DSO affiliation is a local condition. In 2024 it ranged from 2.3 percent of dentists in Hawaii to 26.9 percent in Colorado, with seven states sitting near 25 percent. A national average describes no real market, including yours.
Source: ADA HPI state data for 2024, and Dentist Workforce, August 2025, slide 33.
The distance between the two ends of that range is wide. Two owners reading the same trade article are looking at different worlds. One is deciding whether consolidation is worth thinking about. The other is already recruiting against it every time a chair opens.
The national number is a starting point, not a description
In 2024, 16.07 percent of dentists were DSO affiliated. Two things about that figure matter before you use it for anything.
Source: ADA Health Policy Institute, Distribution of Dentists, 2024 practice modalities data.
First, the measure turns on who manages the non-clinical work. A practice can be counted as DSO affiliated without the owner having sold any equity. Support arrangements and ownership changes land in the same bucket.
Second, HPI has said it “chose to present estimates we feel are slightly below the true level of DSO affiliation.” Treat the number as a conservative floor rather than a precise count.
So the national figure is a floor, built on a definition that mixes management with ownership. It is still worth knowing. It cannot tell you what a buyer, an associate or a specialist in your county is thinking this year. We lay out the same data, with the same limitations attached, in our breakdown of the DSO model.
The gap shows up first in hiring
Affiliation is not spread evenly across careers. 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.
Source: ADA HPI, Dentist Workforce, August 2025, slide 32.
The newest dentists sit further out still. 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 that group reaches about half.
Source: ADA HPI, Dentist Workforce, August 2025, slide 34.
Read that as a hiring statement, not an industry statistic. You do not recruit from the general dentist population. You recruit from the newest cohort. In those four states, group practice is the working frame of reference for much of that cohort.
Intent data points the same way, with a caveat worth keeping. Among 2025 dental school seniors planning to enter private practice immediately, 32 percent intended to join a DSO. A larger share, 50 percent, intended to join a non-DSO practice.
Source: ADEA, Dentists of Tomorrow 2025, Issue 10, January 2026.
The independent practice is not out of the running: it is one of two credible options in a candidate’s mind. What usually decides it is the offer itself, and the offer is where groups have done their homework.
One more figure frames the conversation. Of 2025 seniors planning to join a private practice, 77 percent expected to begin as associates.
Source: ADEA, Dentists of Tomorrow 2025, page 8.
Most new dentists expect an associate seat first. They will measure your version of that seat against a structured package: defined compensation, benefits, mentorship, continuing education, a stated path. You may well be offering something better. You still have to name it, in writing, in terms they can compare.
That is a real cost. Writing down a compensation structure, a mentorship commitment and an ownership path takes work, and it gives up flexibility you have enjoyed. The trade is simple: vague offers lose to specific ones, and in a dense market the specific offer is rarely yours.
How to read your own market
There is no reliable county level data on this, so be skeptical of anyone selling it. You can assemble an honest picture yourself from four signals, and it costs you attention rather than money.
Who is hiring. Watch job boards, dental school career pages and state association listings for your metro, and track them for six months. You are looking for whether groups or individual owners are absorbing the new graduates near you.
What associates are offered. The candidates you interview will tell you, and so will associates you know socially. You want the shape of the package your offer is measured against: base, production terms, benefits, and any path to ownership.
Who is buying. Watch transition brokers, listings that disappear quickly, and practices in your referral network that change hands. The question is whether the likely buyer for a practice like yours is a dentist or a group.
Where referrals go. Look at your own specialist relationships over the last three years. The question is whether your referral pattern is still yours to direct.
Then ask the question that matters most. How does each answer compare with three years ago? Direction tells you more than level. A market with a low share that is moving quickly will feel different in five years. A dense market that has already settled may barely move.
Write the answers down. Four sentences on one page is enough. Kept in your head, this turns into anecdote, and anecdote follows whatever you heard most recently at a study club. On paper it becomes something you can revisit each year. It also becomes something you can hand to an advisor without a long preamble.
What a dense market changes
Three things, in the order you tend to feel them.
Recruiting. You compete against a package, not a salary. If a group down the road offers mentorship, defined benefits and a visible path, your offer needs an answer to each one. “We are a great place to work” is not an answer.
Referrals. When specialists join groups, referral patterns stop being personal and start being routed. The shift is slow, and it is easy to miss until the volume has already moved.
The buyer pool. Who is in a position to buy a practice like yours shapes your options when you transition. That is a question about structure and terms, not about a number. It is worth understanding long before you need it. That is why we treat succession and continuity as a planning subject rather than an exit event.
What a thin market changes
Less pressure, more room to plan, and a real risk of complacency. A state’s place in that range is a snapshot of 2024, not a permanent condition. Low affiliation today tells you about today.
Use the time for the work that is hard to do under pressure. Clean numbers you trust. Documented systems that survive a staff change. A second doctor who could run a Tuesday without you.
None of that is free either. Better information often shows you something you would rather not see, and tighter systems retire habits that have worked well enough for years. That is the honest version of the trade. Disciplined change costs something now and buys you options later. It holds up whether you stay independent, sell, or partner.
Where this leaves the decision
Read your county, not the country. Suppose groups are hiring most of the new graduates near you, buying the practices you know, and employing the specialists you refer to. That is your competitive environment, whatever the national figure says. If none of that is happening, you have time, and time is worth spending deliberately.
The question was never whether to react to a percentage. It is what you want the next ten years to look like, and which structure supports that. Some owners stay solo and do well. Some want scale without leaving the chair. Some want a partner who brings capital and accountability. If a doctor equity structure is on your list, read how a Valére partnership is structured and the kind of practices we partner with before you read anyone’s pitch deck. Every partnership is governed by its final transaction documents, and the documents are where the answers live.
If you want a second read on what you are seeing locally, start a conversation with our team. Bring the four signals above. That is a more useful hour than another look at a national chart.