The DSO groups have an association that supports all of its members exclusively (the ADSO) which gives them an advantage over the “silent majority” of independent practitioners who are isolated and poorly supported by the traditional Dental Association organizations. We believe that independent dentists deserve the same protection of their interests. Our purpose is to give the advantage to independent practice. We have invested our expertise, efforts and resources to make that possible.
Since 2011, the traditional independent practice models have been challenged by investors who see untapped profit in practices and are determined to take advantage of their vast financial resources to acquire and control the dental marketplace in Canada; just as they have done in other countries – Australia, New Zealand, UK and US. These are known as DMSO and DSO models. The good news is that the traditional doctor owned and operated (DOO) model retains a strong position at 80% of the market even when the DMSO/DSO controlled practices reach the tipping point (15-20%).
So, we wondered why we’re hearing more concerns from practitioners – fewer associate positions, less demand for dental services and fewer patients, while price for practices escalate to beyond the realm of reality for an owner-operator. Through considerable research over almost 10 months, the story unfolded. It became clear that over time there were numerous individuals and organizations which saw an opportunity to generate passive income by owning and managing dental practices. Four factors consistently emerged – fear, ignorance, greed, and arrogance – which contributed to some degree in the victimization of dentists and ultimately, the public.
In Canada, dental professionals believed that only a dentist could own a practice. (Most patients also believe this.) But as we found out, as the old saying goes, “where there’s a will, there’s a way.” Investors saw predictable and more importantly, stable, profit by taking an equity position and control over the management of practices. Beginning with the DSO group known as Tridont Dental Centres in the late 1970s, entrepreneurial dentist-investors have developed a variety of operational models (once you’ve seen one; you’ve seen one) with multiple locations and providers, centrally managed. The DMSO evolved from that, when independently owned practices engaged management companies to help the practice operate more efficiently in exchange for a share of revenue or profits (taking an equity position). These business structures rely on economy of scale to support the bloated management and executive levels. The dental practice that once supported the owner-operator and his team of auxiliaries, now also has to support at least another level of management. The DMSO/DSO models have now evolved to the point that they include ownership/investment by major equity fund managers, the largest retail corporation in the world (Walmart) and even insurance companies.
A New “Normal”
Businesses require capital investment to grow and thrive. Private equity funding is not accessible to independent practitioners to build or enhance their practice. DMSO/DSOs do not rely on bank financing; they have shareholders and investors to finance their acquisitions and mergers, just like companies in other industries. Independent practice owner-operators depend on traditional bank loans and credit lines to fund their business. Banks have limitations on the amount that they will lend to any one borrower, regardless of their age or experience or business model. Private equity funding has no limits, but they expect higher rates of return than banks charge their customers.
Competition for patients in the dental marketplace has never been higher. Attracting new patients to a DSO/DMSO practice is done primarily with external promotion and “invitations to treat” (give-aways and other special offers to entice people to come to their practices). Positioning themselves in high traffic areas such as shopping malls and storefronts ensures visibility and convenient accessibility for potential new patients. Equipping their clinics with the latest technology is intended to create an impression on patients of high quality services. These strategies have been emulated by independent practice owners in an effort to compete for those illusive patient dollars. And that is exactly the problem – all of these are simply resulting in commoditizing dentistry.
Reports from the ADA and independent surveys say that dentists who work in these models, earn less and are less satisfied with their careers. Whereas, dentists who operate in DOO practices have higher job satisfaction and earn ~30% more income. That’s not a surprise. The primary differentiation between DMSO/DSO and DOO philosophies is that one is profit-driven and the other is people-centered.
We believe that when patients and members of the public are able to make an informed choice about who they choose as their dentist, they will be more likely to choose a DOO practice, where they are focused on building relationships based on trust and mutual respect. This means that independent dentists need to have the ability and financing to educate and inform the public.
We can learn how to collaborate from the way that DMSO and DSO companies operate. They pool their resources to give their group the power to promote, lobby, and negotiate for the benefit of their shareholders and investors. We can do even better by being a benevolent network that is open, transparent and empowers dental professionals, your patients and the public.
Together We Can Make It Happen
My Practice Matters™ Network is an innovative, comprehensive program developed by Nadean Burkett, the most trusted name in practice management and career transition in Canada, to protect the rights and freedom of independent practitioners to make informed choices in their career and business. This is accomplished in three ways – education, support and collaboration. Be a part of this grassroots revolution – join us today!
Nadean Burkett & Associates Inc. is a privately-owned and operated professional corporation of Nadean Burkett. She founded the firm and business model with the intended purpose of providing a higher standard of education, guidance & support to dental professionals in private practice. Nadean Burkett & Associates Inc. and the My Practice Matters ™ team has built a solid reputation of professionalism, integrity and honesty in dealing with clients and other professional advisers. Her commitment to best suit her clients’ unique individual needs and protecting their interests is without compromise.
As the dental marketplace has changed, so has our approach to delivering services so that we can stay true to our purpose and intention as a community-minded business.
Our Purpose Statement
To empower, unite, and support independent dentistry throughout North America.
Nadean Burkett, CEO & Executive Director of Practice Management & Transitions
Nadean is a member of the public who has a career working with and supporting dental professionals spanning over 3 decades. She supplemented her hands-on clinical and administrative experience working in general and specialty practices with education in Business Administration and Marketing which she applied to operation of dental practices and business issues unique to dentistry. Her skill-sets and people-centered philosophy brings her clients a common sense approach, creative strategies and practical solutions to virtually every aspect of practice management and transition through all stages of their careers.
Nadean has built solid relationships with professionals in private practice as a respected practice assessor, practice management and career transition coach. A prolific author, her articles have been published throughout North America and internationally – including Spectrum Dialogue, Dental Teamwork, Journal of the Canadian Academy of General Dentistry, and Dental Tribune International. She is a respected educational adviser on business planning, management and transition; presenting at dental conferences and study clubs and AGMs – Nadean is passionate about sharing knowledge, information and her experience with others.
Caroll Korner-Dickson, Associate Director, Operations
Following her arrival in Canada from New Zealand in 1994, her career in the dental industry began in the Regulatory Division of the College of Dental Surgeons of BC.
At its inception in January 1999 Caroll joined the British Columbia Dental Association and spent the next 13 years as Executive Assistant to the Director, Member Services assisting its members and dental personnel in many facets of business operation, as well as mediating disputes between dental practices and their patients. As one of the original members of the BCDA Mediations Program she conducted mediations between BCDA members and patients, and provided guidance to many dentists and patients in the areas of administration and clinical processes.
“Thank you Nadean and Caroll for your many hours of hard work and patience (over the years). You have been exemplary in your sensitivity, kindness, perseverance and patience in carrying us through what must have seemed a long and tedious process. We respect and admire you for your understanding in tending to our needs in a gracious and caring manner. We could always rely on your loyalty and clear advice. With much appreciation for your professionalism and your ethics. Thank you again for your expert advice in this seamless transfer and transition of ownership.” IW & KWS, DMD (Abbotsford, BC)
“Thank you so very very very much. You are a very, very hard worker.” TF, DMD (Surrey, BC)
“I would highly recommend Nadean and her company to anyone considering an associate transition, purchase or sale of their dental practice.” AMJW, DMD (Vancouver, BC)
“I have been truly impressed with Nadean’s knowledge of our profession and her contacts in the legal, accounting and dental world. Through proper practice valuation and excellent negotiating techniques she has saved me thousands of dollars.” AK, DDS (Burnaby, BC)
“In Nadean I found someone who provided a realistic point of view and strove to provide a fair settlement for both parties, thereby enabling us both to leave the process feeling comfortable with our decisions. I am so grateful for Nadean’s hard work and dedication.” MAS, DDS (Coquitlam, BC)
“Thank you, thank you, thank you, Nadean. You were (are) wonderful. Can’t say it enough…THANK YOU SO VERY MUCH. I am very grateful and awed by your talents. I don’t think I have ever seen anyone work so hard on a project! You are tenacious, woman. And for that I will be eternally grateful. It’s rare to find an individual with such strong people skills and business savvy. Wow! It’s truly a powerful combination. Use me as a reference anytime.” VR, DDS (Prince George, BC)
“Thanks so much for accomplishing the un-accomplishable. You were great!” MS, DDS (Northern BC)
“Your thoughtfulness, understanding and honesty gave me confidence in an uncertain time in my career. Saying ‘thank you’ are just words and are not adequate to express my appreciation. You are worth 10x your fee!” MS, DMD (Metro Vancouver)
“You accomplished our goal efficiently and made it look so easy – but I know it really wasn’t! I will be calling on you again to assist me in the future.” KK (Vancouver)
“You kept our spirits up and expectations realistic – thanks for everything!”