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The DSO promise that doesn't always hold up

Published about 1 hour ago • 4 min read

I have had this conversation more times than I can count.

A doctor reaches out. They joined a DSO two years ago. They were told they would have clinical autonomy, a supportive team, and real income growth. They were told the organization cared about doctors.

Then the first major business decision came down the line. And the doctor was not in the room.

This is the most common friction point I hear. Not because DSOs are inherently bad. But because there is a gap between what gets promised during the courtship phase and what actually happens when revenue takes priority.

Here is the harder truth though.

Most doctors who end up frustrated did not go in with clarity. They knew they were burned out. They wanted stability, maybe an exit eventually. But they never clearly defined what they actually needed. So they said yes to terms they barely negotiated because the offer felt like relief.

That is not a DSO problem. That is a preparation problem.

DSOs are not the villain in this story. Some are genuinely well-run, doctor-aligned organizations. The outcome depends on which DSO, what stage they are in, what you negotiated, and what you were actually looking for in the first place.

I sat down with Dr. Gaspar, CEO of a DSO with over 120 locations, to talk through exactly this. What they promise versus what they deliver. Where the disconnect happens. And what it looks like when the relationship actually works.

It is one of the most honest conversations I have had on this topic. Link below.

Talk soon,

Dr. Avi

Video of the Week

video preview​

Dave Gaspar, CEO of Smile Partners (120+ practices), pulls back the curtain on what it actually looks like to lead a DSO without a clinical background and why that forces better decisions. In this episode, Dr. Avi and Dave break down the three promises every DSO should make before a doctor signs, why clinical autonomy is only meaningful when you're willing to sacrifice for it, and how grit — not just IQ or EQ — determines whether a partnership actually works. They also get into the real conversation around AI adoption in group practices, what the next generation of dentists gets right (and wrong) about grinding, and why social media is the most underutilized tool in the DSO playbook. If you're a dentist considering a DSO partnership, or already in one, this episode is worth your full attention. The tools and resources mentioned are linked below — use them.

Sponsors for the episode:

SprintRay Midas: ⁠https://info.sprintray.com/midas-podcast; OrthoBrain: ⁠https://orthobrain.co/ClearAlignerAdvisor ; ⁠Neer: ⁠http://getneer.com/patel ⁠; Clear Aligner Advisor: ⁠https://www.clearaligneradvisor.co/ ⁠

Connect with Dave Gaspar on LinkedIn: ⁠https://www.linkedin.com/in/dave-gaspar-2a930311/⁠​

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by Dr. Avi Patel

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