The Future of Dental Practice Is Partnership
Large Practice Sales can help your practice maximize value and retain control by partnering with the right invisible dental support organization.
Dental practice consolidation is accelerating nationally. In 2025, thousands of dentists will join dental support organizations (DSOs) or invisible DSOs (IDSOs). New doctors of all specialties are dealing with mounting student debt. Existing practice owners are facing increasing operational complexity. Today’s challenges include inflation; recruiting; new patient generation; adoption of new technologies, including artificial intelligence; and stagnant reimbursement rates. Running a practice is not getting easier.
Traditional DSOs, which now have thousands of owned practices in all 50 states, have resources to address many of these challenges that are not available to independent dentists. Their sheer size, several with more than 1,000 practices, enables them to pay less for everything including technology, supplies, and team benefits. In addition, they are reimbursed at higher rates by payers.
DSOs can be fierce competitors for team members, patients, and profits. However, in a sale of your practice to a DSO, you will most likely be subject to its procedures on how to run a practice. Doctors will lose full autonomy in virtually all DSO sales. Clinical autonomy is retained, but the ability to decide how to operate the business side of the practice is handed over to the DSO. Not necessarily a bad thing, but an inevitable outcome.
Over the past 10 years, the fastest growing and now largest driver of practice consolidation has been the rise of the IDSO. IDSOs differ from DSOs in several critical areas which has attracted more than 10,000 dentists to partner with them, not sell out to them.
IDSOs have been in operation for more than 35 years. Their owner/operator model has been successful. In just the past 24 months, IDSOs have attracted billions of dollars of new investment and financing. This new capital has enabled doctors to achieve record values for their practices in IDSO partnerships in 2024 and 2025.
IDSOs are very different from DSOs. IDSOs become a dentist’s silent partner by purchasing typically 51% to 80% of the value of a practice for cash at low tax rates. Doctors retain ownership and continue to lead their practice for years or decades with their brand, team, and full autonomy — but only if they choose the right IDSO partner.
In an IDSO partnership, dentists are still owners, and they continue to make not just the clinical decisions, but also the operational decisions in their practice. They decide who to hire and fire, how to set schedules, what products to use, procedures to perform, and payers to accept. They are not micromanaged by their IDSO partner.
IDSO practices benefit from their silent partner’s scale and resources to achieve the operational efficiencies of the DSOs, but without the micromanagement and homogenization dictated from above. There are more than 1,000 IDSOs in the United States today. Some are general practice only, many are multispecialty, and more than 50 focus on single specialties.
The value of the IDSO for doctors is not only the benefits of size with lower costs, higher reimbursement rates, recruiting support, and new patient marketing expertise; the real promise is that the ownership retained by the partner dentist will increase at a far faster rate than remaining independent. Doctors who have chosen the right IDSO partner over the past 10 years have been the beneficiaries of billions of dollars of gains on their retained equity ownership.
In 2024, one of the largest IDSOs achieved a value of over $3.8 billion, up from only $330 million 7 years previously. The 500+ owner doctor partners literally made billions of dollars in a very short time. Fortunately, dozens of these happy dentists were Large Practice Sales (LPS) clients. We helped them choose wisely.
Obviously, the key to a doctor’s daily satisfaction and outsized equity gains is choosing the right IDSO partner. Few will repeat the outcome of 11x gains in 7 years, and other IDSOs will fail. Out of the 1000+ IDSOs in the US, we estimate that less than 100 of them are qualified to bid on LPS clients.
Doctors can learn more about IDSOs and the potential value of their practice in an IDSO partnership without cost or obligation by contacting us at www.LargePracticeSales.com. Larger practices will ultimately join an IDSO or compete with many.
Large Practice Sales
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From Decisions in Dentistry. July/August 2025;11(4):25.
