Tag
#Dso
23 articles
Private Equity Isn't Wrecking Dentistry. It's Pricing It.
Is private equity wrecking dentistry? No. It is pricing it, with an instrument that cannot see where a dental practice's value lives. A former DSO operator on what the machine measures, what it misses, and what owners should actually be angry about.
The Point Guard: The Key-Person Risk Financial Diligence Can't See
The owner produced 4.8% of the practice — and originated 24.6% of everything it diagnosed. Diagnostic dependency is the key-person risk no QoE report measures.
The Second Bite: How Rollover Equity Works and Who Gets Paid First
Rollover equity is a security — minority, illiquid, leveraged, with an exit you don't control. The five questions that decide whether it's a second bite or a second haircut.
The Moving Target: How Dental Practice Earnouts Are Measured and Controlled
An earnout is not a number — it is a measurement system administered by the buyer for 3-5 years. The five clauses that decide whether yours pays $2.1M or $0.
The Graded Exam: Why Your Earnout Is Scored by the Person Who Owes the Money
An earnout is 10-30% of a dental practice sale, paid only if targets are hit — targets the buyer models, under operations the buyer controls, measured on the buyer's books. The mechanics, the tax trap, and the five clauses that un-tilt the table.
The Paper Millionaire: What Your Rollover Equity Is Actually Worth
Rollover equity is 20-40% of a dental practice sale taken as stock in the buyer's platform. The buyer audits you for 90 days; most sellers audit the buyer over a dinner. The five-question diligence every seller owes their second bite.
The Wrong Board: Why Dentists Optimize a Game They Never Chose to Play
Most dentists inherit their practice model — insurance contracts, real estate, associate hires — and optimize a game they never chose. Why that path builds a high-paying job, not the business an institutional buyer pays a real multiple for.
The Boutique Fallacy: Why Size Sets Your Dental Practice Value
Two dental practices, same profit, can sell millions apart. Why size — not margin — decides whether you get an SDE multiple or an institutional DSO/EBITDA exit.
Operational Due Diligence for Dental Practices: Know Your Baseline Before You Buy or Sell
The broker, lender, and CPA all give sound advice — but none establishes your operational baseline. Why buyers and sellers need forensic operational due diligence before they act.
Dental Practice Broker Fees: What a 6 to 12% Success Fee Buys, and What It Doesn't
When a QoE re-trade takes $700,000 off your price, the broker's Double Lehman fee drops $24,000. The 6 to 12% success fee buys a buyer and a close, not the audit of your number. What the fee covers, what it never did, and who defends the number instead.
What Is My Dental Practice Worth? Why the Answer Depends Entirely on Who's Buying
The value of your dental practice depends entirely on who is buying. Here is how individual buyers and institutional buyers calculate it — and why those are two different numbers.
Dental Practice Exit Strategy: The 5-Year Forensic Blueprint for an Institutionally Auditable Sale
A year-by-year dental practice exit strategy for building a practice that institutional buyers pay premium multiples for — the forensic blueprint starting 5 years before you sell.
The $250,000 Audit: How Retroactive Payer Downgrades Destroy Enterprise Value
A $25,000 insurance chargeback becomes a $250,000 enterprise value reduction at a 10x multiple. Here's how retroactive payer audits and QoE extrapolation compound to destroy dental practice valuations.
The KPIs That Kill Your Multiple: Which Dental Practice Metrics Institutional Buyers Actually Score
Not all dental KPIs matter at exit. Here are the metrics PE-backed buyers weight most, the thresholds that move multiples, and the vanity metrics they ignore entirely.
The Other Side of the Door: What You Are Actually Trading When You Sell Your Practice
A 45-year practice owner sold into a DSO and was forced out during COVID by someone 75 miles away. The number was right. The trade was not what he expected.
How DSOs Actually Evaluate Your Dental Practice: The 11 Underwriting Criteria They Score But Never Publish
Former NADG regional director reveals the 11 criteria DSO underwriting teams actually score — and the specific thresholds that separate premium multiples from discount ones.
The Same Playbook: What a Harvard Hospital Study Tells Us About the Future of Dental Practice Valuations
A Harvard study on PE-owned hospitals revealed a 13% rise in ER deaths after acquisition. The same debt-loading, cost-cutting playbook runs in dental M&A — and understanding it is the difference between a defended exit and a seven-figure re-trade.
EBITDA Laundering: The Clinical Blind Spot in Dental M&A
The EBITDA Laundering blind spot in dental M&A: how compliant-looking revenue masks clinical fraud that survives standard due diligence.
The EBITDA Illusion: Why DSOs Buy You at 5x and Trade at 14x (And How to Keep the Difference)
Why dental DSOs trade at 14x while acquirers pay 5x — understand the Multiple Arbitrage mechanism that transfers wealth from practices to PE.
The Myth of the "Unsellable" Practice: Why Rural Dentistry is the Ultimate Diamond in the Rough
Brokers call rural practices unsellable. The data says otherwise: 2–4 dentists per 10K, 15–20 year patient tenure, $50–$100 acquisition cost. Three paths to a real exit.
The Owner's Dilemma: Why Your Second Dental Practice Is The Hardest To Run
Two to nine locations: too big to run like one practice, too small for DSO infrastructure. The three breakdowns of multi-practice management and the data discipline that fixes them.
The Million-Dollar Mistake: Why Waiting Until You're Ready to Sell Could Cost You Your Legacy
Dentists who sell when they feel ready sell two to five years too late. $200,000 of added EBITDA at 6–7x is $1.2–1.4M of price left on the table, plus a smaller buyer pool.
Navigating the Great Squeeze: 5 Critical Insights from the 2025 ADA Dentist Workforce Report
Ownership fell from 84.7% to 72.5%, DSO affiliation doubled to 16.1%, and median GP net income dropped 13.2%. Five findings from the 2025 ADA workforce report and the metric to watch for each.