Friday Perspective: DSOs and How They Benefit the Profession

Dental Support Organizations (DSOs) are business entities that provide management and administrative services to dental practices. Practices can contract with DSOs to provide critical business management and support for non-clinical operations. In essence, these organizations alleviate the non-clinical business operations of dental offices, allowing clinicians to fully focus on providing the highest quality care to their patients.

It is important to note that not all DSOs are the same although critics often paint them with broad brush strokes. DSOs differ in size, mission, structure, and culture. Even the relationship between a dental practice and a DSO can vary; some DSOs own the assets of the dental practice while employing the dentist to provide clinical services. In other arrangements, the dentist may retain ownership of the practice and simply contract with the DSO for the provision of specific services.

While the services provided by DSOs vary widely, they typically include a range of support functions including administrative, procurement, marketing, financial, technology implementation, legal compliance, professional development, and real estate management. By managing administrative tasks, DSOs relieve clinicians of the administrative burdens that come with running a small business. DSOs leverage the collective buying power of multiple dental offices to negotiate better prices on dental supplies and equipment, reducing overall operational costs. Most DSOs provide marketing services, helping dental practices attract and retain patients through professional advertising, and social media management. Financial services provided by DSOs often include assistance with accounting, financial planning, and accessing capital for expansion or technology upgrades. With the rapid pace of innovation and technology in dental care, DSOs assist with the implementation and maintenance of dental technology solutions, such as practice management software, electronic health records, digital dentistry, and AI implementation. Many DSOs offer continuing education opportunities, training in the latest dental techniques and technologies, and even leadership and mentoring programs, which contribute to professional growth and improved patient care within their network. Ensuring that practices comply with all applicable healthcare laws and regulations can be complex, and DSOs often have specialized knowledge and resources to help navigate legal compliance. Some DSOs also assist with the logistical aspects of finding and managing office spaces.

DSOs have steadily grown and many dental school graduates are choosing DSOs as a career choice as they offer a way for new graduates to focus on patient care without the pressures of owning and operating a business and incurring additional debt. However, as with any model, there are critics, particularly regarding the potential for reduced clinical autonomy and the prioritization of profit over patient care. Interestingly, academic health centers in the U.S. are support organization. Dental Schools for all intents and purposes are in fact small self-contained DSOs. While the tension between traditional private practice dentists and Dental Support Organizations (DSOs) can be attributed to several factors, it is improving, and patient care will benefit as a result of evolving mindsets and increased collaboration.

As a long-time clinician, educator, researcher, and administrator in academic healthcare, I see many Dental Support Organizations (DSOs) offering numerous benefits to the field of dentistry, positively affecting both the providers and patients they serve. DSOs manage the business aspects of dental practices, including administrative tasks, human resources, marketing, and compliance – areas that most dental schools do a marginal job, at best, of teaching - allowing clinicians to concentrate primarily on patient care without the distractions of business operations. This can lead to higher quality clinical services and improved patient outcomes. Many DSOs provide robust opportunities for continuing education to their dentists, hygienists, and other clinical team members. They facilitate access to training in the latest technologies and techniques, helping practitioners stay at the forefront of oral healthcare. Look at the recent use of integrating AI into practices such as Overjet or VideaHealth as an example. This continuous learning environment can lead to better patient care and more career growth opportunities for dental professionals. Due to their larger scale and access to capital, DSOs often invest in innovative dental technology that might be cost-prohibitive for a solo practice. This includes digital radiography, implant robotics like Yomi by Neocis, advanced dental imaging, digital dentistry, and electronic health records. What Pacific Dental Services is doing with Epic is nothing short of a game changer for the dental profession and for patient care. These technologies improve diagnostic capabilities, treatment planning, and overall patient care efficiency. In addition, by pooling resources across multiple practices, DSOs achieve economies of scale that reduce costs. This can result in lower prices for dental supplies and equipment, cost-effective administrative services, and potentially lower treatment costs for patients. Similar to dental schools such as East Carolina University School of Dental Medicine, DSOs are often more capable than individual practices of expanding into underserved areas, including rural or economically disadvantaged regions. This expansion helps to increase access to dental care for populations that might otherwise go untreated. Staying abreast of ever-changing healthcare regulations and compliance requirements can be challenging for individual practices. DSOs typically have dedicated teams that ensure all their affiliated practices comply with current laws and regulations, reducing the risk of violations and enhancing patient safety. Many DSOs implement standardized protocols and quality assurance measures across their practices. This standardization helps ensure that every patient receives high-quality care regardless of which location they visit. In a world where evidence-based practice and continuous quality improvement matter, DSOs have a distinct advantage. Who is checking on the solo practitioner to ensure that their care is “current”, and evidence based? In reality, DSOs bring professional management skills to dental practices, improving overall business operations leading to better patient scheduling, reduced wait times, and more effective practice marketing, often enhancing patient satisfaction and stimulating practice growth. One of the wonderful things about dental education is the collegial environment. Similarly, dentists in DSO-affiliated practices often benefit from being part of a larger network of professionals – a team. This network provides a collaborative environment where dentists share best practices, case studies, and professional advice, further enriching the professional experience. Look no further than the incredible email and list-serve network enjoyed by clinicians as a part of Heartland Dental allowing their clinicians in real-time to ask advice from a vast network of colleagues. Yet, an untapped area for growth is leveraging the size and scope of DSOs to advance scientific inquiry, especially in practice-based outcomes research. This involvement can contribute to clinical trials or studies that improve dental techniques, materials, and preventive care strategies, further advancing the field. Lastly, through organizations like the ADSO, DSOs have a strong and collective voice in regulatory and policy discussions that affect the industry and profession. This will help shape policies that are conducive to the advancement of dental practices and the overall population health.

In my experience, DSOs contribute positively to the dental industry and dental profession by enhancing the operational efficiency of practices, improving the quality of care for patients, providing another option to the traditional model for clinicians to practice, and fostering professional development among dental practitioners. These advantages help support the growth and sustainability of dental practices while also addressing broader healthcare needs and access challenges. While the conversation between the traditional private practice clinician and DSOs has been acrimonious in the past, I am pleased to see improved collaboration and dialogue between the ADA and ADSO. The "us versus them" mentality needs to stop, because in the end, the patient and their health is our number one priority.

?Scott S. De Rossi, DMD, MBA

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