The Practicon Viewpoint by Ann Page Griffin

DENTAL SERVICE ORGANIZATIONS—HOW SIGNIFICANT?

Dental Service Organizations, also known as Dental Support Organizations (DSO), promote themselves as providing necessary non-clinical support services for member practices. These support services include billing, IT, marketing, human resources (hiring, firing, payroll, staff management), accounting, supply selection and purchase, equipment leasing or purchase, etc. DSOs are buying practices or, in some cases, contracting with dental practices to form large conglomerates operating as single corporate entities that employ dentists much like any other for-profit business employs its workers.

Typically, DSOs hire dentists to provide dental services only, removing from the practitioner the responsibility of management, profit sharing, and decision-making involved with ownership of a practice. DSOs are particularly attractive to young dentists, most of whom finish their training deeply in debt. They can go to work immediately in a DSO, earning decent wages, with no worry about the management of the office, an appealing option following years of training. Older dentists involved in DSOs are typically those who sell their practice to a DSO in preparation for retirement or because illness might force them out of practice. Their exit from the office can be expedited by selling to a DSO rather than searching for a single buyer.

As DSOs have proliferated, one major concern voiced by many practitioners has been that revenue-driven DSOs, as outright or even tangential owners/managers of a practice, can interfere with dentist-patient care and treatment decisions. Shareholder-owned corporate entities might tip the scale toward greater focus on return-on-investment (profit) and away from quality patient care as the first priority in the practice of dentistry.

Statistics from the American Dental Association’s Health Policy Institute show that affiliation with a DSO involves:

• 16.3% of dentists ages 21 to 34 years
• 9.8% of dentists ages 35 to 49 years
• 3.4% of dentists ages 50 to 64 years
• 2.5% of dentists age 65 years and older

DSOs are quite possibly here to stay and, at some point, you may consider joining one. Any dentist thinking about sale to or affiliation with a DSO should exercise due diligence to thoroughly understand all aspects of the DSO under consideration. If you sell:

Can you maintain all current staff?
Can you choose the supplies and medicaments you want to use?
Can you name your own vacation and other time-off schedule?
How will maintenance and upkeep of the office be decided and funded?
Will you share in profits? How and when?

And on and on—the list of questions is endless. Think of all the items you, Doctor, decide upon as owner/manager, and determine if all those details will be handled by the DSO in ways acceptable to you. Additionally, dentists working for or considering involvement with a DSO could urge their state dental society to promote statewide rules that assure patient protections, including the mandate that treatment decisions are made solely between a patient and his or her dentist.