Before you sign anything, ask for the parts of the deal that are hardest to explain. Who owns what. How the money is calculated. Who decides what happens next. A platform that has thought its model through can answer those questions clearly on the first call.
Diligence runs in both directions. A platform is assessing whether your practice fits its model. You should be assessing whether it deserves the responsibility you are handing over. The test is simple. Partnership should get clearer the harder you look at it. If it gets vaguer under scrutiny, that is your answer. The questions below are the ones we would expect a doctor to put to us about our own partnership structure.
Ownership, and where it sits
Start here, because everything else depends on it. Partner is a word. It is not a structure.
- What exactly would I own, and at what level: my practice, a regional entity, or the parent company?
- Who else holds equity at that level, and in what class?
- What rights come with my class, and what rights do not?
- What happens to my position if the platform takes on outside capital?
A good answer names the entity, names the class, and describes the attached rights in ordinary words. An evasive answer repeats the word partner and changes the subject to culture. The label tells you who supports the back office. The agreement tells you who owns the future.
The published data makes the same point in a different way. The ADA Health Policy Institute put DSO affiliated dentists at 16.07 percent in 2024, in its Distribution of Dentists practice modalities data. That measure turns on who manages the non-clinical work. A practice can therefore be counted as DSO affiliated without having sold any equity at all. HPI also says it chose to present estimates it feels are slightly below the true level of affiliation. Treat the figure as a conservative floor, not a ceiling. Affiliation and ownership are two separate questions. Ask both. If you want the structural background first, read how the DSO model is actually built before the meeting rather than after it.
Economics, and how they are calculated
- What is the management fee, how is it calculated, and what does it cover?
- Which costs sit with the practice and which sit with the platform?
- How is my compensation set, and what would change it?
- What gets charged back to the practice that is not inside the fee?
- Will you run the calculation on a practice like mine?
A good answer walks the math line by line and is willing to do it with real numbers. An evasive answer talks about scale and buying power without ever reaching arithmetic. Ask what the fee does not cover. That one question surfaces the items nobody volunteers. Ask also what the fee is charged against, and whether that base can move without your agreement.
Decision rights
- Which decisions stay with me, which are shared, and which sit with the platform?
- Is that split written down, or is it a habit that could change with new leadership?
- Who approves hiring, capital purchases, fee schedules, and hours?
- When we disagree, what is the process? Name it.
A good answer produces a list and admits where the platform holds the final call. Every model has such items. An evasive answer tells you that nothing about how you run your practice will change. That is rarely true and rarely even intended. Disciplined change is not surrender. But you should know in advance which changes are not yours to refuse.
Required versus optional
- Which systems, vendors, and reporting are mandatory?
- Which are recommended, and what happens if I decline?
- Are lab, supply, and software choices set centrally?
- Can the required list expand later, and who decides that?
A good answer separates the two lists cleanly and gives a reason for each mandatory item. An evasive answer calls everything a best practice. Best practice is often a soft word for a hard requirement. Ask what actually happens if you say no, and listen for whether a real consequence exists.
Clinical authority
- Who sets treatment standards, and who reviews clinical decisions?
- Are there production targets, and what follows when they are missed?
- Can I decline to offer a service the platform is promoting?
- Who chooses materials, labs, and the pace of the schedule?
A good answer is specific about where clinical judgment ends and business standards begin. It does not pretend the line is invisible. An evasive answer calls clinical autonomy absolute while the metrics quietly do the steering. Ask how performance is measured. Then ask what happens to the doctor whose numbers sit at the bottom of the group.
What changes in the first year
- What changes immediately after closing, and who is on site for it?
- What happens to my team, their roles, and their pay?
- Which systems get replaced, and on what timeline?
- What does the platform need from me during that period?
A good answer is a plan with dates and named owners. An evasive answer promises that nothing will change. Nothing changing is not a partnership. Growth does require change: clearer information, stronger systems, greater accountability, and the willingness to retire habits that no longer serve the practice. What matters is whether that change is planned and disclosed up front, or discovered later and one surprise at a time.
Succession and future transactions
- What happens to my interest if I leave, retire, become disabled, or die?
- How is that interest valued, by whom, and under what method?
- Are there restrictions on when I can sell, and to whom?
- How is my interest treated if the platform is sold or recapitalized?
- Who makes that decision, and do I have a vote?
A good answer points you to the specific sections that govern each of those events. An evasive answer describes what usually happens, or what the sponsor intends. Intent is not a term. Nobody can tell you today what a future transaction will produce, and you should be careful with anyone who tries. What can be shown to you is the method: who values the interest, on what basis, and under which clause. Continuity for your patients and your team may be part of why you are doing this. If so, ask how succession is handled in the documents rather than in the conversation.
What the platform commits to carry
- Which functions come off my desk, and starting when?
- Who is my day-to-day contact, and how many practices do they carry?
- What is the standard for response, and what happens when it is missed?
- When a practice underperforms, does support arrive before pressure does?
A good answer names functions, names people, and accepts a standard it can be held to. An evasive answer lists services without owners. Support is a staffing question before it is a philosophy question. Ratios tell you more than a service menu does.
The agreements are the answer
Every question above lands in the same place. The economics, the responsibilities, and the treatment of any future transaction should be understood in the documents themselves. They should not be inferred from a deck, a website, or a good lunch. Every partnership is governed by its final transaction documents, ours included. Marketing language describes intent. The agreement is the obligation.
So ask for the documents early. That gives your own attorney and your own accountant time with the full text rather than a summary of it. Where something said in a meeting does not appear in the paperwork, ask why not. A platform that means what it says will not mind the question. A platform that minds has told you something useful.
If you want to test this list against a real structure, bring it to us. You can read how the Valére model is built on the partnership page. Then start a conversation with the hard questions first. Those are the ones worth the meeting.