Most dentists start their careers in someone else’s practice. Of 2025 dental school seniors planning to join a private practice, 77 percent expected to begin as associates. So if you own a practice and you are hiring, the question is not whether associates will consider a DSO. It is whether your offer is clearer than the other one on their desk.
Source: ADEA, Dentists of Tomorrow 2025, page 8.
Intent is split more evenly than the conversation suggests. Among 2025 seniors planning to enter private practice immediately, 32 percent intended to join a DSO and 50 percent intended to join a non-DSO practice. Within that group, more chose the model you already run than chose the other one. You compete for those people with a specific offer, not with a category.
Source: ADEA, Dentists of Tomorrow 2025, Issue 10, January 2026.
They are comparing two offers, not two philosophies
Associates rarely weigh independence against corporate dentistry in the abstract. They read what is in front of them. One offer usually arrives written. It carries a compensation formula, a start date, an onboarding schedule, and a named mentor. It states the hours and the review point. The other often arrives as a good conversation, a handshake, and a one page letter.
A written offer is not automatically a better offer. It is simply easier to evaluate. When a candidate cannot tell the difference on the merits, they choose the one they understand. That is the advantage most owners hand over without noticing.
Write down the ownership path, even when it is conditional
Do not assume the associate across the table expects to own anything. Ownership is arriving later than it once did. At five to nine years out of dental school, 21 percent of the 2016 to 2020 graduating cohort were owners. For the 2011 to 2015 cohort the figure was 33 percent. For cohorts graduating between 1996 and 2010 it ran from 63 to 70 percent. The gap does narrow later in a career. At 15 to 19 years out, 81 percent of the 2006 to 2010 class were owners, against 89 percent of the 1991 to 1995 class. Read that narrowing carefully. No cohort graduating after 2010 has reached mid career yet, so for the newest classes the later catch up is an expectation rather than a measurement.
Source: ADA HPI, Practice Ownership Trends in Dentistry, June 2025, Table 1.
So write that half of the offer down. You do not have to name a price. You have to name a process. Put in writing when the ownership conversation happens, what you will be looking at, and how terms would be worked out. Your attorney and your accountant shape the terms themselves. What follows is only what associates ask about.
A workable version answers five things:
- The point when the conversation begins, stated as a date or a milestone.
- What you will be evaluating: clinical judgment, production consistency, how they treat the team, how they handle a bad day.
- Who would set a value for the practice, and by what method.
- What the associate would need to prepare on their own side, and by when.
- What happens if the answer is no, on either side.
Say plainly that nothing is settled until it is documented. Every partnership is governed by its final transaction documents, and the same holds for a sale to an associate. That sentence protects both of you.
Do not imply a certainty you cannot honor. A vague promise is worse than a stated condition. The associate will test it in year two and find nothing underneath. Owners who take this seriously usually end up thinking about succession and continuity at the same time. They are the same problem viewed from different ends.
Mentorship has to show up on a calendar
Every practice says it offers mentorship. Few define it. Definition costs you time rather than money.
Name the person responsible. Block the time. Decide what happens when the associate’s case runs long and your column is full. Set the case review cadence and hold it for the first year. Set a continuing education budget and say who chooses the courses. Make it explicit that referring a case out is a judgment call, not a failure.
There is a real cost. Time spent at their chair is time you are not producing. Say so in the interview. An associate who hears an honest answer is more likely to believe the rest of what you tell them.
Responsibility is what keeps them past year one
Recruiting gets people in the door. Responsibility keeps them there. Give a new associate decisions that are genuinely theirs. Input on their schedule template. A say in hiring their own assistant. A service line they build. A piece of equipment they select and justify.
Then show them the operating numbers. Overhead, collections, payer mix, and what a hygiene hour actually contributes. A dentist who has never seen how the business runs cannot evaluate ownership later. They will not trust an offer built on numbers nobody showed them.
This is uncomfortable. Opening the books invites questions about spending you would rather not defend. That is the trade. Practices that keep good people tend to run on shared information rather than protected information. That is much of what the systems side of a practice exists to make possible.
Your local market is not the national one
The competing offer is more common in some places than others. Among dentists less than five years out of dental school, 31 percent were DSO affiliated in 2024. In four states, Nevada, Arizona, Colorado and Oklahoma, the share of dentists less than five years out who are DSO affiliated reaches about half.
Source: ADA HPI, Dentist Workforce, August 2025, slide 34.
The spread across states is wide. In 2024, DSO affiliation ranged from 2.3 percent of dentists in Hawaii to 26.9 percent in Colorado, with seven states sitting near 25 percent.
Source: ADA HPI state data for 2024, and Dentist Workforce, August 2025, slide 33.
Career stage matters as much as geography. In 2024, 26.5 percent of dentists up to 10 years out of dental school were DSO affiliated. That compares with 14.4 percent at 11 to 25 years out, and 9.1 percent beyond 25 years. The people you are hiring sit in the band where affiliation is most common.
Source: ADA HPI, Dentist Workforce, August 2025, slide 32.
If you practice in a higher affiliation state, your candidate has probably seen a structured offer already, and may have classmates working inside one. Your offer has to be at least as specific. If you practice somewhere with less affiliation, you have more time and the same work. It is worth understanding how DSO affiliation is actually counted before you decide how exposed you are. The measure turns on who manages the non-clinical work, so a practice can be counted as DSO affiliated without having sold any equity. HPI also states that it chose to present estimates it feels are slightly below the true level of DSO affiliation. That makes these figures a conservative floor.
Source: ADA Health Policy Institute, Distribution of Dentists, 2024 practice modalities data.
A short test of your current offer
Read your associate offer as if you were a few years out of school and holding two of them. Then answer:
- Could a candidate read it once and explain it back to you accurately?
- Does it name a date or milestone when ownership gets discussed?
- Does it name who sets a value, and how?
- Does it name a mentor and a recurring time on the calendar?
- Does it name at least one decision the associate owns in year one?
- Does it say what happens if either side wants out?
If several answers are no, you are probably not losing candidates on compensation. You are losing them on clarity, which is the cheaper thing to fix.
When the harder question is your own timeline
Some owners cannot write the ownership path because they have not decided their own. That is a legitimate answer, and it is better said out loud than papered over. It also carries a cost. An associate who wants ownership will not wait indefinitely for a date that never arrives.
The same questions sit behind how Valére thinks about who we partner with: whether there is a next generation in the building, what they would actually receive, and who decides. Most owners reach those questions the day a good associate asks something they cannot answer.
If the ownership half of your offer is the part you cannot write yet, work it out before the next hire rather than during it. For a second read on how that path could be structured, you can start a conversation.