Clinical Autonomy and DSOs–They Don’t Have to Be Mutually Exclusive!


So you’re thinking about selling your practice to a DSO. While now is the perfect time to start negotiations, let’s talk about the huge elephant in the room–clinical autonomy. It’s likely you’ve heard horror stories about dentists working for DSOs that have been forced to tow the DSOs treatment line–even when it crosses into unethical practices.

Luckily, there is a way to retain your clinical autonomy AND work with a DSO. Our founder, Gary Kadi, wrote about it in a recent edition of Dental Economics.  Here’s a few highlights from his article:

How you sell matters

Gary acknowledged the apprehensions regarding DSOs transforming dental practices into profit-driven machines, but he also explained that the impact on clinical autonomy varies depending on the specific circumstances. Dentists have two options when considering involvement with a DSO:

Sell Your Practice 100%:
This option entails relinquishing all decision-making rights and transitioning from a leadership role to an employee role, where you must comply with the DSO’s policies and procedures. It is akin to selling your practice to another dentist and working as an associate under their direction.

Sell a Portion of Your Practice:
This choice enables a partnership between the dentist and the DSO, where the dentist retains a significant ownership share (usually around 40%). In this scenario, the dentist still plays a leadership role, determining the areas in which the DSO will be responsible and those they will oversee. This approach allows for a genuine partnership.

You choose what to keep and what to delegate

If you sell a portion of your practice, you also get to decide which aspects of the practice to hand over to the DSO and which to retain. For instance, you could choose to delegate business-related tasks such as payroll, collections, taxes, accounting, and marketing to the DSO while holding onto responsibilities like team training, hiring, and chairside work. The flexibility of this approach allows you to focus on what they enjoy most and delegate tasks they find less appealing.

An additional advantage of retaining partial ownership and autonomy is the newfound freedom to allocate your time as you see fit. You could pursue additional certifications, explore more profitable areas of dentistry, mentor younger dentists, or simply enjoy a longer vacation.

Importantly, dentists who choose the partnership route continue to benefit financially from their efforts. If they opt for higher-profit dental services, they still reap the associated profits. Moreover, if the DSO undergoes recapitalization, you’ll get a second payout. How’s that for a win-win?

To sum it all up….

Gary’s key takeaway is that maintaining clinical autonomy is possible when selecting the right DSO. Ask questions during negotiations and establish your terms upfront. Selling only a portion of your practice, rather than the entire entity, is a strategic choice that allows for greater control. If a DSO is unwilling to accommodate your terms, it may be prudent to explore other options. Seeking a second opinion on any formal offer and enlisting the assistance of a trusted partner during the process can also help ensure that you’ll secure a favorable arrangement.

It IS possible to navigate the DSO landscape while preserving your clinical autonomy. With a well-informed, strategic approach, selling to a DSO can be a mutually beneficial, financially life-changing road forward.

Check out Gary’s article for a deeper dive into negotiating clinical autonomy with a DSO, or schedule a free, one-on-one call with our DSO expert to get your specific DSO questions answered.