The Dental Boardroom

In this episode of the Dental Boardroom Podcast, Wes Read continues his analysis of the ADA Health Policy Institute 2024 study, focusing on one of the biggest shifts in modern dentistry who actually owns the industry today.

This episode dives deep into the rise of Dental Service Organizations (DSOs) and compares them with traditional private practice models. Wes breaks down real data on ownership trends, career stages, and practice sizes, and shares practical insights from years of advising dentists.

Beyond the numbers, he explores the hidden challenges of scaling multi-location practices, the financial trade-offs of choosing employment over ownership, and the reality behind DSO deal structures.

The episode closes with a strong perspective on the future of DSOs, why many may struggle in the long term, and why private practice ownership remains the most powerful path to autonomy, control, and wealth in dentistry.

1) Ownership Trends Are Shifting

Younger dentists are moving away from solo ownership.

The majority of older dentists still prefer private practice.

2) DSOs Are Growing, but Not Dominating

Only a small percentage of dentists are DSO-affiliated.

Most practices are still single-location setups.

3) Scaling Is Harder Than It Looks

Expanding beyond one location adds significant complexity.

Many dentists struggle in the “in-between” growth phase.

4) Stability vs. Wealth Trade-Off

DSOs offer more predictable income.

Private ownership offers significantly higher long-term earnings.

5) Small Income Gap = Massive Lifetime Impact

Even a $50K annual difference can lead to millions lost over time.

6) DSO Deals Can Be Misleading

Higher valuations often come with strings attached.

Earn-outs and equity rollovers carry uncertainty.

7) Early Players Win in DSOs

The biggest gains go to early adopters.

Late entrants typically see limited upside.

8) Private Equity Plays a Short-Term Game

The focus is often on scaling and reselling, not long-term operations.

9) Future Risk for DSOs

Talent retention and performance consistency are major challenges.

Many DSOs may struggle as original owners exit.

10) Private Practice Still Wins (for Most)

Greater control, autonomy, and wealth-building potential.

The best path for long-term financial success in dentistry.

1. The current breakdown of DSOs vs. private practice ownership in dentistry
2. Why solo practice is declining among early-career dentists
3. How student debt is influencing career decisions and risk tolerance
4. The real challenges of scaling from one to multiple locations
5. How DSOs are structured and how their deals actually work
6. The difference in income and long-term wealth between owners and employees
7. Why many dentists may be leaving money on the table by choosing DSOs
8. The role of private equity in shaping the dental industry
9. Predictions on the future of DSOs and potential market shifts

In this episode of The Dental Boardroom Podcast, host Wes Read, CPA and financial advisor at Practice CFO, breaks down fresh data from the ADA Health Policy Institute (2024–2025) to uncover what’s really happening inside the dental industry. While many dentists are earning less despite working more, rising overhead, stagnant PPO reimbursements, and economic pressure are creating real challenges.

But here’s the truth: not every practice is struggling.

Some dentists are not only surviving but thriving. They’re building highly profitable practices, growing wealth faster than their peers, and creating systems that allow them to win despite industry headwinds.

This episode dives into both sides of the story and, more importantly, what separates those who struggle from those who succeed.

1. Dentistry is facing real financial pressure: Dentists are working more hours while earning less due to rising expenses and flat reimbursements.

2. Overhead is the silent profit killer: Staff wages, supplies, and operational costs are increasing year over year, shrinking take-home income.

3. Flat revenue = declining wealth: If your collections aren’t growing with inflation, you’re effectively losing purchasing power every year.

4. Growth creates leverage: Because most dental costs are fixed, increasing revenue significantly boosts profit margins.

5. PPO dependence is expensive: Insurance-based dentistry often sacrifices profitability for patient volume.

6. Business skills are no longer optional: Top-performing dentists aren’t just clinicians—they’re strong business operators.

7. “Platforming” your practice is the key to scaling: Building systems, processes, and teams allows growth beyond your personal clinical hours.

8. Three core systems drive success:

1. Marketing → drives patient flow
2. Practice Management → improves efficiency & experience
3. Financial Systems → maximize profit and control cash flow

9. What gets measured gets improved: Regularly tracking performance metrics and reviewing financials is essential for growth.

10. Less personal spending = more business growth: Reinvesting in your practice (rather than lifestyle inflation) accelerates long-term success.

In this episode of The Dental Boardroom Podcast, host Wes Read talks with Matt Coggin about how dental education is evolving in today’s fast-changing healthcare landscape. They explore how dentists can stay competitive through continuous learning, team training, and effective communication, while navigating challenges like staff turnover, AI integration, and the rise of DSOs. The episode highlights practical strategies for improving clinical skills, patient care, and overall practice performance.

1. Evolution of dental education and continuous learning
2. Training pathways for early-career dentists
3. Blended learning: online modules + hands-on workshops
4. Importance of training the full dental team
5. Enhancing patient communication for higher case acceptance
6. Integrating AI into dental practice
7. Addressing staff turnover and operational consistency
8. Impact of DSOs and private equity on dentistry

1. Continuous Learning Is Essential: Ongoing education improves both clinical skills and patient outcomes.
2. Support for Early-Career Dentists: Structured training helps new dentists gain confidence in procedures and decision-making.
3. Blended Learning Works Best: Combining online modules, workshops, and coaching reinforces knowledge and practical application.
4. Team Alignment Matters: Training the entire dental team ensures consistent patient experiences and smoother operations.
5. Communication Drives Growth: Clear patient communication increases trust, case acceptance, and overall practice success.
6. AI Is Emerging in Dentistry: Tools can assist diagnostics and treatment planning, but must be integrated thoughtfully.
7. Staff Turnover Requires Planning: Structured onboarding and ongoing training help maintain efficiency despite staffing changes.
8. DSOs and Private Equity Influence Practices: Scalable education systems are key for multi-location or corporate-backed practices.

In this episode of the Dental Boardroom Podcast, Wes Reed dives into some of the most common and costly business and practice management mistakes dentists make. Drawing from years of experience working with hundreds of dental practices, Wes explains how strong clinical skills alone aren’t enough to build a sustainable, profitable, and stress-free practice.

He breaks these mistakes into six core areas, covering everything from management systems and PPO economics to lease agreements, partnerships, financial planning, and KPIs. Throughout the episode, Wes uses practical examples and real-world analogies (including agile software development) to show how intentional systems and financial clarity can free owners from burnout and help practices scale intelligently.

This episode is a must-listen for practice owners who want to stop managing reactively and start operating with structure, clarity, and long-term strategy.

Many dentists manage by instinct instead of by process. Without a clear management operating system including defined roles, meeting cadence, accountability, and decision-making frameworks, practices become reactive, inconsistent, and owner-dependent. Wes explains how adopting even a simple system and iterating over time can dramatically improve operations and reduce burnout.

PPOs often increase top-line revenue but quietly erode profitability. Wes breaks down how fee schedules, write-offs, chair utilization, and hygiene profitability impact the bottom line. He emphasizes that PPOs are essentially an expensive marketing channel and that growth without profitability can lead to exhaustion, not success.

A lease is often the largest non-clinical financial commitment a dentist makes, yet many sign without fully understanding the implications. Wes discusses escalation clauses, renewal options, relocation clauses, and why poor lease terms can hurt practice value or even prevent a successful exit.

Partnerships often fail not because of personality conflicts, but because of unclear financial structures. Wes explains why production, ownership, expenses, and profit splits must be modeled and stress-tested before forming a partnership and why aligning accounting execution with the partnership agreement is critical.

Most practices rely only on historical financial reports, such as P&Ls, which show where the practice has been, not where it’s going. Wes explains how FP&A (or a CFO model) helps dentists forecast cash flow, plan strategically, and turn financial anxiety into financial control.

Without key performance indicators, practices lack visibility and accountability. Wes highlights the importance of both leading and trailing KPIs, the value of KPI software, and how daily or weekly team huddles around metrics create a culture of ownership and consistency.

1. Clinical excellence alone doesn’t guarantee a successful practice; systems and strategy matter.
2. A management operating system frees the owner from being the bottleneck.
3. PPO participation must be understood at the procedure- and profitability-levels, not just collections.
4. Lease terms can significantly impact long-term practice value and exit options.
5. Partnerships should be treated like financial marriages, with detailed modeling upfront.
6. FP&A helps dentists make forward-looking decisions instead of relying on gut instinct.
7. KPI create clarity, accountability, and better team alignment.
8. AI should enhance well-designed systems, not replace leadership, processes, or strategy.

In this episode of The Dental Boardroom Podcast, host Wes Read is joined by Megan Shelton (Shelton Solutions) and Michael Anderson (co-founder of Wondrous) for an in-depth executive session focused on one of the most challenging stages of practice ownership: scaling without creating chaos.

The conversation explores the concept of “No Man’s Land” the phase where a dental practice is too big to operate informally, yet not structured enough to run like a true organization. The panel breaks down what typically breaks first as practices grow, why culture and clarity often erode before financial performance does, and how intentional systems, leadership layers, and data-driven decision-making can help owners scale sustainably.

This episode is especially relevant for dentists approaching $1.5–$2.5M in revenue, adding providers, or feeling increasingly busy, stressed, and constrained despite apparent growth.

1. The “No Man’s Land” phase of practice growth
2. Founder vs. CEO identity shifts
3. Culture, values, and psychological safety as scaling foundations
4. Measuring quality beyond production and revenue
5. Marketing ROI, lead quality, and tracking systems
6. Operational dashboards, KPIs, and accountability
7. Delegation, leadership development, and team structure
8. Common myths and misconceptions about growth

When revenue outpaces infrastructure, practices experience rising stress, declining consistency, and fractured operations even if production looks strong on paper.

Teams feel instability before leaders can name it. Communication breakdowns, confusion, and burnout are often the earliest warning signs of unhealthy growth.

Clear mission, values, and standards create alignment and serve as a filter for decisions around hiring, marketing, scheduling, and patient care.

True quality indicators include:

1. Case acceptance consistency
2. Patient retention and re-treatment rates
3. Team turnover and engagement
4. Diagnostic alignment across providers
5. Cash flow clarity

More leads don’t equal better outcomes. Practices must track where patients come from, how they convert, and which channels actually drive ROI.

Scaling requires owners to let go of certain roles and build leadership layers while maintaining accountability through systems and metrics.

Without structure, adding providers, patients, or locations often increases stress instead of freedom.

A key test of operational maturity: if another doctor stepped in tomorrow, what would continue to function and what would immediately break?

In this episode of The Dental Boardroom Podcast, we take a deep dive into the Q4 2025 State of the U.S. Dental Economy Report from the ADA’s Health Policy Institute to understand where dentistry stands heading into 2026.

Using AI-powered analysis, we explore how dental practices are navigating rising costs, staffing shortages, flat insurance reimbursements, and shifting patient behavior. While many dentists are feeling financial pressure, the data reveal a profession that remains resilient, adaptable, and focused on long-term growth.

Despite inflation and operational challenges, patient demand continues to rise, proving that oral healthcare remains a top priority. This episode highlights why 2026 may be a pivotal year for practice owners willing to rethink their business models and embrace strategic change.

1. Q4 2025 dental industry performance
2. Patient spending trends and demand
3. The “fiscal squeeze” facing practices
4. Insurance reimbursement challenges
5. Staffing shortages and labor market shifts
6. Differences between private practices and DSOs
7. Technology vs relationship-driven growth
8. Dentist confidence and investment outlook for 2026

1. Patient Demand Remains Strong: Dental spending is up 9% compared to pre-pandemic levels (inflation-adjusted), showing that patients continue to prioritize oral health.
2. The Fiscal Squeeze is Real: Rising supply and labor costs combined with flat insurance reimbursements are shrinking profit margins across the industry.
3. Confidence is Under Pressure: Many dentists are busy but earning less, leading to frustration and declining economic confidence.
4. Staffing Remains a Challenge: Hygienists are still extremely difficult to hire, while assistant hiring shows slight improvement.
5. Uneven Growth Creates Opportunity: Some practices have excess capacity, creating opportunities for better marketing and patient conversion.
6. Fear Limits Major Changes: Although many dentists want to drop low-paying insurance networks, few actually take action due to uncertainty.
7. 2026 Shows Signs of Optimism: More dentists plan to hire, invest in equipment, and restructure networks—signaling belief in long-term demand.
8. DSOs and Private Practices Differ in Strategy: DSOs rely more on technology and automation, while private practices emphasize relationships and personalized care.
9. Patients Value Dentistry More Than Insurers Do: Consumer spending proves that patients recognize the value of dental care, even when insurance does not.

In this episode, Wes Read continues his series on common financial mistakes dentists make, focusing on retirement planning and investing. He explains how poor decisions around 401 (k) plans, defined benefit plans, debt management, and private investments can significantly impact long-term financial success.

Wes breaks down how the U.S. tax system works, why retirement accounts are powerful tax-saving tools, and how dentists can use smart financial strategies to accelerate their path toward financial independence. He also shares real-life examples of mistakes he has seen in his practice and offers practical advice to avoid them.

This episode is designed to help dentists make informed decisions, protect their wealth, and build a sustainable financial future.

• Understanding the importance of choosing the right 401(k) strategy
• How progressive taxes impact high-income professionals
• When to Consider a Defined Benefit (Cash Balance) Plan
• Why paying off low-interest “good debt” too early can hurt growth
• Risks associated with private and non-transparent investments
• The importance of diversification and due diligence

Use 401(k) Plans Strategically: A well-structured 401(k) is one of the most effective ways for dentists to reduce taxes and build retirement savings. When implemented at the right time, it benefits both the owner and the team.

Consider a Defined Benefit Plan in High-Income Years: For dentists with strong cash flow and high tax exposure, defined benefit plans can allow much larger, tax-deductible retirement contributions. However, they require professional management.

Don’t Rush to Pay Off Good Debt: Low-interest, tax-deductible debt used for assets like a practice or home should not always be paid off early. Investing that money can often produce higher long-term returns.

Be Careful with Private Investments: Many private deals lack transparency and liquidity. Dentists should avoid investing based on hype and always perform proper due diligence.

Think Long-Term, Not Emotionally: Financial decisions should be based on data, strategy, and long-term goals—not fear, pressure, or short-term emotions.

Tax Planning Is a Key Part of Wealth Building: Understanding how taxes work and using retirement accounts properly can save tens of thousands of dollars over time.

In this episode of The Dental Boardroom Podcast, host Wes Read continues his series on common financial mistakes dentists make, with a deep dive into tax planning gaps that often lead to paying unnecessary taxes.

Wes explains how many dentists rely on reactive tax filing instead of proactive tax planning, causing them to miss powerful deductions and make poor timing decisions. He breaks down practical, real-world strategies such as the Pass-Through Entity (PTE) tax election; overlooked deductions like kids on payroll, home office, vehicles, meals, and travel; and why depreciation must always align with cash flow.

The episode also highlights the risks of overly aggressive tax strategies, why meeting with your CPA only once a year isn’t enough, and how a CFO-style, proactive approach can significantly accelerate a dentist’s path to financial independence.

1. Common tax planning mistakes dentists make
2. How the Pass-Through Entity (PTE) tax election works
3. Why the timing of tax payments matters
4. Low-hanging tax deductions many dentists miss
5. Kids vs. spouse on payroll (and when it makes sense)
6. Home office, car, meals, and travel deductions
7. Risks of aggressive tax strategies like misused R&D credits
8. Proper vs. improper use of depreciation (Section 179)
9. The difference between reactive CPAs and proactive, CFO-style planning

1. PTE tax election is a major opportunity: Dentists in high-tax states can significantly reduce federal taxes if payments are made correctly and on time.
2. Cash timing determines deductions: Tax deductions only apply in the year money actually leaves your account.
3. Small deductions compound: When combined, kids on payroll, home office, vehicle use, meals, and travel can create meaningful tax savings.
4. Spouse on payroll requires retirement planning: Without a 401(k) or defined benefit plan, it can increase taxes instead of reducing them.
5. Depreciation isn’t free money: Misusing Section 179 can create future cash flow problems.
6. Avoid crossing the line: Aggressive or poorly justified strategies increase audit risk.
7. Tax planning follows cash flow planning: Taxes are a subset of cash flow—not the other way around.
8. Proactive advice matters: Dentists benefit most from advisors who specialize in dentistry and meet multiple times per year.
9. CFO-style planning accelerates wealth: Integrated tax, cash flow, and financial planning lead to faster and more sustainable financial independence.

In this episode of the Dental Boardroom Podcast, host Wes Reed introduces a brand-new subseries called The Executive Session. This interdisciplinary series brings together experts in finance, marketing, and practice management to discuss the real business challenges dental practice owners face today.

Joined by co-hosts Megan Shelton (https://www.instagram.com/doctormeganshelton/ (Practice Management & Operations) and Michael from Wondrous Agency (instagram.com/wonderistagency/) (Dental Marketing), this kickoff episode explores how the definition of a “successful” dental practice has evolved over the last decade. The panel breaks down how marketing, operations, and financial strategy must work together to drive sustainable growth without burnout.

From tracking real ROI in marketing to improving case acceptance and building systems that support both profitability and lifestyle, this episode sets the foundation for what modern dental leadership looks like.

Success today is more than revenue

1. A successful dental practice balances strong collections with profitability, lifestyle flexibility, and personal fulfillment.

Top-line growth without bottom-line control is dangerous

1. High revenue means nothing if margins are thin. Profitability and cash flow matter more than ever.

Marketing must be measurable

1. Website traffic and rankings don’t pay the bills new patients, collections, and ROI do. Integration with practice management software is critical.

Operations make or break marketing

1. Even the best marketing fails if front desk systems, case presentations, and patient experience aren’t aligned.

Data visibility across the entire pipeline is essential

1. From leads → appointments → case acceptance → collections, successful owners track every stage.

Growth requires systems, not hustle

1. Sustainable growth comes from leadership, team retention, clear communication, and predictable processes not longer hours.

You can’t do it alone

1. High-performing practices invest in expert support marketing, operations, and finance to scale efficiently.

Seasons matter

1. Balance looks different at different stages of ownership. Clarity, reflection, and intentional decision-making are key.

In this episode of the Dental Boardroom Podcast, host Wes Read, CPA and financial advisor at Practice CFO continues his series on common financial mistakes dentists make, this time focusing on tax planning gaps. Wes explains why many dental practice owners unknowingly overpay taxes and how poor tax planning often results from weak cash flow management, rather than bad intentions.

This episode breaks down complex tax concepts into practical insights, helping dentists understand how smarter planning throughout the year, not just at tax time, can lead to tens of thousands of dollars in savings annually and faster financial independence.

1. Many dentists believe tax planning is handled solely by their CPA at year-end.
2. Real tax planning happens throughout the year, tied directly to business decisions.
3. Waiting until December often means it’s already too late to reduce taxes effectively.

1. Taxes cannot be optimized in isolation.
2. Every dollar flowing through the practice revenue, expenses, payroll, debt, and savings affects tax outcomes.
3. Smart tax strategies must consider current and future cash flow, not just immediate deductions.

3. Common Tax Planning Gaps Dentists Make

1. Missing legitimate deductions (leaving money on the table).
2. Buying equipment just for a tax write-off without considering long-term loan payments.
3. Poor timing of depreciation and capital purchases.
4. Not coordinating payroll, distributions, and retirement planning.

1. Being an S Corp does not automatically mean you’re saving taxes.
2. S Corps come with higher administrative costs, so the tax benefits must outweigh them.

In general:

1. Under ~$150k income → Sole proprietor may make more sense.
2. $180k–$200k+ profit → S Corp usually becomes beneficial.

1. As an S Corp owner, you pay yourself in two ways:
2. W-2 wages (subject to payroll/FICA taxes)
3. Distributions (not subject to FICA)
4. Paying too little W-2 can trigger IRS penalties.
5. Paying too much W-2 can unnecessarily increase payroll taxes.
6. Finding the right balance is critical to staying compliant and tax-efficient.

1. FICA taxes apply only to W-2 wages.
2. Distributions avoid FICA but are still considered taxable income.
3. Higher W-2 wages allow for:
4. Larger retirement plan contributions
5. Bigger income tax deductions
6. Strategy depends on whether you’re prioritizing tax savings now or retirement funding for the future.

1. Cookie-cutter 401(k) plans often fail dentists.
2. Retirement plans should be designed based on:
3. Practice profitability
4. Owner age vs. staff age
5. Ability to consistently fund contributions
6. Poorly planned retirement strategies can increase complexity without meaningful tax benefits.

1. Overspending today steals from your future self.
2. Automating savings and planning intentionally creates long-term freedom.
3. Proper tax planning can realistically save:
4. $30,000–$50,000 per year for well-run dental practices
5. Even more for higher earners with strong cash flow