The headline of the recent Becker’s article — “The Growing Gap Between Big DSOs and Small Practices” — certainly grabs attention. But it does so by playing into a scarcity mindset, painting an unnecessarily negative picture of private practices. From where I sit, working closely with thousands of dental practitioners across the country, I don’t see the situation that way at all.
The article cites several points of concern:
“There are a couple of things I am nervous about. Our industry is very fragmented. We don’t have that structure of everyone working toward one goal. You have that difference between a one-practice mentality and those big DSOs, and that’s a huge difference between the two. The small practice is limited in their research and development, their acquisition of recent technologies, their levels of treatment they can provide, and their ability to negotiate with insurers. The DSOs have all the resources, but sometimes are limited in getting the small office feel. So between those two, there’s a huge gap.”
Let’s unpack this:
Private practices are not falling behind in R&D. In fact, it’s quite the opposite. Most of the doctors I know who consistently attend continuing education (CE) courses and advanced clinical trainings are owners or associates in private practices. They’re the ones driving clinical innovation and pushing the boundaries of patient care — often far beyond the constraints of corporate protocols. The flexibility they have allows them to invest in the latest techniques without the red tape.
Supporting References:
The notion that private practices are lagging in tech adoption doesn’t match reality. Manufacturers of AI-powered diagnostics, CAD/CAM systems, and 3D printers will tell you — private practice dentists are some of their best customers. Access to capital is not the bottleneck; in many cases, it’s the nimbleness of the private practice model that drives early adoption.
Supporting References:
The idea that small practices offer “limited” levels of treatment feels outdated. Today, even dentists nearing retirement age are upgrading technology and expanding their services. New practice owners are reequipping offices with advanced diagnostic tools, modern software, and expanding into implants, clear aligner therapy, and same-day dentistry. Innovation is thriving in independent offices — often driven by doctors who want to differentiate their care.
Supporting References:
The only real challenge private practices face is negotiating with insurers, where DSOs have greater leverage due to scale. However, many independent practices are countering this by shifting toward fee-for-service or going out-of-network altogether — a trend that’s accelerating as dentists seek more control over treatment decisions and financial sustainability.
Supporting References:
If private practices want to maintain their edge and continue closing the perceived "gap," here are key strategies:
Conclusion
The so-called "gap" between DSOs and private practices is not as wide — or as one-sided — as the headline suggests. Private practices remain agile, innovative, and competitive. They’re not just surviving — they’re thriving, often offering a more personalized, technologically advanced, and patient-centered experience than their corporate counterparts.
Rather than focusing on gaps, we should be celebrating the remarkable resilience and innovation driving private dental practices today.