Dentistry is rapidly evolving, from technology to practice settings. Each year technology assists practices and patients move toward better health. Practice settings for hygienists have evolved from one doctor and one hygienist, to multiple doctors, multiple hygienists, and multiple locations. It is the “multiple locations” that is the hallmark of dental service organizations (DSOs). But what exactly is a DSO, and what are hygienists’ roles within a DSO?
What is a DSO?
DSO can stand for either dental support organizations or dental service organizations. Within dentistry both terms are considered to be accurate. For purposes of this article, a DSO will refer to the service organization.
There are several types of DSOs. A DSO can be a practice that is dentist-owned but that works with a large management group, company, or agency to handle all of the business aspects of the practice. It can be dentist-owned group practices, or a combination of group and management.
There is no one set type of DSO. A DSO can be run by a national management group, a regional management group, or an individual dentist who is the owner and is consolidating existing practices in an area. The DSO may have structured C-suite hierarchy—chief operating officer, chief financial officer, and chief information officer—or it may have only a dentist-owner overseeing several practices and practice managers in each location.
Many state laws require a dentist to be the owner of the practice; therefore, a dentist must be involved in the management of the DSO. The creation of DSOs has allowed dentists to practice dentistry and be concerned only about the clinical aspects, without worrying about the ever-expanding business aspects of running a practice.
A DSO can provide general dental services in a traditional dental practice setting, or it can be a specialty organization that focuses on treatments such as pediatrics, dentures, or implants. The DSO management provides the business and nonclinical operations of the practice. The management team focuses on the day-to-day business concerns, human resources management, and consolidation of buying power for large and small practice purchases. This management perspective allows the dentist and team to focus on patients.
Pros and cons of DSOs
As in any organizations there are both positive and negative aspects to consider with DSOs. It has been estimated by the American Dental Association that 7% of all dentists in the United States are affiliated with DSOs, with a high percentage of young dentists, female dentists, and pediatric dentists participating.1 Many believe that DSOs contribute to access to care, while others consider DSOs to be “production mills.” Many DSOs pay team members a salary plus bonus based on production and collection rates, as well as provide liberal benefits packages that many single-doctor practices may not be able to provide.
It is often difficult to spot a DSO if it is part of a management group or corporation rather than a national DSO. The management group will often retain the original practice name and many of the same team members. From an outside perspective, the dental practice looks and acts the same as before, yet the management of the practice resides outside of the physical practice.
It is estimated that the growth of DSOs will expand exponentially in the coming years due to a variety of factors, ranging from dental student debt to changes in health care and regulatory systems. Yet determining whether a DSO is the right environment for you as a hygienist is the same as determining how you would view any employment opportunity. Weighing the pros and cons about any hygiene position often depends on someone’s situation in life.
Most hygienists employed in a DSO practice as clinical hygienists. Depending on the type of DSO, clinical standards may be set by the management organization or may be left to the individual practice. When the clinical standards are set by the organization, all clinical team members across all practices are required to follow the same guidelines for patient care and treatment. These can range from the amount and type of radiographs to types of patients who qualify for periodontal treatment. These protocols can enhance team collaboration and ensure quality assurance through standardization of care and improved infection control and risk management protocols.
Team members often have access to similar state-of-the-art technology, regardless of whether they’re employed in practice A or practice B. Yet these standardized protocols may not correspond to a hygienist’s beliefs and practice philosophy. Doing your homework about a DSO and its practice philosophy prior to accepting a position is critical in preventing buyer’s remorse about your chosen opportunity. DSOs provide hygienists with opportunities for growth and leadership that smaller practices may not offer. As an employee of a DSO, the hygienist is part of a large organization beyond the actual practice where care is provided.
Educational and management opportunities
Ongoing education is one focus of DSOs. Team members have access to a variety of educational opportunities ranging from various CE programs to soft skills and business education. These are often provided at little or no cost to team members. DSOs recognize the importance of hygienists in the practices; therefore, ongoing support is an integral part of the practice. If a hygienist wishes to move beyond clinical practice, opportunities often exist in the DSO for leadership roles such as mentoring, management, or training.
Hygienists can mentor other clinical hygienists, become a practice manager, administrator, or treatment coordinator, or become a regional or district educational trainer. Hygienists in small private practices often lament the lack of camaraderie or resources available. In a DSO, there’s a team of hygienists to collaborate on patient care, along with dentists, assistants, and business team members who share in the success of the practice. DSOs want all team members and patients to be successful.
A number of hygienists have pursued management and educational roles beyond the operatory in DSOs. Costs are often contained in DSOs; therefore, supplies or instruments must be purchased within a budgetary time frame. But the opportunity to purchase the latest hygiene equipment is viewed as a positive enhancement to patient care. DSO hygienists often participate in local community projects or events to enhance community service and involvement.
There have been many stories about hygienists who have become involved with DSOs, whether through a practice transition or by actively seeking employment with a DSO. As in any career opportunity, there are both good and bad tales. One hygienist was asked to take bitewing radiographs on all patients, regardless of whether radiographs were needed or not. Another was asked to work numerous days with little or no break time. Yet many other hygienists have said they appreciate the growth opportunities and excellent salary and benefits that DSOs provide.
Is a DSO right for me?
Deciding whether to become a hygienist in a DSO practice depends on a number of factors. These include:
• being comfortable in your work environment and enjoying the rewards of the work,
• believing in the practice philosophy of care, and
• working with team members who respect and share values.
DSOs are here to stay. As with any employment opportunity, hygienists must weigh the opportunity with their needs to make the choice that is right for them.
1. Lucken N. What is a DSO anyway? Dental Billing website. https://dentalbilling.com/what-is-a-dso-anyway/. Published December 5, 2018.
ANN-MARIE DePALMA, MEd, RDH, CDA, FADIA, FAADH, is a technology advisor for Patterson Dental, a writer for RDH magazine, and an author in dental hygiene textbooks. She is the 2017 MCPHS Esther Wilkins Distinguished Alumni recipient. She is a fellow of the Association of Dental Implant Auxiliaries and American Academy of Dental Hygiene, a continuous member of the American Dental Hygienists’ Association, and an active member of the Massachusetts Dental Hygiene Association.