After dental school: Considerations for joining alternative types of practices

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By Bruce Bryen, CPA, CVA

Before graduating from dental school, the dental student is inundated with information about joining dental practices from all over the country. It is, of course, in many ways, a life-altering decision. The geographic environment, salary and benefits, and quality of life are just a few of the items being considered by the soon-to-be graduate before he or she decides upon which practice and type of office to join.

The graduates may consider an opportunity as an associate with a chance to be an owner in this choice of recruitment opportunity. Some of them see the lure of working for a DSO and earning a reasonable compensation package with minimal administrative responsibilities as the optimum goal. This would appeal to the graduate seeking an excellent style of life without the hard work and effort needed to build his or her own practice or to take a practice he or she is joining to a higher level of growth and profit by transitioning into it.

There are so many opportunities out there for the dental school graduate that taking time and thinking about the decision is a wise choice.

Also, the availability for consulting with someone who may have the wisdom and experience necessary to assist in making the right call is invaluable and a wise choice. That someone may be the professor who could have had actual work experience on his or her own besides or before becoming an instructor. A dental consultant or dental CPA would be another person to consider but that consult would probably be with a charge being incurred.

We will discuss owning after a learning period, working with a DSO, and other options upon graduation in the following paragraphs.

The graduate working as an associate to ultimately become an owner

Upon graduation, the newly minted, ready for action dentist may have thought of his or her possibilities for employment and decided to choose the dental practice where the ultimate ownership of the practice may have been the lure. The geographic part of the country along with a reasonable compensation package was a driver of which practice to join. The main reason for taking that associateship was the ability to ultimately become the owner of the practice compared to other opportunities without that option.

With this type of situation, the newly titled associate will learn from the current owner and others working at the dental practice. He or she will develop habits taught by these professionals. There will be a challenge to learn many things not taught in dental school, such as the administrative duties that an owner must know how to perform since no one else at the practice probably has that responsibility nor do they want it. This is a good thing if the associate takes advantage of seeing how the owner delegates some of the chores such as office management, accounting, bookkeeping, purchasing, and inventory needs. It can also be part of the learning process of whether buying, leasing, or repairing equipment is addressed to assist in understanding about the profitability of the dental practice. These lessons will teach the associate how to manage an office and how to interact with various suppliers, office personnel, and financial people.         

These administratively learned functions will also allow the associate to be on a shorter list for the options of joining a DSO at a later date at a higher level of earning ability than a strictly clinically oriented dentist. Solid administrative credentials are part of a DSO organizational need.  

Shall the DSO be the choice of the recent graduate?       

DSOs are certainly a heavy recruiter of dental school graduates, along with the rush of the standard dental practice owners. Some recruitment categories of the graduates are by dental practice owners who may own more than one practice, but do not want to be part of a DSO since they won’t accept the ownership limitations or the “feel” of a DSO as part of the patient experience.

What the DSO does offer the associate is the ability to work in a clinical manner and to avoid many administrative headaches that the potential owner may experience as he or she is learning about the clinical performance of the practice. This dentist must also learn the duties needed to be attended to by an owner or someone who may want to become an owner.

DSOs are the coming wave in the profession of dentistry, so it is good to understand what they offer a graduate. Interviews with DSO recruiters are an important part of the graduate’s learning experience and should assist the graduate in making the decision about which type of dental practice to choose for his or her career path. At the age of the graduate, this choice of where to start his or her career is not one that must remain for an entire lifetime in dentistry. This can, however, help the associate with the options that are available and learn where not to concentrate his or her energies for right now.

Another choice for the recent graduate is to obtain a job as an associate and concentrate on his or her clinical skills for a while before delving into the administrative side of the practice for a few years.

Which comes first: The chicken or the egg?

The adage of which comes first can be applied to the dental field as well for the graduate. Does the new dentist start in the traditional sense and learn as much as possible about the clinical side of dentistry? Does he or she hone the skills necessary to be ready for an opportunity when finding one to buy from a transitioning dentist who may be ready to retire or move to another state? Does the dentist hear about the DSO format and make his or her decision after the sales offer of this type of job? Learning while working and earning enough to pay down some of the dental school debt will seem better than the dental school experience to many of the recent graduates. This type of on- the-job training will allow the graduate to be available for better job offers with higher income and all of the above rewards after a few years of this type of situation.

The more the new dentist knows, the more he or she will be worth in the market workplace for years to come.

Bruce Bryen, CPA, CVA is a certified public accountant with more than 45 years of experience and is a part of Baratz & Associates CPAs. He specializes in deferred compensation, such as retirement planning design; income and estate tax planning; determination of the proper organizational business structure; asset protection and structuring loan packages for presentation to financial institutions. He is experienced in providing litigation support services to dentists with Valuation and Expert Witness testimony in matrimonial and partnership dispute cases. He is also a financial writer for several dental journals. You may contact him at 609-502-0691 or at Bryenb@baratzcpa.com.

Note: “Start Arrow Sign” by qubodup is licensed with CC BY 2.0. To view a copy of this license, visit https://creativecommons.org/licenses/by/2.0/

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Testimonials

Rosie, RDH

Rosie, RDH

I had the pleasure of working with Candy as a dental hygiene consultant over the course of several months, and her...
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Rosie, RDH

I had the pleasure of working with Candy as a dental hygiene consultant over the course of several months, and her impact on both our hygiene department and overall practice was exceptional. Candy is highly knowledgeable, approachable, and genuinely invested in the success of the team. She is an excellent listener who takes the time to understand challenges and provide practical, effective solutions. One of the qualities I appreciated most was her accessibility, she was always available to answer questions, offer guidance, or return a call when needed. Her hands-on approach and commitment to helping our team succeed were evident in every interaction. Candy’s focus extends beyond productivity and practice growth; she truly cares about the people within the practice and works to create a supportive, collaborative environment. As a fellow dental hygienist, it was especially refreshing to work alongside someone who shares a similar philosophy and approach to patient care, team development, and practice success. We view many aspects of dentistry and hygiene through the same lens, which made collaboration seamless and productive. Having the opportunity to work with another hygienist who understands the challenges, opportunities, and importance of our role was invaluable. The hygiene modules she developed were incredibly valuable. They were well organized, easy to follow, and provided clear, actionable guidance. The accompanying handouts and resources gave our team the tools and confidence needed to implement new concepts successfully. Her training materials were practical, relevant, and tailored to the real-world needs of a busy dental practice. Candy’s expertise and dedication to excellence have made a lasting impact on our team. I would highly recommend her to any dental practice looking to strengthen its hygiene department, improve systems, and support the growth and success of its team. She is a true asset to any practice fortunate enough to work with her.
Rosie, RDH
Dr. Justin Elikofer

Dr. Justin Elikofer

Our story with IgniteDDS began almost five years ago when my wife and I purchased an established fee-for-service practice. At...

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Dr. Justin Elikofer

Our story with IgniteDDS began almost five years ago when my wife and I purchased an established fee-for-service practice. At the time, we promised the team that everything would stay the same. The practice was thriving, and from the outside it seemed clear they had found a successful recipe for success. Our goal wasn't to change it—we simply didn't want to mess it up.

What we discovered was that while everyone wanted the outcome of success, there wasn't alignment around how we achieved it or measured it. Success in room 1 wasn't the same as Room 2. It took us nearly four years to fully understand that because we were doing well. During that time, we also realized we weren't leading as effectively as we could have been. We weren't communicating a clear vision, establishing consistent standards, or implementing clear protocols. Instead, we allowed people to continue doing things their own way. Some team members appreciated that freedom, while others felt frustrated by the lack of consistency and direction.

After four years, we found ourselves at a crossroads. We felt stuck. Morale was low and we weren't sure we could get the practice where we wanted it to go on our own.

As owners who value relationships as much as results, David immediately stood out to us. His personality was authentic, approachable, and trustworthy. He was someone we could see ourselves learning from and building a genuine relationship with. Being local was a bonus, but what really resonated with us was that his vision for practice growth, demonstrated through his own private practice, closely mirrored our own. He had already built the type of practice we wanted to create.

This stood in contrast to many other consultants we spoke with, whose focus seemed to be on PPO models and increasing volume. David's experience aligned with the type of practice we wanted to build: a high-touch, high-end patient experience centered on quality rather than quantity.

The IgniteDDS team—David, Dawn, and Candy—started by helping us understand where we truly stood. Through discovery, data gathering, and DISC assessments, they helped us identify opportunities for improvement and build a foundation for long-term growth. Rather than jumping straight to solutions, they gave us clarity.

Candy's coaching was instrumental in aligning our hygiene department and our office as a whole with the hygiene department. With her help, we were able to improve the patient experience and new patient process.

We also tackled practical issues that had become major challenges, including an accounts receivable system that was largely out of control. IgniteDDS didn't just point out problems—they provided systems and processes to solve them.

One of the most valuable aspects of the relationship was having experienced coaches to help us navigate team conflict and leadership challenges. As practice owners, those situations can feel isolating. Having a trusted team to walk through difficult conversations and decisions was invaluable.

Another large impact came through our office managers' work with Dawn. Rather than relying on the doctors to drive every initiative, IgniteDDS empowered our office managers to take ownership of the process and lead from within the organization. They embraced that responsibility wholeheartedly. No challenge was too large or too small. Dawn consistently met them where they were and helped them develop the confidence and skills to lead. The answer was rarely, if ever, "no." Instead, it was, "Let's figure out how."

Today, our practice is more aligned, more accountable, and better equipped to deliver the experience we've always envisioned. We have clearly defined protocols, team agreements, and expectations that simply didn't exist before. Our collections have improved significantly, particularly through implementing systems that helped us address and recover outstanding balances.

If we could offer one piece of advice to another practice owner considering IgniteDDS, it would be to identify the team members who are willing to take ownership and invest in their growth. Share your vision with the IgniteDDS team, trust the process, and allow them to help shape your team into the organization you want to become.

Working with IgniteDDS has been one of the most impactful investments we've made in our practice, our team, and our own growth as leaders. Are things perfect? No. Are we closer? Absolutely, yes!

Dr. Justin Elikofer
Dr. Sanjie Jackson

Dr. Sanjie Jackson

I was running on empty, and honestly, everyday I thinking of my exit strategy when I met Dr David Rice. ...
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Dr. Sanjie Jackson

I was running on empty, and honestly, everyday I thinking of my exit strategy when I met Dr David Rice. As the sole owner of two dental practices, I knew I couldn't continue trying to do everything on my own. Not if I wanted to grow and lead at a higher level. Partnering with IgniteDDS has been, hands down, one of the best investments I've made for both my practices and my team. Just halfway through my first year with IgniteDDS, the impact has already been remarkable. The knowledge, systems, accountability, and leadership development they have provided have transformed the way we operate. Not only have I gained valuable tools and insights as an owner, but my entire team is getting empowered with skills and confidence that are helping us elevate every aspect of our patient experience and practice performance. What sets IgniteDDS apart is the genuine commitment they have to their clients' success. Their guidance is practical, actionable, and tailored to the everyday realities of me running two dental practices. I am incredibly grateful for Dr. David Rice, Dawn, Candy, and the entire IgniteDDS team. Their expertise, continuous encouragement, and unwavering support have made me feel like I am not alone on this journey. If you're a practice owner looking to strengthen your leadership, improve your systems, and create sustainable growth, I cannot recommend IgniteDDS highly enough. The value they provide is truly exceptional, and I am excited to see what the rest of this journey brings.
Dr. Sanjie Jackson
Alyse Berta

Alyse Berta

Dawn, thank you for the great advice and guidance you’ve shared as we work on improving our practice's efficiency. I...
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Alyse Berta

Dawn, thank you for the great advice and guidance you’ve shared as we work on improving our practice's efficiency. I truly appreciate your support and the time you’ve taken to help us move forward in a more streamlined and effective way. Your insight has been incredibly valuable and is helping us make meaningful progress.
Alyse Berta
Dani S.

Dani S.

IGNITEDDS has made a real difference in our practice and in my role as office manager. The support I’ve received has...
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Dani S.

IGNITEDDS has made a real difference in our practice and in my role as office manager. The support I’ve received has helped me grow with more confidence and clarity, and our systems and leadership have improved because of it. Dawn has been an incredible support to me personally, always present, approachable, and truly invested in our success. I never feel alone when challenges come up, and that level of guidance and encouragement has been invaluable. IGNITEDDS doesn’t just support practices; they support the people behind them.
Dani S.
Eva B.

Eva B.

Working with IGNITEDDS Coaching has been such a great experience! Having David as a dentist makes a huge difference. He truly...
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Eva B.

Working with IGNITEDDS Coaching has been such a great experience! Having David as a dentist makes a huge difference. He truly understands the day-to-day challenges we face in practice. His insight makes their guidance practical, relevant, and easy to implement. Working alongside Dawn has been such a gift! She’s always available to answer questions, talk through ideas, and help us find the right solutions. Her advice is thoughtful, effective, and supportive. It hasn’t just helped me, it’s positively impacted our entire team and elevated our patient experience. I’m incredibly grateful to partner with Ignite as we continue to grow, strengthen our team, and serve our patients at a higher level.
Eva B.
Kylinn Tucker, RDH

Kylinn Tucker, RDH

I had an amazing experience with the IGNITEDDS Coaching program. Especially since I am a new hygienist, everything...
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Kylinn Tucker, RDH

I had an amazing experience with the IGNITEDDS Coaching program. Especially since I am a new hygienist, everything you guys shared was so helpful. It’s evident that you guys prioritize each individual team member of a dental office and do everything you can to make the environment and schedule run as smoothly and efficiently as possible. I learned so much about treatment planning, Dentrix, scheduling, teamwork, and overall ways to continue improving as a new grad. I wish every dental office had the opportunity to complete this program.
Kylinn Tucker, RDH
Dr Ben Truong

Dr. Ben Truong

It was great working with a team to help bring out the best in each of us. Our team is ...
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Dr. Ben Truong

It was great working with a team to help bring out the best in each of us. Our team is small, but we work closely together to provide a great patient experience, while having fun at work as well! Your team was able to help us learn to work together, with each person having a vital role in providing care to the patient! Helping us all become streamlined and on the same page will help us become an even more successful practice!
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Dr. Ronnetta Sartor

Dr. Ronnetta Sartor

The 90-Day Jump Start has been transformative for our office. Dawn and Dr. Rice guided us through implementing essential systems ...
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Dr. Ronnetta Sartor

The 90-Day Jump Start has been transformative for our office. Dawn and Dr. Rice guided us through implementing essential systems and processes, from new patient calls to treatment planning and case acceptance. Their focus on patient care and team accountability has helped us create better structure, improve work/life balance, and stay aligned with our goals. In a short time, our practice has grown tremendously.
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Dr. Chandler Oldenburg

Dr. Chandler Oldenburg

IGNITEDDS has been truly transformative for our practice. Within just a few months, our accounts receivable collections increased by $30K, ...
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Dr. Chandler Oldenburg

IGNITEDDS has been truly transformative for our practice. Within just a few months, our accounts receivable collections increased by $30K, and our operations became far more streamlined. Their clear procedures and policies gave our team structure and confidence, while their step-by-step ownership guidance addressed our specific challenges. Thanks to David and Dawn, we feel more organized, empowered, and aligned than ever before. I highly recommend IGNITEDDS to any practice ready to grow and strengthen its foundation.
Dr. Chandler Oldenburg

Bruce Bryen

Bruce Bryen, CPA/CVA Dental Practice Valuation Analyst, Baratz & Associates, PA

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