The uptick in DSOs, rising dental school debt and the lack of reimbursement increases have resulted in fewer dentists remaining in independent or solo practices.
Here are five notes on the state of dentist independence:
1. The rise of DSOs and increasing private equity
More dentists are affiliating with private equity. From 2004 to 2015, there were fewer than 20 documentedd private equity transactions involving dentists. In 2021 alone, there were 96 transactions, according to the American Dental Association.
"For me, DSOs are a business model that has been around for a long time, the model of group practice," Emily Letran, DDS, CEO of Sea Breeze Dental in Huntington Beach, Calif., told Becker's. "The main difference, and one of the reasons this model has risen up, is centralized management and a very practical approach that is metrics driven. The DSO model has grown significantly because it is a working model. Going forward, I expect more group practices to form to cater to the patients' needs of efficiency and availability, such as group practices offering longer hours of operation."
2. Focus less on administrative tasks and more on the clinical side of dentistry
"Trying to stay on top of that, do all the care and manage the staff, do all of the HR, do all of the retirement, all of that kind of stuff — the administrative burden has skyrocketed," Paul Boerman, DDS, an oral surgeon in South Burlington, Vt., told Becker's. "That's the biggest challenge. A lot of independent oral surgery practices, whether you're solo or you're a group of two to five surgeons, you just can't compete. That's why being part of a larger management organization allows you to be a part of a bigger family. You have the confidence to do patient care and focus on the things that are important."
3. Percentage of solo dentists vs. dentists affiliated with DSOs
The percentage of dentists who are affiliated with DSOs has continued to increase, climbing from less than 8% in 2015 to nearly 14% in 2024. Across the U.S., 35% of dentists work in a single-location, solo-dentist practice, according to the ADA's Health Policy Institute.
4. Dental school debt
"If the trend of diminishing solo dentists persists, the field of dentistry is poised to witness a surge in dentists seeking stable positions within DSOs, particularly among those burdened with hefty student loan debts," Jacob Ferris, DDS, a dentist in Superior, Wis., told Becker's. "The weight of educational loans prompts many dental graduates to prioritize the stability and support offered by DSOs over the risks associated with independent practice ownership. While both options, solo ownership and affiliation with a DSO, have their advantages and drawbacks, there will always be a demand for dentists capable of delivering personalized, high-quality care. However, achieving comparable income levels may prove challenging amid stagnant insurance reimbursement rates and escalating operational expenses, necessitating dentists to carefully weigh their options in the evolving landscape of dental practice."
5. Stagnant reimbursements
"The biggest thing is insurance reimbursement. Inflation is sky high, staff salaries are through the roof and the overall cost of doing business is going up. Meanwhile, insurance companies jack their premiums up every year and [have left] reimbursement rates stagnant for a decade," Owen Waldman, DMD, a dentist in Scottsdale, Ariz., told Becker's.
"While going all fee-for-service is the goal, it's not always possible in many instances and in some way, shape or form, the vast majority of offices have to deal with them. If they gave dentists [cost of living-adjusted] reimbursements on an annual basis like the way they jack up their premiums annually, dentists would be paid fairly for their skills and there would be much more money for innovation, office improvements, etc."