The DSO Path for New Dentists
by Frank Schiano, DMD, Guest Contributor
One of the greatest aspects of selecting dentistry as a profession is the fact that your life truly will be a choose-your-own-adventure book. Imagine you are a senior dental student who is about to complete four hard years of didactic and clinical study. Maybe you are a recent graduate looking for a new opportunity. It has come time to make the next big decision in your life — where and how to practice in a way that will maximize your growth both personally and professionally. There are so many variables to consider; be prepared to experience a lifetime of emotion in your early career stages.
One option is to practice in a DSO setting. “DSO” stands for “dental support organization,” which means a management company provides nonclinical supportive services to the dental office. This includes all aspects of the business side not directly related to patient care. I co-founded a New England-based DSO and helped grow it to 14 locations and $30 million in revenue. As the chief clinical officer, I was responsible for all clinical aspects of our business, including hiring dentists and supporting them. My goal is to help you understand and genuinely feel what it is like to be a clinician practicing within this type of organization.
There are many types and structures of DSOs, and “DSO” was a dirty word for many years. However, with high levels of student debt, rising practice acquisition and startup costs, and a desire to be part of something bigger, nearly half of all new graduates and younger dentists are employed by DSOs today. If you choose the right group and show commitment and dedication to your office, your patients and the company, the positives will far outweigh the negatives.
Remember, you graduated having inserted at most five crowns and quite possibly have never filled a real root with gutta-percha. You still perform “caries control,” and it takes four appointments to finalize the restoration on that tooth. You were taught that a four-surface posterior composite encompassing half a tooth is a successful long-term and predictable procedure. You certainly did not learn much about managing the business side of dentistry, such as how the operations and clinical teams overlap for a dental office to function at a high level. How comfortable are you at this point to practice alone?
There is a tremendous amount of benefit to working for a DSO at this stage in your career. Perhaps the most significant benefit of working with the right DSO is the level of direct clinical support and mentorship that you will receive from more senior doctors. Most groups have cloud-based software, which allows your clinical support director (also a dentist) to review your patient records, including radiographs and clinical photos, and host virtual meetings with you to discuss your diagnoses and treatment plans. This does not mean someone is watching you to suggest procedures that are not necessary to boost office production. It means that you have a resource to help you provide outstanding clinical outcomes while ensuring an excellent patient experience. There is no value to anyone in destroying either one of those. You will learn how to work with the hygiene team by understanding effective communication strategies and setting expectations for comprehensive and periodic exams. You will learn about efficient procedure scheduling and detailed and complex interdisciplinary treatment planning for the real world. Collaboration with other doctors in your network will take you to the next level.
You will be paid some percentage of either production or collections as a W-2 employee. Specialists may be offered 1099 contractor positions. The good news is most DSOs collect close to 100% of what is produced. There are revenue cycle teams that are submitting claims and reviewing denials on your behalf. The operations staff has been trained to take copayments at the time of service. Therefore, you can expect a steady income to support your family and pay your student loans, without the administrative burden of running your own practice.
Another draw toward DSOs for early career-stage dentists is the opportunity to use the latest technologies to treat patients. AI programs such as Overjet and Pearl are excellent in helping identify areas of concern on radiographs, such as caries and bone loss. Intraoral scanners, such as the iTero and Trios, help you provide visual education to your patients and quicker turnaround times with dental labs using a more efficient digital workflow. Additionally, CBCT units are common in some of the larger, multispecialty offices, and this technology will help elevate the standard of care you provide.
There are some personal priorities to consider. Work-life balance is important for the new generation of graduates. My suggestion is to be clear about your personal expectations during the interview process, including commute time. What will your schedule look like? How available are you after hours for call and emergency coverage? Flexibility on your part goes a long way. Do not expect to take off every holiday throughout the year. Other benefits may include health insurance, access to a 401(k), CE allowances, malpractice insurance and other various miscellaneous reimbursements.
The landscape of dentistry is constantly changing. It is the new and younger generation of dentists that will help shape the future of our profession. Working in a DSO setting might not be your career choice, but it is a great place to start. You have all the opportunity in the world to choose your own adventure. Use the wisdom and experience you gain to evolve. Learn from your mistakes. Most importantly, give back to your patients and fellow dentists every chance you get.
