HIGHBusinessTier 1
The biggest challenges facing DSOs
SourceBecker's Dental + DSO ReviewTier 1Hard News
By Ariana Portalatin
Originally at beckersdental.com
Summary & scoring by The Bell Brief (Dr. Jennifer Bell) using the Drill-Down Protocol (Drill-Down Score) — not the original publisher.
Why it matters for dental
DSO leaders report that groups reliant on cheap debt and rapid roll-ups now face tighter capital, higher labor costs, and the need to generate real operating value rather than rely on financial engineering. Practice owners and DSO executives evaluating affiliations or expansion should weigh demonstrated EBITDA creation, retention infrastructure, and realistic growth expectations.
Key points
- Dylan Bates, CEO of SALT Dental Partners, states that organic growth is now essential and warns that several groups became over-leveled and impaired partner doctors’ rollover equity.
- Mark Greenstein, Chief Growth Officer at Heartland Dental, notes that practices started after 2018 are shifting from acquisition-driven growth to value creation because high interest rates block further exits.
- Ashish Bagai, Co-CEO at Vitana Pediatric & Orthodontic Partners, observes that economies of scale flatten beyond 20–40 locations and that same-store revenue growth depends more on local leadership than size.
- Geith Kallas, DDS, CEO of Smile Maker’s Dental Center, states that DSOs built on 4% loans and 15× EBITDA multiples now face 9.5–11% debt costs and 6–8× multiples, with several expected to face bankruptcy within the next 18 months.
Who should care
OwnerDSO
Read the original on Becker's Dental + DSO Review
Full reporting and any paywall content live on beckersdental.com. We summarize and score; we do not republish.