How solo practices can survive as DSOs continue to grow


Learning how to change your tactics and mindset is crucial.

The definition of inevitable is incapable of being avoided; certain to happen; unavoidable. It is inevitable that DSOs will continue to grow.

As William Blair stated in their report: “To summarize, we have seen a surprising proliferation of dental service organizations over the past five to 10 years, with the largest chains growing their number of practices at an annualized rate of 13 to 14 percent, by our estimates, compared with a 2 to 4 percent pace of broader dental spending. We believe DSOs currently own or control approximately 16 percent of total practices in the United States. We expect that DSOs will grow at approximately 15 percent annually over the next five years, implying U.S. penetration could reach 30 percent by 2021.”

But rather than “getting on the train” by participating, collaborating and partnering with other stakeholders, DSOs and dentists, solo practitioners and their representative organizations are throwing up as many road blocks as possible to try to stop the inevitable.

Related reading: Why managed group practice will dominate the future

What is the source of this fierce resistance by solo practitioners and their political organizations? Why are they so adamantly opposed to managed group practice? Why are they so angry, irate and incensed by the progress and growth of managed group practices? Why? Because they feel threatened, and when people feel threatened, they react.

Here are the reactions I often encounter with solo practitioners.

Defensiveness: Change creates "winners" and "losers." Solo practitioners feel strongly they will be directly harmed by the change. In fact, their professional life and practice will be directly damaged. And, their personal lifestyle will be ultimately hurt. Whether this is based on merit or not doesn’t matter. Perception is reality.

Resentment: Solo practitioners don’t feel they will benefit from the change and feel their colleagues will be hurt, so they feel resentful. Resentment is expressed as anger, fault and blame directly at the organizations and people who are causing the change.

Anxiety: Dentists get anxious starting with the first rumors. When they hear of solo practitioners being endangered by the proliferation of managed group practices, they feel they will be next.

Self-absorption: Being threatened causes people to focus on themselves. They begin to worry about how the changes will affect them personally. Self-absorption can undermine collegial relations when they feel their colleagues can turn into competitors by selling and joining a managed group practice.

Stress: Transition causes stress. Some of the physical and emotional symptoms of stress include headaches, indigestion, teeth grinding, back pain, mood swings, irritability, apathy, compulsive eating and hyperactivity. By anecdotal observation, these symptoms are much more prevalent in solo practitioners.  

In my work with solo practitioners, I strive to make them overcome their resentment, anxiety, stress and defensiveness and enable them to make the transition in mindset, skill set, strategy and tactics to succeed in this new ecology. Because this new world, which will be dominated by managed group practices, is inevitable.

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