David Vs. Goliath – A Dental Sleep Parable

Dentists face myriad pressures from dental service organizations (DSO). In 2017, a mere 7.4% of dental practices were associated with a DSO, but that number increased nearly 40% over the following three years. Some forecasts estimate that by 2030 ~80% of practices will be affiliated with a DSO or similarly managed organization. 

If you haven’t already sold out, you might be queuing up the Dante’s Inferno quote, “Abandon all hope ye who enter here.” That’s understandable. DSOs have resources, experience, and efficient marketing schemes. They drive prices down. They poach patients. They’re in with every insurance plan and create practice-hoppers out of previously loyal patients. Many of your colleagues feel these organizations extract the fulfillment and profitability out of dentistry while injecting fear and loathing into the sulcus that was once your career. 

It doesn’t have to be this way.

This is where you arrive on the scene armed with nothing but a slingshot, a vision, and a strategic plan of action. However, you won’t need the slingshot. You aren’t going to slay DSOs. You aren’t even going to think about them ever again. Grab some S’mores and gather ‘round the fire. I have a story to tell, a true story.

A friend of mine, let’s call him “Dr. Conan”, is a renowned DSM educator. He also operates of the most prolific sleep practices in the country. At the time this story took place, Dr. Conan was treating around 80 sleep patients each month. He’s the real deal. 

During one of Dr. Conan’s lectures, the owner of a burgeoning 10 office group practice approached him. He waxed excitedly about his desire to implement DSM in all his offices. Dr. C had heard this one before. DSO representatives frequently waited in the wings after his presentations. Most fell into one of two categories: Either they claimed a strong interest in implementing but bailed after wasting everyone’s time and energy or they snidely disclosed all the (ill-informed) reasons DSM is a bad business case for dental practices.

But this guy was different. He itched to put real energy and money on the line. Dr. C signed on to help the group implement a DSM program involving their 50 dentists across 10 locations. Much to his wife’s chagrin, the group’s offices were located two time zones away, so some travel was necessitated but much of the training was scheduled for Zoom.

Dr. C is a student of the psychology of teams, an authority on the powers of persuasion, and a veritable specialist of sundry learning behaviors. Yet after spending 3 months training the group online, via Zoom calls, through workbooks, and even dedicating 2 weeks to embedded training live at the offices, only paltry growth resulted. 

You won’t believe what he did next. Dr. C restructured his contract with the group practice, packed up the wagons, uprooted his entire family, and moved across the country. He worked full-time in the practices; training, coaching, providing hands-on demonstrations with live patients, and treating some patients himself. 

One year into the relationship, the owner scheduled a review session. Dr. C entered the meeting and expected to be dealt the first business failure of his enviable career. His eyes widened and his brow furrowed as the owner gleefully proclaimed that the offices had finally surpassed the 100 treated patients per month metric. His alacrity was countered by Dr. C’s disappointment. 

Dr. C matter of factly informed him that he was treating nearly 100 patients by himself back home. After a full year of total immersion with the group, their 50 dentists in 10 locations were doing about as much as he was doing by himself.

Flabbergasted, I asked Dr. C what he learned from the experience. His response is tattooed on my brain. 

“Jason, dental sleep is antithetical to the DSO model which is totally reliant on transactional patient experiences and maximizing efficiencies. It is process, not purpose driven. Because of this, a focused, smart, caring owner practitioner will beat the DSO all day, every day. That dentist will build a medical referral base, earn patient referrals, treat patients right, and the collections will grow. That’s the message dentists need to hear. David will beat Goliath every time when it comes to dental sleep.”