Corporate or Private Practice: What’s Right for You?

Dental Service Organizations are here to stay — and for many practitioners, that’s a good thing. Dental service organizations (DSOs) provoke strong reactions in the dental community. Some say they limit autonomy, stifle growth and are unfair competition for private practices. Others have a different view, citing the ability of DSOs to bring successful business templates to struggling practices, negotiate better rates from suppliers and reduce administrative burdens, giving dentists more time to treat patients. Let’s take a closer look at a few of these myths about DSOs and how they affect dental practices:

1. DSOs LIMIT AUTONOMY

Some dentists choose the profession because it gives them the opportunity to own a business and run their own show. DSOs by their nature do have rules and regulations that their licensed dental practitioners must follow. These are not unlike the standards maintained by large hospitality brands such as Marriott and Hilton, where they provide a spectrum of services to individual hotels in return for those hotels doing things the “Marriott way.” The benefits to DSO dentists are similar to hoteliers who choose to affiliate with a large brand. Patients feel comfortable choosing a known brand and practitioners get the benefits of the brand’s experience in the industry. They can bring together best practices, policies and business models that have been proven in the marketplace, and put them to work for individual dentists.

2. DSOs ARE UNFAIR COMPETITORS

DSOs have demonstrably expanded access to dental care for lower-income patients. If lowering the cost of professional dental services to patients is unfair, then DSOs are unfair. This criticism really revolves around the ability of solo practices to match the quality/value formula of DSOs. Given the leverage large DSOs have with suppliers and insurers, they can and do extract better terms from them for their practitioners. They can buy equipment at lower prices and on better terms. They get higher reimbursements from insurers. This does not mean that DSOs are inherently unfair, or that solo practitioners cannot compete. It means that solo practitioners need to sharpen their own business practices and concentrate on other parts of the quality/value equation, such as in the services they provide or the way in which they provide them through avenues like concierge dentistry.

3. DSO DENTISTS ARE LESS ACCEPTED BY PEERS

Being part of a professional community is important to many people, whatever industry they work in. The ability of DSOs to offer dental services at lower rates than traditional owner-operated offices can generate resentment. Working for a corporate practice in an area dominated by private offices may not be wildly popular with your local peers. Some younger practitioners may be concerned this will limit their professional mobility and their ability to learn from more experienced colleagues. However, the local or state dental society can provide that sense of community, as can service through any number of dental and charitable organizations. Younger professionals often find that it’s easy  — and encouraged — to connect with older mentors within their DSO, and many provide both continuing education courses and the time to attend them.

4. DSOs AREN’T A GOOD CAREER PATH

One time-honored pathway for dentists has been to build up a successful practice over time, bring in associates as the business expands, then sell the practice to those associates or another dentist when the time comes to retire. A DSO may not offer that same progression. However, especially for younger dentists with a lack of business experience and significant student debt, they do offer a pathway to success. The DSO has a business template that has proven itself over time. DSOs use their size and volume to negotiate better rates with suppliers. Most have a marketing strategy in place and some level of brand recognition. Many DSOs offer young associates a student loan repayment benefit that can significantly reduce their debt. For older dentists who own a practice, affiliating with a DSO could provide a smooth and certain glide path to retirement; they can simply work fewer days a week and, eventually, sell their practice to the DSO.

5. DSOs LIMIT INNOVATION

While DSOs provide a business template, the choice of how to treat patients remains with the dentist. Your ability to learn new techniques and try new devices and techniques is directly related to how much time you have to experiment and whether you can afford a new piece of equipment. When a DSO takes on a significant part of the administrative burden of running a practice — payroll, compliance with OSHA and HIPAA rules, insurance billing — that leaves dentists more time to explore treatment options. Dentists within larger DSOs share experiences trying out new processes, procedures and devices and — if they’re found effective — the DSO can negotiate pricing for equipment and supplies. Rather than limit innovation, these things can accelerate innovation while more quickly facilitating a consensus on whether or not a procedure or device is effective. Being part of a DSO is not for everyone, but for some practitioners, working with a DSO can be rewarding professionally, personally and financially. For some, the time and energy needed to optimize and attend to the administrative needs of their own practice is worth the effort. For others, having an organization that’s continuously optimizing those things gives them the ability to do work that they love — treating patients — while still maintaining a “normal” personal life outside of the office.

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