We sat down with a young doctor who works for a DSO supported practice to explore the issues, attitudes, prejudices, and worries surrounding this career choice. DSO supported practices comprise 20% of the dental market, and some say that will rise to 50% in the next five years, so it is vital to understand what is going on.
ProOrtho: How long have you been out of school?
Doc: 1 year
ProOrtho: Why did you choose to work with a DSO?
Doc: It was a good opportunity to fill several days at once which can be difficult as a new graduate. Working for multiple employers, especially in ortho, can be complicated regarding schedule coordination, different sources of income, varying practice styles, etc. Additionally, the DSO paid very well and being able to start seeing a full schedule of patients right away was a big plus.
ProOrtho: Was that your first choice?
Doc: Towards the end of residency, I had accepted an associate position with another doctor. I was looking to add extra days, and the DSO fit my schedule well. Initially, I assumed the traditional practice would be my long-term focus, and the DSO would supplement until I was ready to buy the other practice or start my own. However, I soon realized that I much preferred the DSO environment. When things didn’t work out with the other practice, I decided to commit to the DSO full-time.
ProOrtho: Why did you avoid working with a DSO initially?
Doc: Fortunately, I didn’t avoid it. However, I was aware of some concerns about corporate-type practices that definitely made me pause and think about it first.
ProOrtho: Tell me what you were told by your peers and professors about DSOs?
Doc: The dentistry is shady. The patients are a nightmare. You will be pressured to meet unrealistic production goals. You won’t make any money doing Medicaid. You won’t be able to take good care of the patients like you would in your own practice. You won’t be able to make your own decisions. Working for a DSO is not as prestigious, and you won’t be regarded as highly by your peers. The ultimate goal is to own your own practice anyway.
ProOrtho: What surprised you about working with a DSO?
Doc: How scary and exciting it was to start as the doctor in charge with a packed schedule from day one. Even though the high-volume can be stressful at times, I started learning very quickly from my successes and failures.
How much I actually like treating the patient population that often tends to end up at a DSO due to Medicaid/insurance and financial needs. There are certainly challenges, but it has been extremely rewarding professionally and financially, both aspects which I’ve heard others doubt.
ProOrtho: What do you like about working with a DSO?
Doc: Obviously it is important to find out who you are really working for, how certain situations will be handled, and where you can provide input. I’m sure each DSO is different. In my case, I am allowed to make my own decisions including when to accept/not accept a patient, the treatment plan, early dismissal, etc. Guidance is available if I need help or haven’t dealt with a particular issue before. My suggestions for improving patient care and processes are considered by the administration and often implemented.
I enjoy being able to focus on the ortho and the patients without the stresses of owning a business, especially so soon out of residency. There is no obligation to network with local practitioners or solicit referrals, although I do maintain my outside professional relationships and continue learning from my peers. It’s great to have general dentists and specialists under the same umbrella to make communication between providers easier.
ProOrtho: What do you not like about working with a DSO?
Doc: Because it’s not my practice and the supplies are standardized for many offices, there is less ability to experiment. Sometimes I read or hear about what others are using and wonder if I’m missing out. However, it does help me learn what I am capable of and to be creative with the products available. In many cases, I’ve realized that keeping things simple is a good thing.
The staff often work with several different doctors, so it’s difficult for them to keep track of individual preferences which can reduce efficiency at times. They are not my employees which is nice in the sense that I’m not in charge of the human resources challenges, but I also then have less control over with whom I work.
In a large organization, there is the high potential for seeing patients of other doctors although we are working on minimizing crossover. This can be particularly difficult in ortho because of the longer treatment plans and doctor-specific methods of case progression. When patients bounce between several providers, it’s easier for things to get off track or be overlooked.
I also occasionally worry that by not learning as much about the business aspect now that I will be at a disadvantage if I want to open own a practice in the future. At this point, however, I am not sure if I ever want that, so I am focusing on improving as a provider for now.
ProOrtho: How does your experience working with a DSO compare to what you’ve heard from peers in a more traditional setting regarding pay, work environment, quality of life, after-hours obligations, or any other differences?
Doc: The pay is far better with the DSO as compared to the traditional rates I’ve seen. On the order of 2-3 times the average per diem in our area. I think our work environment is very good compared to some traditional practices to which I’ve been exposed. There are occasional hiccups, but one benefit of a large organization is having dedicated resources to continually refine policies and procedures. There are, of course, those amazing traditional practices that everyone admires, but there are also plenty that are a total logistical mess. So I am grateful that I can fit in and function well in my current situation.
I am busier than many of my peers just starting out. I realize that successful traditional practices are also very busy, but it can take a while to get there. I am fortunate that my daily hours are compact, and the patients accept it without much complaint. When I get started, I barely stop moving until I’m finished. But I like it that way. I do spend a fair amount of time after hours reviewing my cases and making sure I stay organized. I’m sure those in traditional practice do as well. But I don’t have to spend additional time running a business or networking.
I am more directly in charge of my treatment approach than some new grads. This can be both good and bad as I may not be getting as much benefit from direct mentorship as someone in an associate position would. However, it has been a positive experience to own my decisions and learn from my mistakes.
ProOrtho: What advice would you give to young doctors, students or residents when considering their employment options?
Doc: Get out there and visit as many practices as you can, talk to former residents and colleagues, reply to classified ads. At least contact and interview (in person) with as many different employment sources as possible. Even if one doesn’t seem right for you at first glance or you already have a doctor promising you an associateship. Things pop up and also fall through at the last minute, trust me. More exposure will help you identify what you like and don’t like about particular environments, schedules, doctors, staff, etc. It’s so frustrating to start somewhere and know within days that it’s not for you, especially when patients, contracts, etc., are involved. The trial and error approach many new doctors experience can be uncomfortable. So do your best to be open to all options and don’t be afraid to ask questions and observe before you commit.
ProOrtho: Anything else?
Doc: DSOs can be a great opportunity to practice without having to own a business. They may not be for everyone, but I’m glad that I gave it a chance, and I may never want to leave!