Why DSO Operators Are Being Blamed for a Problem They Didn't Create

Why has the DSO deal market stalled even as demand for dental care remains strong?

In this episode of The Dental Economist Show, host Mike Huffaker speaks with Kyle Welch, Associate Professor of Accountancy at the George Washington University School of Business, about the capital-market forces shaping private equity, DSO valuations, and the path to liquidity for dental entrepreneurs.

Kyle explains his central thesis: the current slowdown is not simply an operator-performance issue or a reflection of what is happening in the dental chair. It begins higher up the chain with how private equity is valued, how institutional investors allocate capital, and how rising rates have changed the economics behind acquisitions and exits.

Drawing on his experience at the Stanford University endowment and his research into private equity reporting, Kyle explores why private-market valuations can appear smoother than public markets, why secondary-market discounts matter, and why the capital that once fueled DSO consolidation has become more constrained.

The conversation also examines what comes next. Kyle and Mike discuss the pressure created by extended hold periods, the importance of retaining doctor partners, refinancing and debt restructuring, and why combining platforms and pursuing public-market liquidity may offer a more durable path forward for some dental organizations.

Episode chapters

00:00 The capital-markets problem behind the DSO slowdown

02:09 Kyle’s path from institutional investing to academia

03:32 Why private equity’s challenges matter to dentistry

06:49 The accounting “smoothing” effect in private equity

12:36 Secondary markets and the gap between reported and market value

15:13 Why this is a private-equity issue—not just a dental issue

20:00 Capital constraints, dry powder, and the liquidity freeze

26:50 The two priorities for DSOs: debt coverage and doctor retention

33:19 Restructuring debt and working with lenders

39:56 A potential path forward: consolidation and public-market exits

Connect with the team:

👉 Mike Huffaker on LinkedIn: https://www.linkedin.com/in/huffaker/

👉 Planet DDS: https://planetdds.com/

👉 Kyle Welch on LinkedIn: https://www.linkedin.com/in/ktwelch/

You can also listen to our podcast here:

👉 Apple Podcast: https://shorturl.at/ikORx

👉 Spotify: https://shorturl.at/SMInC

Want to be a guest on The Dental Economist Show?

If you’re a growth-focused leader in the dental business world or someone shaping its future through technology, consulting, or innovation, we’d love to hear from you.

Whether you’re leading a DSO, building the next generation of dental technology, or helping redefine patient care, The Dental Economist Show is where the industry’s leading voices come together to discuss what’s next.

What does it take to help clinicians deliver more consistent care, build confidence in the chair, and grow into effective leaders?

In this episode of The Dental Economist Show, host Mike Huffaker speaks with Dr. Shilpi Priyadarshini, Chief Dental Officer at the Dentist Entrepreneur Organization (DEO), about the clinical systems, mentorship, and communication practices that help dental organizations improve care at scale.

Dr. Shilpi reflects on her journey from practicing dentist to regional leader at Jefferson Dental and now clinical coach at DEO. She explains why dentistry does not have a standard-of-care problem as much as it has a systems problem—and why clear processes, mentorship, and regular clinical audits can help clinicians make better decisions for patients.

The conversation explores how radiographic AI can support more consistent diagnosis and patient communication, the importance of separating treatment planning from insurance benefits, and the role empathy plays in case acceptance. Dr. Shilpi also shares her “LIGER” framework for clinicians, practical approaches to coaching providers based on their strengths, and how better systems can reduce decision-making fatigue and burnout.

Episode chapters

00:00 From the chair to clinical leadership
08:33 Why dentistry has a systems problem
12:12 Repetitions, mentorship, and building clinical confidence
14:15 How radiographic AI improves patient communication
18:05 Creating a better patient experience from the first conversation
21:26 Treatment planning beyond insurance benefits
26:30 Coaching dentists and building customized mentorship pathways
33:07 The clinical systems leaders often miss
41:03 Decision-making fatigue, burnout, and operational clarity
43:59 AI as a tool—not a magic solution

Connect with the team:

👉 Mike Huffaker on LinkedIn: https://www.linkedin.com/in/huffaker/
👉 Planet DDS: https://planetdds.com/
👉  Dr. Shilpi Priyadarshini on LinkedIn: https://www.linkedin.com/in/shilpi-priyadarshini-8137831a8/
👉 DEO: The Dentist Entrepreneur Organization: http://www.deodentalgroup.com

You can also listen to our podcast here:

👉 Apple Podcast: https://shorturl.at/ikORx
👉 Spotify: https://shorturl.at/SMInC

Want to be a guest on The Dental Economist Show?

If you’re a growth-focused leader in the dental business world or someone shaping its future through technology, consulting, or innovation, we’d love to hear from you.

Whether you’re leading a DSO, building the next generation of dental technology, or helping redefine patient care, The Dental Economist Show is where the industry’s leading voices come together to discuss what’s next.

What does it take to build a dental organization that expands access for millions of patients while creating lasting opportunity for providers and teams?

In this episode of The Dental Economist Show, host Mike Huffaker speaks with Bob Fontana, Founder, Chairman and CEO of The Aspen Group, about the principles that have shaped Aspen Dental from a single practice in East Syracuse into a multi-brand consumer healthcare platform.

Bob shares the founding idea behind Aspen Dental: becoming a “yes” organization in a market where patients too often encounter barriers around cost, access, convenience, insurance, scheduling and financing. He explains why a deep understanding of the consumer—particularly working-class and middle-America patients—must inform everything from location strategy and affordability to the patient journey and on-site capabilities.

The conversation also explores the operating model behind long-term scale. Bob discusses why a national brand creates both patient demand and accountability, why provider alignment and practice ownership have been fundamental to Aspen’s success, and why learning and development cannot be treated as an HR add-on. He also reflects on the evolution of his own leadership, the role of culture in helping thousands of people make good decisions at scale, the synergies across TAG’s healthcare brands, and why the next generation of DSOs must add real value for patients and providers.

Episode chapters

00:00 Building a “yes” organization

04:17 The barriers to dental care: cost, access and convenience

08:32 Why a national dental brand matters

12:36 Provider alignment and the practice ownership model

18:21 TAG University and investing in people

27:18 Evolving as a leader while the organization scales

31:15 Culture as a distributed decision-making system

32:11 The multi-brand consumer healthcare platform

37:57 The founder-led advantage and passionate discontent

43:13 Building better DSOs and giving back to dentistry

Connect with the team:

👉 Mike Huffaker on LinkedIn: https://www.linkedin.com/in/huffaker/

👉 Planet DDS: https://planetdds.com/

👉 Bob Fontana on LinkedIn: https://www.linkedin.com/in/bob-fontana/

👉 The Aspen Groupl: https://www.teamtag.com/

You can also listen to our podcast here:

👉 Apple Podcast: https://shorturl.at/ikORx

👉 Spotify: https://shorturl.at/SMInC

Want to be a guest on The Dental Economist Show?

If you’re a growth-focused leader in the dental business world or someone shaping its future through technology, consulting, or innovation, we’d love to hear from you.

Whether you’re leading a DSO, building the next generation of dental technology, or helping redefine patient care, The Dental Economist Show is where the industry’s leading voices come together to discuss what’s next.

What will separate the next generation of winning DSOs from the roll-up models of the past?

In this episode of The Dental Economist Show, host Mike Huffaker speaks with Chris Moxon, Managing Director and Partner at Boston Consulting Group, about the future of the dental market, DSO consolidation, and the operational foundations required for sustainable growth.

Chris shares BCG’s data-led perspective on why dentistry remains a compelling market: resilient underlying demand, a significant number of patients still outside the care system, and growing recognition of the connection between oral and overall health. He explains how preventative care, salivary diagnostics, and better patient communication can improve treatment acceptance while creating better outcomes.

The conversation also explores the realities of consolidation. Chris explains why dental is unlikely to consolidate like pharmacy, why de novo growth depends on more than capital and real estate, and why strategic acquisitions need a clear clinical and operational rationale. He also discusses lender-controlled platforms, specialty growth, clinician incentives, and why the doctors with the greatest clinical autonomy may be working inside the best-run DSOs.

Episode chapters

00:00 Clinical autonomy inside well-run DSOs

00:17 Introduction

08:03 The case for growth in dentistry

15:10 The future of DSO consolidation and de novo growth

22:06 Strategic acquisitions, specialty, and lender-controlled platforms

35:02 The platform playbook: operations, incentives, and clinical autonomy

42:24 AI, treatment acceptance, and the connected patient journey

Connect with the team:

👉 Mike Huffaker on LinkedIn: https://www.linkedin.com/in/huffaker/

👉 Planet DDS: https://planetdds.com/

👉Chris Moxon on LinkedIn: https://www.linkedin.com/in/moxon/

👉 Boston Consulting Group: https://www.bcg.com/

You can also listen to our podcast here:

👉 Apple Podcast: https://shorturl.at/ikORx

👉 Spotify: https://shorturl.at/SMInC

Want to be a guest on The Dental Economist Show?

If you’re a growth-focused leader in the dental business world or someone shaping its future through technology, consulting, or innovation, we’d love to hear from you.

Whether you’re leading a DSO, building the next generation of dental technology, or helping redefine patient care, The Dental Economist Show is where the industry’s leading voices come together to discuss what’s next.

What separates a DSO that is ready for a successful capital event from one that is not?

In this episode of The Dental Economist Show, host Mike Huffaker speaks with David Murphy, Managing Director at Moelis & Company, about the M&A market, capital strategy, and what dental operators should be building today to maximize their options tomorrow.

David explains the role of an investment bank, when DSO leaders should begin building advisor relationships, and how to evaluate the right banking partner. He breaks down the trade-offs between debt and equity financing, why the dental M&A market is beginning to recover after a challenging period, and how higher—but more predictable—costs of capital are changing deal structures.

The conversation also explores what buyers look for in diligence: durable organic growth, clinician retention, accurate financial reporting, integrated technology, disciplined de novo performance, and high-quality EBITDA. David shares why well-integrated businesses with strong operational performance are positioned to take market share, why specialty platforms continue to command a premium, and how AI could become a major growth and margin opportunity for dental organizations.

Connect with the team:

👉 Mike Huffaker on LinkedIn: https://www.linkedin.com/in/huffaker/
👉 Planet DDS: https://planetdds.com/

👉 David Murphy on LinkedIn https://www.linkedin.com/in/david-murphy-a7841462/
👉 Moelis & Company: https://www.moelis.com/

You can also listen to our podcast here:

👉 Apple Podcast: https://shorturl.at/ikORx
👉 Spotify: https://shorturl.at/SMInC

Want to be a guest on The Dental Economist Show?

If you’re a growth-focused leader in the dental business world or someone shaping its future through technology, consulting, or innovation, we’d love to hear from you.

Whether you’re leading a DSO, building the next generation of dental technology, or helping redefine patient care, The Dental Economist Show is where the industry’s leading voices come together to discuss what’s next.

What happens when a state dental board introduces rules that could fundamentally change how DSOs support dental practices?

In this special breaking-news episode of The Dental Economist Show, host Mike Huffaker speaks with Andrew Smith, CEO of the Association of Dental Support Organizations (ADSO), and Steve Bilt, Co-Founder and CEO of Smile Brands, about Colorado’s newly adopted dental-board rules and the ADSO’s legal challenge.

The conversation explores the practical effect of restrictions on DSO-held leases and clinical equipment, as well as the potential disciplinary exposure for dentists whose arrangements are deemed noncompliant. Andrew and Steve explain why they believe the rules exceed the dental board’s authority and could create serious financial burdens for dentists already operating under established support arrangements.

They also discuss the wider implications for patient access, affordability, Medicaid participation, clinical autonomy, capital investment, and the future of the DSO model nationwide. With the rules scheduled to take effect in January 2027, the episode examines the legal and legislative paths ahead—and why every DSO operator should be paying attention.

Connect with the team:

👉 Mike Huffaker on LinkedIn: https://www.linkedin.com/in/huffaker/
👉 Planet DDS: https://planetdds.com/

👉 Andrew Smith on LinkedIn: https://www.linkedin.com/in/andrewmulherinsmith/
👉 Association of Dental Support Organizations: https://theadso.org/

👉 Steve Bilt on LinkedIn: https://www.linkedin.com/in/steve-bilt-782835b/
👉 Smile Brands: https://www.smilebrands.com/

Want to be a guest on The Dental Economist Show?

If you’re a growth-focused leader in the dental business world or someone shaping its future through technology, consulting, or innovation, we’d love to hear from you.

Whether you’re leading a DSO, building the next generation of dental technology, or helping redefine patient care, The Dental Economist Show is where the industry’s leading voices come together to discuss what’s next.

What does it take to make complex dental care more accessible, efficient, and patient-centered?

In this episode of The Dental Economist Show, host Mike Huffaker speaks with Rahma Samow, President and CEO of ClearChoice Dental Implant Centers, about her journey from medical technology to dental care leadership and the transformation she has led at ClearChoice.

The conversation explores four structural challenges Rahma identified at ClearChoice: patient acquisition, financing, case acceptance, and treatment delivery. She discusses how the organization diversified its marketing, expanded financing options, introduced greater treatment choice, modernized clinical workflows, and reduced treatment timelines from as long as a year to approximately 60 to 90 days in some centers.

Rahma also shares ClearChoice’s larger mission: becoming a platform of hope for patients who have lost confidence, struggle to eat, or feel they must hide from the world. Looking ahead, the organization is working toward impacting one million lives by 2030 while thoughtfully introducing AI and strengthening its technology infrastructure.

Connect with the team:

👉 Mike Huffaker on LinkedIn: https://www.linkedin.com/in/huffaker/

👉 Planet DDS: https://planetdds.com/

👉 Ramah Samow on LinkedIn: https://www.linkedin.com/in/rahma-samow/

👉 ClearChoice: https://clearchoice.com/us/en

You can also listen to our podcast here:

👉 Apple Podcast: https://shorturl.at/ikORx

👉 Spotify: https://shorturl.at/SMInC

Want to be a guest on The Dental Economist Show?

If you’re a growth-focused leader in the dental business world or someone shaping its future through technology, consulting or innovation, we’d love to hear from you.

Whether you’re leading a DSO, building the next generation of dental technology, or helping redefine patient care, The Dental Economist Show is where the industry’s leading voices come together to discuss what’s next.

How do you transform dentistry from treating teeth to improving whole-body health?

In this episode of The Dental Economist Show, host Mike Huffaker sits down with Stephen Thorne, Founder and CEO of PDS Health, to discuss why the future of dentistry lies in prevention, integration and a deeper understanding of the connection between oral health and overall health.

Stephen explores how integrated medical and dental care, saliva-based diagnostics and better patient engagement can help clinicians identify risk earlier and make more informed decisions. He also discusses how dental education must evolve, what will distinguish successful DSOs over the next decade, the role of private equity and why today’s dental insurance model is not built to support prevention.

The central message is clear: the future of dentistry is not simply restoring what is damaged. It is preventing disease earlier, connecting oral health to overall health and giving clinicians better tools to improve patient care.

#dentaleconomist #dentistry #dso #oralhealth #healthcareinnovation #dentaltechnology 

If you enjoyed this episode, make sure to subscribe, like,
 and comment 📱

Connect with the team:

👉 Mike Huffaker on LinkedIn: https://www.linkedin.com/in/huffaker/

👉 Stephen Thorne on LinkedIn: https://www.linkedin.com/in/steve-thorne-9184146/

👉 PDS Health: https://www.pdshealth.com/

👉 Planet DDS: https://planetdds.com/

Want to be a guest on The Dental Economist Show?
If you’re a growth-focused leader in the dental business world or someone shaping its future through technology, consulting or innovation, we’d love to hear from you.

Whether you’re leading a DSO, building the next generation of dental technology, or helping redefine patient care, The Dental Economist Show is where the industry’s leading voices come together to discuss what’s next.

Colosseum Dental, one of Europe's largest dental organizations with 650 clinics across 11 countries, faced a staggering 60% dentist churn rate in its UK business back in 2022. How did they bring it down to just 11% in three years?

We’re unpacking it all in this episode of The Dental Economist Show as host Mike Huffaker sits down with Dr. Farzeela Rupani, Group Chief Medical Officer of Colosseum Dental, for the ultimate insider’s perspective. Tune in to explore how Dr. Rupani couples clinical expertise with commercial intelligence to drive organic value , why shifting away from a defensive retention strategy transforms a DSO into a career destination , and how to leverage data-backed pilot programs to speak the boardroom's language. Most of all, this conversation highlights why the chief medical officer role must expand beyond a checklist of compliance to unlock true, same-store growth.

#dentaleconomist #dsoleadership #dentaltechnology

If you enjoyed this episode, make sure to subscribe, like, and comment📱

Chapters:

00:00 Introduction & Meeting Dr. Farzeela Rupani

02:07 From Clinician to Group Chief Medical Officer

08:32 Bridging the Gap Between Clinical and Business Education

13:36 The DSO’s Role in Teaching Practice Financials

17:31 Taking Dentist Churn from 60% to 11% in Three Years

29:37 Creating Non-Clinical Paths for Dental Leaders

34:55 Moving the CMO Role Beyond Compliance to Growth

41:29 Building the Business Case for Clinical Investments

45:11 AI Diagnostics and the Next Frontier in Dentistry

Connect with the team:

👉 Mike Huffaker on LinkedIn: https://linkedin.com/in/huffaker/

👉 Dr. Farzeela Rupani on LinkedIn: https://www.linkedin.com/in/dr-farzeela-rupani-279139153/

👉 Colosseum Dental Website: https://colosseumdental.com/

👉 Planet DDS Website: https://planetdds.com/

You can also listen to our podcast here:🎙️

👉 Apple Podcast: https://apple.co/3SeeOfY

👉 Spotify: https://spoti.fi/3tMmaO7

👉 Fame Host: https://bit.ly/4aQNQ51

Want to be a guest on The Dental Economist Show?

If you’re a growth-focused leader in the dental business world or someone shaping its future through technology, consulting, or innovation we want to hear from you.

Submit your interest here: https://forms.gle/BjAmyYLsFgNJBf8f8

Whether you’re leading a DSO, building the next big dental SaaS tool, or redefining patient experience, this show is where the smartest minds in dental business come to talk strategy!

The Dental Economist Show with Mike Huffaker is handcrafted by our friends over at: fame.so

What if a dental asset sat at the center of the universe for the entire dental market? We’re unpacking it all in this special live edition of The Dental Economist Show, coming to you from the Planet DDS Ignite event in Newport Beach. Host Mike Huffaker sits down with Paul Kaiser, CEO of Dental Exchange, and Drew Hamilton, its CRO, for an insider's look into how they are redefining revenue cycle management (RCM).

Tune in to explore how Dental Exchange successfully navigated explosive growth following the Change Healthcare disruption , why KKR backed their extensive 30-year transaction infrastructure , and how new innovations like Eligibility AI and Reconcile AI are pushing the platform far beyond a traditional clearinghouse. Plus, get a direct perspective on the complexities, definitions, and major growth opportunities surrounding real-time adjudication and getting payer buy-in.

#dentaleconomist #rcm #dentaltechnology

If you enjoyed this episode, make sure to subscribe, like, and comment📱

Chapters:

00:00 Introduction & Welcoming Paul Kaiser and Drew Hamilton

01:18 KKR’s Investment in Dental Exchange

04:21 Navigating the Change Healthcare Disruption

05:19 Moving Beyond a Clearinghouse with AI Innovations

06:58 The Heartland Rollout & Process Hardening

08:19 Unique Factors Driving the Right to Win

09:14 The Strategic Power of Practice Management Partnerships

11:00 Defining Real-Time Pre-Adjudication

14:26 Looking at Instant Pay and the Future of RCM

16:01 Braving the 6 AM Pacific Pledge

Connect with the team:

👉 Mike Huffaker on LinkedIn: https://linkedin.com/in/huffaker/

👉 Paul Kaiser on LinkedIn: https://www.linkedin.com/in/paulalankaiser/

👉 Drew Hamilton on LinkedIn: https://www.linkedin.com/in/drew-hamilton/

👉 Dental Exchange Website: https://www.dentalxchange.com/

👉 Planet DDS Website: https://planetdds.com/

You can also listen to our podcast here:

👉 Apple Podcast: https://apple.co/3SeeOfY

👉 Spotify: https://spoti.fi/3tMmaO7

👉 Fame Host: https://bit.ly/4aQNQ51

Want to be a guest on The Dental Economist Show?

If you’re a growth-focused leader in the dental business world or someone shaping its future through technology, consulting, or innovation we want to hear from you.

Submit your interest here: https://forms.gle/BjAmyYLsFgNJBf8f8

Whether you’re leading a DSO, building the next big dental SaaS tool, or redefining patient experience, this show is where the smartest minds in dental business come to talk strategy!

The Dental Economist Show with Mike Huffaker is handcrafted by our friends over at: fame.so