TALENT TRENDS

Young dentists are deferring ownership—now what?

Early‑career dentists are choosing employment, often at DSOs, over hanging their own shingle, and the data says it’s not a blip. Ownership is still the endgame for most, but it’s happening later. Translation: The associate era is here. The question for DSO leaders is whether you’ll be a short layover … or the destination.

What’s happening: Practice ownership has trended down for two decades. According to the ADA Health Policy Institute (HPI), just 72.5% of U.S. dentists were owners in 2023, a significant drop from 84.7% in 2005. The shift is especially sharp for newer grads. HPI data shows that among dentists 5–9 years out of school, only 21% of the 2016–2020 cohort owned a practice, compared to 63–70% for those who graduated in 2010 or earlier at the same career stage. By mid‑career, ownership rates converge.

• The DSO pull is real: In 2024, the ADA HPI reported that 27% of dentists less than 10 years out of school were affiliated with a DSO, an increase from 24% in 2023.
  

• Pipeline preferences are changing: An ADEA survey of recent dental school seniors found that nearly one‑third (32%) of those planning to enter private practice intended to join a DSO-affiliated practice, with the figure rising to 35% among historically underrepresented groups. 

Why it’s happening: Debt and start‑up math favor DSOs early. With six‑figure loans for new grads and practice start-up costs frequently topping half-a-million dollars, salaried roles with benefits, CE, and mentorship are proving more attractive for those in the early days of their career, even if long‑term economics still favor equity.

• New dentists still aspire to own, but they’re taking the scenic route to build skills and pay down loans before buying in. That keeps the DSO talent funnel full until years 7–15, when ownership intent catches up with them.

Why it matters: Recruitment tailwinds turn into retention headwinds. You’ll have no shortage of eager associates, but the same cohorts are statistically more likely to pursue ownership later. Without a credible path to equity, you risk becoming the “finishing school” for future independents.

• Brand and culture are differentiators, not window dressing. For a generation that prizes mentorship and work‑life balance, a strong clinical culture and structured development can beat pure comp for top talent.
  

• Market power shifts. As DSOs absorb more early‑career clinicians, payer negotiations, vendor pricing, and tech adoption increasingly run through scaled platforms, making “associate value prop” a strategic revenue lever, not just an HR line item.

What to do now: Savvy DSOs are adjusting their practices to capitalize on this trend. Here are five ideas you can consider implementing to attract and retain the best young talent:

• Build a real ownership ladder. Offer time‑boxed, criteria‑based tracks (e.g., 24–36 months) to minority equity or profit share in local groups. Publish the rubric, hit the timeline, and backstop with financing partners who ignore student loan balances when underwriting buy‑ins. You’ll convert “someday owners” into “your owners.”
  

• Sweeten early‑career ROI. Pair above‑market CE budgets with paid mentorship time, not just cases; add targeted student‑loan repayment and relocation stipends; and protect new dentists from schedule volatility with minimum daily guarantees.
  

• Design for flexibility. Offer predictable PT options (three‑ or four‑day clinical weeks), gradual transitions back to work post-leave, and cross‑office float pools to smooth chairtime without burning out early‑career clinicians.
  

• Plan for “graduation risk.” Treat retention like an investment cycle: Assume a portion of associates will pursue ownership after 5–10 years. Create an internal marketplace of partnership slots, de‑novo spinouts, or structured alumni transitions that keep production inside your network instead of losing it across the street.
  

• Diversity and gender dynamics matter. Women now comprise the majority of dental students, and HPI data reveals a 16-percentage-point gap in practice ownership between early-career male and female dentists. DSOs that solve for flexibility, parental leave, and predictable schedules gain an edge.

Bottom line: Young dentists are delaying ownership because the economics and lifestyle math make employment the smarter first move, but that doesn’t mean they don’t want to own down the road. DSOs that turn the early‑career decade into a compelling on‑ramp to equity will win the war for talent and the long game for production. If you don’t build the ladder, don’t be surprised when your best associates climb someone else’s.