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What I learned meeting with a 100+ location DSO CEO

Published about 13 hours ago • 4 min read

I recently met with the CEO of a DSO with over 100 locations.

And I walked away with a few realizations that most dentists don’t think about.

Not every DSO is bad. But every DSO is different.

Dentists love to generalize.

“DSOs are corporate.” “DSOs don’t care about doctors.” “DSOs only care about numbers.”

Some do.

Some don’t.

The real issue isn’t whether DSOs are good or bad.

It’s whether you’ve done the work to understand how a specific one operates.

If you’re considering working for a DSO or selling to one, it’s on you to figure out:

  • What is their growth model?
  • How do they define success?
  • What do they expect from you post-transaction?
  • How long do they expect you to stay?
  • What does autonomy actually look like?

Every model is different.

You can’t outsource that clarity.

⸻

Most dentists are not clear on what they actually want.

And that’s where the problems begin.

If you only want to work two more years after selling… But the DSO expects five…

You will be unhappy.

If you want full clinical autonomy… But they’re tightening systems and KPIs…

You will feel trapped.

Misalignment isn’t evil. It’s unclear expectations.

The best partnerships start with uncomfortable conversations.

Be straight up. Ask direct questions. Say what you actually want.

Clarity filters out the wrong fit before it becomes regret.

⸻

There is a real disconnect between leadership and the operatory.

This one surprised me less, but it’s real.

Many DSO CEOs don’t deeply understand what dentists experience day to day.

That’s not malicious.

It’s structural.

They’re focused on growth, EBITDA, operations, capital, expansion.

Yes, most groups have a Chief Dental Officer or clinical leadership. But even then, decisions often tilt toward numbers.

From the outside, this can feel frustrating.

From the inside, it often looks like blind spots.

And blind spots create gaps.

⸻

The education and mentorship gap is bigger than most realize.

When I propose solutions to help educate doctors and bridge that gap, some DSOs immediately understand.

Others hesitate.

Not because they don’t believe it would work.

But because they don’t even realize it’s a problem.

If you talk to dentists on the front lines, they know.

Confidence gaps. Mentorship gaps. Implementation gaps.

They’re real.

The interesting part is watching which leaders are willing to lean into that reality and which aren’t.

That tells you a lot about the future of their organization.

⸻

I’m having more and more of these conversations.

With CEOs. With clinical leaders. With solo doctors. With vendors trying to build better solutions.

There are people in this industry genuinely trying to make it better.

But alignment matters.

Clarity matters.

And asking better questions matters.

If you’re navigating DSOs right now and have questions, send them my way.

The more conversations we have openly, the better decisions this industry will make.

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-Dr. Avi

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