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If you’ve spent any time looking at dental partnership organizations or DSOs in the last five years, you’ve seen the phrase “dentist-led” on almost every website you’ve visited. It’s become the industry’s most popular marketing claim. And it’s also the most abused one.
If you’ve spent any time looking at dental partnership organizations or DSOs in the last five years, you’ve seen the phrase “dentist-led” on almost every website you’ve visited. It’s become the industry’s most popular marketing claim. And it’s also the most abused one.
The problem isn’t that these organizations are lying. Most of them have dentists in visible roles. The problem is that “dentist-led” can mean almost anything, from a dentist serving on an advisory board that never meets to a dentist-majority board with voting control over every strategic decision the company makes.
Those two structures produce wildly different outcomes for the practice owner who partners with them. From the outside, they look identical.
We want to help you tell the difference.
The DSO model has been around since the late 1990s, but its reputation started shifting around 2015. A wave of private equity-backed consolidation moved through the industry, and the stories that came out of those transactions weren’t always good ones. Practice owners who’d been promised autonomy found their supply chains dictated by suits in office buildings. Teams that had been together for a decade got restructured. Clinical protocols were standardized by people who hadn’t treated a patient in years, or ever.
The industry’s response was predictable: every new entrant started calling themselves “dentist-led” or “dentist-friendly.” The language was a direct reaction to the trust deficit that traditional DSOs had created. The problem is that the language ran ahead of the structure. Organizations started claiming the label without building the governance to back it up.
The result is a market where nearly every dental partnership organization uses the same words to define themselves, and practice owners have no easy way to tell which ones mean it.
When you’re evaluating any organization that calls itself dentist-led, there are three structural questions worth asking. Everything else — the marketing, the testimonials, the pitch deck — is noise until you’ve answered these.
This is the most fundamental question and the one most organizations obscure. In a typical DSO, the equity is held by a private equity fund or a holding company controlled by financial investors. The dentists may receive “phantom equity” or stock options that vest only if the company sells. This means their financial upside is entirely dependent on decisions made by people whose interests may not align with theirs.
In a genuinely dentist-led model, the dentists hold real equity. Not options. Not phantom shares. Actual ownership stakes with voting rights and distributions attached. The difference matters because ownership determines who the organization ultimately serves. If the equity holders are financial investors, the organization optimizes for investor returns. If the equity holders are dentists, the organization optimizes for what dentists care about: clinical autonomy, team stability, patient experience, and long-term practice health.
At Rising Tide, our holding company is 100% dentist-owned. Our partner doctors hold real equity in their practices. This isn’t a marketing claim, it’s a legal structure that any prospective partner can verify in the governance documents.
Many DSOs have a dentist on their board. Fewer have a dentist-majority board. The difference between “a dentist on the board” and “dentists control the board” is the difference between advice and authority.
An advisory role means a dentist’s voice is heard but can be overridden by financial stakeholders at any time. A voting-majority role means the dentists have the final word on strategy, capital allocation, leadership hires, and growth decisions. Those two structures produce completely different organizations over a five-year horizon.
At Rising Tide, our board has dentist-majority voting control. Our CEO, Dr. Anthony Leonetti, is a practicing dentist. Our leadership and support teams reports to a dentist-led board. Operational decisions roll up to dentists, not to a fund manager.
This is where the rubber meets the road for most practice owners. You can have perfect governance on paper, but if someone at corporate is telling you which labs to use, which procedures to prioritize, or which insurance plans to accept, your clinical autonomy is gone in practice even if it exists on the org chart.
In a genuinely dentist-led organization, clinical direction is set at the practice level by practicing dentists. The organization may provide resources, benchmarking, and best-practice sharing, but the clinical decisions stay with the doctor who’s treating the patient.
At Rising Tide, our clinical direction is set by practicing dentists. Our Clinical Director, Dr. Cedric Lewis [cross link to bio], still treats patients. He’s not a former dentist turned executive, he’s a working clinician who also leads clinical strategy for the organization. That distinction matters.
Over the past several years, I’ve talked to hundreds of practice owners who’ve been approached by various DSOs and partnership organizations. The red flags that come up most often fall into a few categories.
Phantom equity is the most common structural red flag. If the “equity” you’re being offered only materializes on a sale event, and the sale event is determined by investors you’ll never meet, you don’t really have equity. You have a lottery ticket with someone else holding the drawing.
Advisory-only boards are another signal. If the dentists on the board serve in an advisory capacity, meaning they can recommend but not decide, then the organization isn’t dentist-led. It’s investor-led with a dentist-friendly veneer.
Clinical mandates from corporate are the most visible red flag, and usually the one that triggers practice owners to start looking for alternatives. If your supply chain is dictated, your insurance participation is mandated, or your staffing model is standardized without your input, you’ve traded autonomy for support. And the support is rarely worth the trade.
Earn-out structures tied to performance metrics you don’t control are a more sublte red flag. If your payout depends on hitting targets that are set by corporate and measured against benchmarks you can’t verify, the incentive structure is designed to benefit the buyer, not the partner.
On the other side, there are structural signals that suggest an organization genuinely means what it says about dentist leadership.
A dentist-majority voting board is the single most important green flag. It means the dentists have structural control over the organization’s direction.
Real equity grants with transparent terms are the second green flag. If you can read the operating agreement, see your ownership percentage, understand the distribution waterfall, and verify that your equity isn’t contingent on a sale event, you’re looking at a real partnership.
Partner-doctor input on hiring, protocols, and growth is the third. If the organization’s default is “you decide, and we support” rather than “we decide, and you execute,” the culture matches the structure.
A leadership team that still practices dentistry is a strong signal too. When the people making organizational decisions are also treating patients multiple days a week, the decisions tend to be different. They are more grounded, more practical, and more aligned with what actually matters in a practice and to its patients.
If you’re evaluating a dental partnership organization, these five questions will tell you most of what you need to know.
The organizations that are genuinely dentist-led will welcome these questions. The ones that aren’t will redirect you to the marketing deck.
We call ourselves a Dental Partnership Organization (DPO) rather than a DSO because the word “partnership” is doing real work in that name. It’s not a rebrand of the same model. It’s a different legal structure built around a different set of incentives.
Our founding group is 15 dentists with over 250 years of combined clinical experience. Our 27 locations across 10 states are led by practicing dentists who hold real equity, sit on a dentist-majority board, and maintain full clinical autonomy in their practices. Our leadership team reports to those dentist-Founders.
We didn’t build this because we think other DSO models are bad. We built it because the version of dental ownership we wanted didn’t exist. And based on the conversations we’ve been having with practice owners across the country, we’re not the only ones who were looking for it.
“Dentist-led” should mean something. It should mean ownership, governance, and clinical authority are structurally in the hands of practicing dentists. It should mean the organization’s incentives are aligned with what doctors care about — not what fund managers care about.
When you’re evaluating any partnership organization, don’t take the label at face value. Ask for the documents. Ask the five questions. Look at the structure, not just the story. The organizations worth partnering with will make that easy.
If you want to see how Rising Tide’s structure works, we’d love to learn more about you and tell you more about us.
CTA: Reach out to Dr. Steve Albert (crosslink to Bio) at steve@risingtidedental.com or visit risingtidedental.com to start a conversation.
A Note From Our Founders
We started Rising Tide because we looked at what was happening to dentistry and decided someone needed to offer a different path. If you believe in protecting private practice dentistry, let's talk.