Independent Practice vs. DSO in 2026: What the Data Say

An associate offer arrives from a DSO-supported group: a salary floor, benefits, no overhead to manage. A practice nearby is for sale. Or a DSO wants to buy the practice you built. Each choice shapes your income, your hours and who has a say in your treatment plans, down to which lab makes your crowns.

Opinions about DSOs are loud; the data are quieter. Below: what the ADA Health Policy Institute (HPI), peer-reviewed studies and federal agencies report, and what each model means for your lab work.

Quick Answer

The data do not crown a winner. DSO affiliation reached 16.1% of U.S. dentists in 2024 and 30.7% of those 0 to 5 years out of school, while practice ownership is being delayed rather than abandoned. Owners earn more and work slightly longer. New dentists rate unaffiliated practice higher for autonomy and business influence, while DSO settings offer benefit packages and fewer business duties. Research on patient prices and quality is limited.

How Fast Is DSO Affiliation Growing?

HPI counts a practice as DSO-affiliated when an outside entity manages some or all of its non-clinical functions, such as billing, marketing or human resources. The definition is about who runs the business side, not who owns the practice, and HPI says its method slightly undercounts DSO affiliation. By that measure, the share of dentists in DSO-affiliated practices more than doubled, from 7.2% in 2015 to 16.1% in 2024. In 2024, 11% of dentists worked in practices with 100 or more locations.

Affiliation drops with each career stage: 21.9% at 6 to 10 years out, 14.4% at 11 to 25 years and 9.1% beyond that. For the cost pressures behind many of these decisions, see our look at the dental practice squeeze.

Is Practice Ownership Disappearing?

Not overall. In 2023, 73% of dentists owned their practice, down from 85% in 2005. The decline is concentrated among younger dentists:

HPI reads this as ownership delayed, not reduced: most dentists eventually become owners, just at a later career stage. People also move between models. Of dentists less than 10 years out of school who were DSO-affiliated in 2016, 57.0% were still affiliated in 2021 and 43.0% had left; of those unaffiliated in 2016, 91.0% stayed unaffiliated and 9.0% joined a DSO.

The pipeline points both ways. In ADEA's 2025 survey of dental seniors entering private practice right away, 32% intended to join a DSO, up from 28% in 2021, and 50% planned to join non-DSO practices, up from 44%.

How Do Income and Hours Compare?

HPI's income and hours series compare owners with nonowners, not DSO with non-DSO dentists, and a DSO-affiliated dentist can be either. With that caveat, owner general dentists averaged $228,975 in net income in 2025 and nonowners $160,448. The gap is narrowing: comparing 2011 to 2015 with 2021 to 2025, owner general dentists' inflation-adjusted income fell by $23,000, while nonowners' was essentially unchanged.

Owners also work longer: 36.1 hours a week in 2025, against 33.6 for employee or associate dentists. Debt does not appear to drive the choice: in HPI's survey, educational debt at graduation was similar for dentists who started in affiliated practice, unaffiliated practice or federally qualified health centers.

What About Clinical Autonomy?

In 2023, HPI surveyed 1,010 dentists who graduated from 2013 to 2022, comparing affiliated private practice (part of a DSO or a multi-site group) with unaffiliated private practice. Unaffiliated practice scored highest on 7 of 11 job attributes, including schedule flexibility, influence on business decisions and workplace culture. Among affiliated dentists, 48% planned to leave that setting, including 39% who planned to move to unaffiliated practice; among unaffiliated dentists, 8% planned to leave.

HPI adds a balance: dentists who switched settings became more satisfied in either direction, and they may sort by what they value. Those planning to leave affiliated practice appeared to want more influence; those leaving unaffiliated practice, better benefits.

The legal frame matters too. In 2014, FTC staff noted that most states do not permit non-dentists, including corporations, to own dental practices or employ dentists, and wrote that DSO-affiliated dentists retain full control over the clinical aspects of patient care. The ADA's ethics council, writing about employee dentists in any setting, including DSOs, lists performance metrics, pressure from non-clinical staff and unavailability of appropriate materials and instruments as forms of interference.

How Big Is Private Equity's Role?

ADA News describes DSOs as either privately held or partnered with private equity firms that supply capital. In research led by HPI economists in Health Affairs, the share of dentists affiliated with private equity rose from 6.6% in 2015 to 12.8% in 2021, particularly among larger practices and specialists such as endodontists, oral surgeons and pediatric dentists. Private equity-affiliated practices were more likely to participate in Medicaid.

Federal agencies have spoken on both sides. In 2014, FTC staff warned Texas regulators that restricting dentists' contracts with DSOs could mean higher prices and reduced access, especially for underserved patients. In 2024, the FTC, the Justice Department and HHS opened an inquiry into private equity and corporate control in health care, warning such deals may maximize profits "at the expense of quality care." GAO's September 2025 review of consolidation research covered physician practices and did not address dentistry.

What Happens to Patient Prices and Access?

A 2026 study in Health Services Research looked directly at prices. Using commercial claims from 2015 to 2021, a team led by HPI economists found that after a private equity acquisition, dental offices raised their charges by 3.3% while the prices insurers allowed stayed statistically unchanged. Acquired offices shifted from diagnostic and preventive procedures toward restorative, specialty and surgical care and were more likely to become multispecialty. The authors note that higher list prices can still be passed on to patients.

On access, the Health Affairs study found higher Medicaid participation among private equity-affiliated practices, and in Virginia's Medicaid program for children from 2003 to 2011, DSO providers saw more patients and filed more claims per provider than private-practice providers (Brickhouse et al., 2021). Bargaining power is limited: a 10% rise in dentist concentration was associated with only a 0.71% rise in gross payments, against a 1.95% drop for a 10% rise in insurer concentration (Nasseh et al., 2021). On quality, the Health Affairs authors call for research into whether private equity affects affordability and quality.

What Does Each Model Mean for Lab Choice and Case Quality?

In an independent practice, the owner chooses the lab, the materials and how to weigh a lab fee against remake risk; associates work within those choices. In a DSO model, FTC staff list services that may include buying equipment and supplies and "management of external laboratory services." The ADSO, the DSO trade group, says buying power and vendor negotiation lower dentists' supply costs. Whether that means one contracted lab, a short list or your own choice depends on the agreement. None of the studies above report how often DSO practices use a single lab.

Compensation can tie lab work to your pay. ADA News suggests asking how production is calculated and whether it factors in lab fees. If lab fees come out of your production, remakes and premium materials show up in your paycheck. State law is part of the picture: a 2024 article lists control over equipment and materials, and over clinical judgment, among the principles state dental practice acts address (Cameron and DeVore, 2024).

Working With Elegant Dental Laboratory

• Full-service lab at 2308 McDonald Ave, Brooklyn, NY, founded in 2007 by Gary Fingerman: a 7,000 sq. ft. facility where more than 35 technicians make every case in house, with no outsourcing.
• Digital scans are reviewed before production. We accept STL and PLY files from all major intraoral scanners (submit a digital case), and for zirconia we follow the brand or grade written on the Rx.
• 5 business day standard turnaround on most restorative cases, rush options, and up to a 7-year warranty on final restorations (policies and warranties).
• Free pickup and delivery by our own drivers every business day during lab hours in all five New York City boroughs and 13 northern New Jersey counties; UPS labels for practices anywhere. Send a case or call 877-335-5221.

FAQ

What share of U.S. dentists work in a DSO?

16.1% were DSO-affiliated in 2024, by HPI's count, which it says slightly undercounts. Among dentists 0 to 5 years out of school, 30.7%.

Do DSO dentists earn more than independent dentists?

HPI reports income by ownership, not DSO status. Owner general dentists averaged $228,975 in 2025 and nonowners $160,448.

Does a DSO choose my dental lab?

It depends on the agreement. DSO services may include managing outside lab services, so ask before you sign and get the answer in writing.

Do private equity-owned practices charge more?

In one study of 2015 to 2021 claims, list charges rose 3.3% after acquisition, while insurer-allowed prices did not change.

Is practice ownership still the norm?

Yes, but later: 73% of dentists owned a practice in 2023, while only 8.8% of dentists under 30 did.

Can I leave a DSO later?

Many do: 43.0% of new dentists affiliated with a DSO in 2016 were no longer affiliated in 2021. Check any restrictive covenant first.

Reviewed by Gary Fingerman, founder and CEO of Elegant Dental Laboratory, Brooklyn, New York (founded 2007). Last reviewed: October 1, 2026. Figures are from the sources listed; this article is general information, not legal, financial or career advice.