensation and production-based pay.
• What does the employment agreement say about term, termination and duties?
• Is there a non-compete clause or restrictive covenant, and how far does it reach?
• Who owns patient records, and what happens to them if you leave?
• If ownership or a buy-in is offered, how is value set, and who does the due diligence?
• How does staff turnover look at the location, and who makes hiring decisions?

An attorney who works with dental contracts should review any agreement before signature. A CPA should review the tax effects of any sale, buy-in or equity offer. This guide is general education and not legal, tax or financial advice.

What does the data not tell us?

The data show who is affiliated with what, and how the share is changing. They do not show which model gives better care, better income or a better life. HPI says it is still examining whether there are differences across practice models in career satisfaction, work-life balance, earnings and patient outcomes. Until those studies are published, claims that one model is better should be treated with caution.

A few more limits are worth stating:

• Percentages come from HPI’s own database and method, so compare only HPI figures with other HPI figures.
• DSO affiliation is not a single thing. It covers very different organizations.
• Views of dentists differ. The ADA article reports that some dentists in DSOs loved that model and some were eager to leave.
• National figures may not describe your state, your town or your own situation.

For the debt side of the story, see dental school debt. For the numbers on affiliation, see how many dentists work with a DSO and DSO vs private practice data.

Next step

Read the practice ownership overview for the paths from associate to owner, then list your own answers to the questions above. Contact Dr. Copeland about consulting. Dr. Jon Copeland, DDS, is a general dentist in Wildwood, Missouri.