There are growing discussions about solo dental practices and dental support organizations (DSOs). This conversation has become very important in order to determine how modern dentistry will operate in the future.
Many independent clinics and corporate practices are now competing against each other aggressively to find and keep qualified dental providers in a rapidly changing hiring environment across Canada and the USA.
Many traditional methods of recruiting, such as referrals from other community members, have disappeared from the marketplace and been replaced with heavily competitive environments based on salary structures, expected work-life balance, technological capabilities, and long-term career plans.
The growing dental workforce shortage in the USA and similar staffing pressures in Canada have intensified this competition. Hygienists, associate dentists, and specialists are now evaluating employers based on far more than salary.
Understanding Both the Models
Before evaluating who may gain the upper hand in this hiring battle, it is essential to clearly understand the structural differences between solo practices and dental service organizations.
What Are Solo Dental Practices?
Solo dental practices are independently operated clinics that are run either by a single dentist or a small group of dentist partners, where the dentist have complete authority on clinical decision-making, running the practice, and staffing.
Recruitment practices in solo dental practices are generally local and based upon personal relationships. Recruiting decisions will typically occur internally, therefore allowing for flexibility and a cultural fit.
However, many solo dental practices may not have the same amount of capital and recruitment resources available to them as larger organizations.
What Are DSOs (Dental Service Organizations)?
The term “Dental Service Organizations” (DSOs) is often used when discussing how a DSO hires vs. a small practice. The DSO is a corporate entity that offers the support of multiple dental offices by managing non-clinical operations such as Human Resources, Payroll, Compliance, Marketing, and Recruitment.
The DSO's corporate support allows for a large commitment to talent acquisition efforts, creating employer branding, and offering relocation incentives to attract high-quality talent.
What is the current dental workforce landscape?
The factors affecting the dental workforce shortage are critical to understanding the talent competition. There are several important factors that contribute to the dental workforce shortages.
1. Aging Workforce Transition: A large number of dentists that are active are nearing retirement. With the existing dentists retiring, there is and will continue to be more demand for replacing them. This transition impacts the continued ownership of private practices and how many staff they need to hire.
2. Hygienist Supply Imbalance: The volume of newly trained hygienists has not kept pace with the increasing demand for dental care (the larger number of patients needing and wanting to be seen by dentists).
3. Changing Career Expectations: Younger members of the workforce have different expectations about their careers. They desire more predictable hours of work, a reduction in administrative duties, and ultimately more clearly defined paths for their careers.
Why Do Dentists Choose DSOs?
The increasing use of corporate dentistry has been driven by a number of advantages available through structured employment that encourage new graduates and entry-level professionals.
1. Income Stability: DSOs generally offer base salaries plus production bonuses that lead to predictability in income, which eliminates the financial uncertainty that many entrepreneurs embrace.
2. Staff Support: Corporate support takes over the burdens of human resource management, negotiating with vendors, and ensuring regulatory compliance. As a result, dentists have the ability to spend all of their time on their clinical work, instead of dealing with all of the issues that come along with running a business.
3. Business Advancement Opportunities: The ability to advance your career within a multi-location organization offers potential for advancement and growth into a leadership role (Clinical Director, Regional Supervisor, etc.) that may not be available with a solo practice.
4. Investment in Technology: Many DSOs lead the way in technology by implementing advanced imaging systems, AI-based diagnostic systems, and digital workflow processes. These technologies allow for continued personal growth and improvement in clinical efficiency.
Why Dentists Still Prefer Solo Practices?
While there is a trend toward corporate growth, independent practices continue to attract healthcare providers seeking autonomy as well as potential ownership.
Benefits of Professional Independence
Clinical Decision Making Control: Dentists are able to make all decisions concerning the treatment of their patients without production quotas and outside the influence of a corporation.
Long-Lasting Relationships with Patients: Independent practices develop long-term patients who are committed and connected to the practice through a community relationship and provide dentists with more than just financial rewards for their work.
Creation of Wealth Through Entrepreneurial Ownership: Independent practices offer the owner of the practice the ability to build equity, build a successful business and provide for the next generation in a way that can be achieved through an independent practice and not necessarily through an employment-based organization.
Compensation War: Who Pays More?
The importance of compensation is an important part of the debate regarding hiring new graduates and existing clinicians into DSOs and private practices.
The competitive earnings packages, including starting salaries, sign-on bonuses, and student loan support, provided by DSOs are particularly attractive to new graduates, many of whom have large amounts of educational debt.
On the other hand, while private solo practices typically offer a lower base salary to start, there is long-term potential for greater earnings through profit sharing, partnership, and ownership transition.
Culture & Retention Battle
Retention is becoming a more important factor than simply how many employees a company will hire. The loss of staff due to high turnover rates, in addition to causing disruption for patients who seek to maintain care continuity, leads to an increase in costs for the organisation.
Due to the pressure of increased expectations on employees, some companies are experiencing employee burnout. Those that practise as solo practitioners may have a difficult time being able to provide the same benefits or leave policies as their corporate counterparts.
Technology & Infrastructure Advantage
Technology investments increasingly impact hiring decisions in the dental profession, as many contemporary dentists will expect that they work with various technologies such as digital imaging, CAD/CAM systems, and data-driven diagnosis tools.
In addition to this, DSOs typically have sufficient capital capacity to do so across all of their facilities.
As for single practitioners, although many practice owners are modernizing their facilities, they can take much longer to implement these types of upgrades due to differing levels of financial flexibility.
2030 Forecast: Who Will Win?
According to analysts, the chances of a single dominant model being produced by 2030 are lower. The traditional DSOs will continue to have dominance due to their financial leverage in metropolitan areas and their operational scale.
In addition, independent/small private practices will still attract professionals seeking to have control over their careers and/or own their own business.
Additionally, hybrid business models that combine support from a corporate entity with some of the elements of business ownership will likely change how dental practices compete for market share over the next ten years.
What This Means for Dental Employers Today?
Clinics that are proactive with their employer branding, compensation structure, technology investments, and workplace culture are likely to remain competitive; however, if they delay their adaptation process, then they could end up having jobs vacant for long periods of time and losing revenue as a result.
Strategic workforce planning and hiring practices focused on retaining workers will play a starring role in the changing dental employment environment moving forward.
Final Thought: Collaboration Over Competition
The battle between solo practices and DSOs is more a sign of the evolution of the industry than a zero-sum competition; each of these two models has unique benefits that appeal to different sets of priorities within the profession.
By 2030, the organizations that are most successful will be those that change their hiring practices to align with new workforce expectations while ensuring that they continue to deliver exceptional clinical care and remain operationally viable.
Frequently Asked Questions
1. Are DSOs taking over dentistry completely?
While DSOs are experiencing rapid growth in urban markets, solo practitioners continue to flourish in local communities and rural regions that provide personalized care to their patients.
2. Do DSOs Offer Higher Salaries Than Solo Practices?
While DSOs typically provide competitive starting salary packages, private practice may offer greater long-term potential for financial gain based on ownership opportunities.
3. Why Are Dentists Attracted to Corporate Dental Groups?
Dentists are attracted to corporate dental groups because they receive administrative assistance, structured benefits, career advancement opportunities, and access to advanced technology.
4. Is Private Practice Dentistry on the Decline?
While private practice dentistry is not declining, it is evolving, and many (independent) dental practices have adopted partnerships and hybrid models.
5. By 2030, what factors will impact how Dentists are hired?
Factors such as workforce supply/demand trends, compensation innovations, technological advances within the dental profession, and employer branding will have a large impact on the way Dentists are hired.
