The Premise & Persistent Question

“Can I even compete with DSOs in buying a dental practice?”

This is a fear I hear all the time from associates ready to buy their first practice. They find a listing they love, start running numbers, and then freeze, convinced a corporate buyer is going to swoop in with a bigger check and snatch it away. But are independent buyers competing against DSOs?

I get why it feels that way. DSOs have acquisition teams and what sometimes seems like unlimited capital. The narrative in dentistry has been that corporations are taking over and private practice is dying.

But here’s what I’ve learned after being involved in hundreds of transitions: 

That narrative is mostly wrong.

I sat down with Marie Chatterley from CTC Associates on our podcast recently, and she shared a statistic that surprised even me!

95% of her sellers prefer to sell to an independent buyer. Not 50%. Not 70%. Ninety-five percent.

So if you’ve been sitting on the sidelines thinking you can’t compete, it’s time to rethink that statement.

Why the Playing Field is More Level Than You Think

The assumption is that DSOs will pay more for practices. They throw around impressive-sounding numbers at conferences and on forums. You hear stories of doctors getting “100% of collections” from a corporate sale and think, there’s no way I can match that.

But those headlines never tell the full story.

Marie Chatterley broke it down simply, when you compare cash at close to actual money the seller walks away with – independent buyers and DSOs often land in a very similar price range. The difference is what comes along with that number.

A DSO offer might sound and look larger on paper, but when we dig into the details and you’ll typically find:

• Sellers only get 50-70% in cash at closing
• The remaining 30-50% tied to earnout bonuses, production targets, or equity rollovers
• Many deals include 3-5 year work-back requirement where the seller stays on as an employee
• Production performance conditions that may or may not materialize

An independent buyer, by contrast, offers a cleaner transaction for sellers. Independent buyers offer cash at close, a short transition period, and the seller walks away on their terms. No strings attached. No three-year employment contract. There is no hoping and waiting for the DSO’s equity play to actually pay off. You might be better off investing in the stock market over time.

When sellers understand this distinction (and more of them do now than five years ago) the “DSO premium” starts to look less appealing.

Three Realities That Work in Your Favor

If you’re an associate or first-time buyer worried about competing, here are three realities that should give you confidence:

Reality 1: Sellers Have Seen the Cautionary Tales

Marie also mentioned something that stuck with me – In her markets, multiple practices have closed under corporate ownership. 

Some sellers have watched colleagues lose promised bonuses when a DSO underperformed. Others have seen friends buy their practices back from DSOs after poor management decisions.

Word travels in dentistry. Sellers talk to each other. And increasingly, docs are choosing the certainty of an independent sale over the gamble of a corporate payout.

Reality 2: DSOs Are Evaluating the Same Fundamentals You Are

There’s a misconception that DSOs have some secret valuation formula that justifies higher prices. They don’t. On the podcast Marie also confirmed what I’ve seen repeatedly – DSOs look at the same things you should be looking at: profit margins, patient demographics, operational efficiency, and growth potential.

The difference is that DSOs are optimizing for their business model, not yours. They need practices that fit into a regional portfolio strategy. They need enough scale to justify management overhead. A practice that doesn’t fit their model isn’t getting a premium offer and maybe even passed over entirely.

That mismatch works in your favor more often than you’d think! Check out this other blog post on What Actually Drives Dental Practice Value

Reality 3: You Have Something DSOs Can’t Offer

Sellers care about more than price. They’ve spent 20, 30, sometimes 40 years building relationships with patients and staff. Many of them genuinely care about what happens after they leave. So in those cases no, independent buyers are not competing against DSOs!

A DSO can’t promise continuity. They can’t promise the selling doctor’s name will mean anything six months post-sale. They can’t promise the team won’t be restructured to hit corporate margins. You can! When you work with NEXT LEVEL CONSULTANTS during your practice acquisition search, we even help you establish connections with docs thinking of selling via our letter drop program. 

When you show up prepared with a pre-approval for financing, a clear vision for the practice, genuine respect for what the seller built, you’re offering something a corporate buyer simply can’t. You offer them the continuation of a legacy that they are proud of. For a surprising number of sellers, that matters more than an extra 10% on paper.

The Opportunity

Here’s the reality no one talks about at conferences: private practice isn’t dying. It’s evolving.

Yes, DSOs have consolidated parts of the market. But the days of cheap money are gone and doctors who sell to them are a specific subset. Often their primary goal is optimizing purely for maximum payouts or they want to stay on as employees without the ownership headaches. That’s a legitimate choice, but it’s not the majority.

Most sellers [95% in Marie Chatterley’s experience] want to hand their practice to someone who will take care of it. Someone who will show up, treat patients well, and honor the business they built.

If you’re that buyer, you’re not competing against DSOs. You’re competing against other prepared independent buyers. And that’s a competition you can win with the right preparation and guidance.

Positioning Yourself to Win

The buyers who succeed in this market don’t just show up with financing. They show up with a full package: pre-approval from a reputable lender, clinical skills that match the practice’s production, a transition plan that puts the seller at ease, and often a buyer’s representative who knows how to navigate negotiations.

At NEXT LEVEL CONSULTANTS, we’ve helped hundreds of dentists step confidently into practice ownership, not by outbidding DSOs, but by being the better overall choice. 

We’ll help you present a complete package, do a valuation analysis, clinical fit assessment, vet lender relationships, and develop a solid transition strategy.

So independent buyers competing against DSOs is a false pretense and you don’t have to let that stop you. Stop wondering whether you can compete and start positioning yourself to win, let’s have that conversation!