Learn quick insights and success strategies from Women in DSO members shaping the future of dentistry. Gain wisdom, inspiration and practical guidance.
Leaders
Learn quick insights and success strategies from Women in DSO members shaping the future of dentistry. Gain wisdom, inspiration and practical guidance.
The last two-plus years have been the toughest economic environment in the history of the DSO industry. The challenges began in early 2021, near the end of the COVID-19 pandemic, with a new presidential administration that flooded the economy with a surplus of aid programs, many of which proved unnecessary. Around a year later, Russia invaded Ukraine, destabilizing global markets, followed by several crises in the Middle East. The result was the highest interest rates and inflation in the history of the DSO industry, coupled with record costs for goods and labor. These difficult economic conditions significantly lowered EBITDA, leaving many organizations struggling to maintain positive cash flow and comply with the terms of their credit facilities. These conditions also caused a massive slowdown in the once-booming DSO M&A markets, creating great uncertainty heading into the November 2024 presidential election.
In November 2024, one of the most closely watched elections in U.S. history took place, resulting in the election of a new presidential
administration. Interest rates have since been lowered by the Federal Reserve. This raises the question: what can we expect for the DSO industry in 2025?
Going into 2025, there are a number of favorable economic conditions, including the following:
1. The Federal Reserve cut interest rates three times in the latter half of 2024, during meetings in September, November, and December, totaling a full percentage point reduction. This has led to more favorable lending conditions, with expectations that rates will continue to decline throughout 2025.
2. Investor confidence has improved significantly after the outcome of the 2024 presidential election, with the stock market rising more than 1,500 points and 3.6% the day after the election and continuing to rise over the next few weeks.
3. An enormous amount of investor capital remains on the sidelines, waiting for the right opportunities.
4. There is also a large inventory of dental organizations of all sizes that are seeking recapitalization events.
5. Many technological innovations have either come online or are expected to come online soon, which can dramatically improve the same-store growth of dental organizations.
Going into 2025, the regulatory environment appears much more favorable, including the following factors:
• The FTC’s proposed non-compete rule was enjoined by a federal court on August 20, 2024. The new administration is not expected to pursue the enforcement of this proposed rule, which will create much more favorable conditions for the labor market.
• The Corporate Transparency Act was enjoined by a federal court on December 3, 2024. If this injunction is upheld, it will create a less burdensome environment for corporate entities.
• The current FTC director will be resigning, and a new director appointed by President Trump will be taking over with a much more business-friendly philosophy.
• President Trump has pledged to overhaul the Justice Department, which is expected to lead to less aggressive healthcare-related investigations and enforcement actions.
• Governor Gavin Newsom recently vetoed SB 842 (in September of 2024), which, if signed into law, would have allowed the California Attorney General broad powers to block healthcare M&A transactions.
This is truly one of the most exciting times in the history of the dental industry. There have been more innovations in the last five years than in the previous 100 years. Some of the most incredible innovations that either exist or are coming soon include:
• Diagnostic AI allows for the diagnosis and treatment of many more dental conditions than ever before.
• AI is automating payment of invoices, adjudication of insurance claims, approvals, collection of receivables, and improving revenue cycle management. AI is also reviewing phone calls to maximize patient retention.
• A revolutionary product exists that has the potential to regenerate enamel and monetize the treatment of minor cavities without resorting to the traditionally invasive “drilling and filling” procedures.
• Membership plans are increasing the ability of dental organizations to attract and retain patients who lack insurance.
• Technological advancements and innovations in clear aligners, implants, anchored dentures, sleep medicine devices, and traveling specialists have made the integration of specialties into general dentistry offices easier than before.
• Innovative patient finance solutions have made access to treatment easier than before.
• Other technology advancements include real-time tracking of capital tables and earn-outs, lease management, management of merchant fees, the use of big data to determine market presence, and lab consolidation—all of which have the potential to reduce overhead.
These technologies can increase same-store growth, lower overhead, and compensate for shortages in clinical and non-clinical employees. However, challenges remain in the adoption of these technologies, including resistance to change, lack of effective implementation plans, and the integration with existing technologies already in use at dental organizations.
There are several key questions as we enter the first half
of 2025:
In December of 2024, the Federal Reserve Chairman delivered disappointing news, by projecting just 2 rate cuts, down from its original anticipated rate cut of 4. This caused stocks to tumble. The Chairman cited persistent inflation as the main reason for the smaller-than expected reduction, warning that it could take until the third or fourth quarter of 2025 for inflation to improve.
Investor confidence is at its highest point in the last three years, and there is significant capital waiting to be deployed but inflation still remains higher than it should be and interest rates will not be reduced as quickly as the market had hoped.
I believe valuations will be fair but not as high as they were at the end of 2020 and 2021, when market highs were reached.
The market will continue to utilize rollovers, earn-outs, and joint ventures as a means of mitigating risk for transactions into 2025. EBITDA will also be scrutinized much more strictly than it was during the market highs in 2021.
Organizations that adopt new technologies, properly implement them, and integrate them with existing systems will experience substantial same-store growth.
• New wars or global unrest.
• The implementation of draconian policies,
such as onerous tariffs.
• Failure to achieve low enough interest rates.
• Stubbornly high inflation.
I predict a gradual recovery during the first two quarters of 2025, with smaller to mid-sized deals closing in this period. I expect to see improved deal activity in the third and fourth quarters of this year, assuming there are no major global or domestic setbacks. Additionally, I anticipate a dramatic increase in the adoption and successful implementation of new technologies in 2025, which will lead to significant same-store growth for dental organizations.
In the fiercely competitive landscape of dental service organizations, most approaches to staffing remain reactive rather than strategic. The focus is most often on short-term wins—filling a chair for a day or covering a shift at the last minute—instead of building a foundation for sustained growth. However, as patient demand surges and market competition intensifies, leadership at forward-thinking DSOs are shifting their perspective. They treat staffing not as a stop-gap measure, but as a strategic lever for long-term profitability.
To explore this approach, I recently spoke with several DSO executives and dental leaders within the onDiem network: John Murphy, Vice President of Talent Acquisition at Aspen; Joshua Perry, CEO of Access Care; and Misty Mattingly RDH, BS, Senior Vice President and Chief Dental Hygiene Officer at Sage Dental. As some of the most experienced authorities in our industry, they candidly shared both the challenges their organizations have faced and the strategies they’ve adopted to turn staffing into a competitive advantage. Their insights, combined with broader trends, shed light on how DSOs can reframe workforce challenges as opportunities for sustained growth.
“We’re at a crossroads,” said John Murphy of Aspen. “Demand for dental services is at an all-time high, and the workforce just isn’t keeping up. That puts enormous pressure on us and our margins.”
Murphy’s perspective is critical. In the midst of rising labor costs, evolving patient expectations, and expanding access to dental care, practices must find innovative and flexible ways to maintain capacity.
This challenge highlights a critical gap in the traditional DSO staffing model. In their quest to attract top talent, practices may sometimes underestimate the factors that keep employees engaged and committed long-term. (Smaller practices with limited resources, in turn, may not always be aware of state and local laws that require even part-time dental workers to be classified as W-2 employees entitled to all associated benefits and protections.) For many dental workers, particularly part-time staff, access to benefits and flexible scheduling can be a non-negotiable.
Addressing these issues requires creative and strategic solutions, such as collaborating with staffing partners who can offer benefits and administrative support that DSOs and practices may struggle to provide on their own. By tackling these gaps proactively, DSOs can not only reduce turnover but also enhance employee satisfaction and loyalty.
Let’s explore how staffing can become a growth driver by focusing on three critical elements: retention, quality, and optimization.
Transforming staffing into a growth driver requires a multi-pronged approach that prioritizes retention, quality, and optimization. These three elements come together to create a sustainable staffing strategy that addresses immediate needs while positioning the DSO for long-term growth and success.
Benefits as a Competitive Edge
Retention isn’t just about keeping staff; it’s about reducing the costs and risks of turnover. According to Joshua Perry of Access Care, “One of our early pain points was losing part time employees who needed a more comprehensive health insurance program. At the time, we simply couldn’t offer it without skyrocketing costs or administrative headaches. That’s where our staffing partnership with onDiem came into play.”
Staffing companies such as onDiem are W-2 compliant nationwide, allowing them to provide all dental professionals (regardless of their full-time or part-time status) on their platform with W-2 benefits such as comprehensive health insurance, PTO, malpractice insurance, workers’ compensation insurance, and more. Through onDiem’s SafePay™ offering, practices and organizations such as Access Care have been able to hire and book their own temps through onDiem’s platform—immediately granting them access to these benefits without dealing with the administrative burden or cost.
Perry credits onDiem for Access Care’s improved retention rate, noting that it increased significantly within the first year of partnership. “This partnership was a game-changer for us,” says Perry. “It allowed us to provide benefits to our essential part-time and temp employees without the administrative headaches—and was more cost-effective than building the infrastructure ourselves.”
Choosing a staffing partner that allows for this arrangement not only can enhance retention for the DSO, but also position the DSO as an employer of choice in a highly competitive labor market.
Building a Pipeline of High-Performing Talent
Retention alone isn’t enough; DSOs must also ensure that the talent they retain and recruit is top-notch. “Like any other dental organization, we’ve had our share of mismatches,” Misty Mattingly of Sage Dental admits. “Sometimes we’d bring in a temp who wasn’t a good fit, and it would disrupt the team dynamic or patient experience.”
Mattingly’s solution? Building a pipeline of high-performing talent. “Our philosophy is simple: hire the best temps, and rehire them when possible,” Mattingly explained. “By treating temporary staff as an extension of our team, and choosing a staffing partner with the same philosophy, we’ve reduced mismatches and built a high-quality pipeline.”
Staffing services can play a pivotal role here by offering access to pre-vetted professionals—and in the case of onDiem, by providing access to fully W-2 compliant and certified workers to mitigate costly legal risk. Additionally, sophisticated staffing platforms allow DSOs to track and re-engage high-performing temps, creating a seamless talent pipeline.
“It’s not just about filling roles; onDiem has helped us create a system where we know the best possible talent is always within reach when we need them,” Mattingly emphasizes. “That confidence lets us focus on scaling our business and improving our standards of patient care.”
Flexible Solutions for Dynamic Needs
Staffing challenges are rarely static or fully predictable. Holidays, unexpected sick leaves, and the addition of new columns or service lines all demand flexibility. “One of our biggest headaches was managing staffing during peak periods,” Murphy noted. “We’d often end up short-handed, and it impacted patient satisfaction and care.”
Murphy’s challenge is unfortunately shared across the DSO and practice community. But by moving away from traditional and frenzied “whack-a-mole staffing,” as Murphy puts it, and toward staffing strategy that maximizes your practices’ capacity, a DSO stands to gain for the years to come. “At several of our locations, dental chairs regularly went empty, because it’s hard to ramp up when you’re in the throes of high patient need,” he explained. “Our staffing partner helped our team switch our approach, and now we are proactively staffing to each location’s full capacity, treating more patients, and witnessing significant growth in our margins.”
Flexible staffing solutions such as onDiem expertly adjust to dynamic needs—enabling DSOs to cover peak periods year-round; test new markets or specialties by bringing in specialized talent temporarily; and expand operating hours or columns without immediately committing to full-time hires.
“Our staffing partner helps us adjust in real-time,” Murphy added. “That flexibility has been a big part of our growth story.”
Dental Staffing: A Strategy for Sustainable Growth
Our partner organizations offer a compelling example of how DSOs can evolve their approach to staffing. By focusing on retention, quality, and optimization—and by partnering strategically with a staffing service — they’ve turned a regular challenge into a driver of growth.
“Staffing isn’t just about today,” Murphy said. “It’s an investment that can pay off with growth and profitability. It’s about building the kind of workforce that ensures we’re here tomorrow.”
Across Amy McCarthy’s professional journey, her passion for innovation and entrepreneurial spirit have been driving forces behind her success. They have defined her career and are now shaping the future of Envista. As the newly appointed leader of Envista’s DSO initiative, she is spearheading a transformation designed to elevate how DSOs operate, scale, and deliver exceptional patient care.
Amy’s entrepreneurial journey began early. At 17 years old, she founded a mail courier service in Everett, Washington, which served over half of the local medical community. Her innovative service cut delivery times for medical records in half, streamlining workflows for countless healthcare providers.
“I was creating solutions that added value. I didn’t realize it then, but that experience taught me the importance of identifying pain points,” Amy shares. Over the next decade, she grew this business while pursuing a college degree, a career, and later an MBA. This hands-on experience laid the foundation for professional work in the pharmaceutical industry where she quickly made her mark. At 25 years old, Amy became one of the youngest district sales managers in the company’s history.
“I focused on understanding my customers’ goals and needs. By aligning my efforts with their objectives, I was able to build trust and long-lasting relationships. That approach has been a cornerstone of my leadership philosophy,” she explains.
But Amy’s career trajectory shifted when she chose to leave her high-pressure role to focus on raising her two young children.
“On my youngest child’s first birthday, I quit my role as Regional Sales Manager at Sanofi-Aventis Oncology. I was traveling constantly and felt like I wasn’t doing anything well — being a mom or a manager. No matter what adjustments I tried, I couldn’t find balance or happiness. It was one of the hardest decisions I’ve ever made. I loved my career, but I felt a lot of pressure—and pull—to be with my kids. My family always valued stay-at-home parenting, so I decided to give it a try,” Amy recalls.
Yet even during this work hiatus, Amy’s entrepreneurial drive could not be stopped. She soon launched a photography business, a passion project that allowed her to balance motherhood with work through a creative outlet.
“It filled my constant need to learn and improve. I built a custom website, grew a thriving client base, and enjoyed the flexibility. But after a few years, I found myself wanting more,” Amy reflects.
That desire led her to consulting, where she advised small businesses on strategic planning, operations, and marketing. Consulting ultimately connected her to Premier Periodontics, a Seattle-based DSO who brought Amy on to scale operations. Amy was pivotal to the organization’s success.
“I started as Director of Operations and moved into marketing, and eventually I became COO. During my time there, we expanded Premier to eight locations and helped launch Evident Alliance, a 25-location multi-specialty DSO,” Amy explains.
She credits much of her success to the trust her colleagues placed in her.
“They let me make decisions and run with them, which is how I work best. Dr. Will Fernyhough and Dr. Issa Dkeidek remain great friends to this day,” she adds.
In 2021, Amy joined Envista, drawn by the opportunity to combine her expertise in innovation and healthcare.
“Envista’s portfolio is unmatched. I knew that it would be an opportunity to grow personally and offer endless opportunity to innovate and create value for customers,” Amy says.
Amy shared her vision for the future of Envista’s place with DSOs last spring with CEO Paul Keel. Paul saw the importance, shared Amy’s excitement for the opportunity and added DSO to the strategic planning process. As a result, extensive voice of customer interviews were completed, new resources allocated, and restructuring occurred to suit the needs of these very important customers. All focused on leveraging Envista’s vast customer-centric solutions and portfolio.”
Envista’s success with DSOs boils down to three key elements: solutions, simplicity, and scale.
Envista’s portfolio includes best-in-class solutions, products and technologies across categories: diagnostics/imaging, implants, consumables, and ortho. What sets the company apart, however, is its ability to integrate these offerings into tailored solutions for DSOs.
“We’re not just selling products. We’re partnering with DSOs to help them operationalize and scale their businesses. This means creating training programs, offering fleet management tools, and collaborating on innovations that improve efficiency and patient care,” Amy explains.
Envista offers simplicity for DSO partners. The advantages of working with one manufacturing partner for multiple solutions / across multiple categories is enormous. Having a single point of contact, one contract, a partner who knows your goals and paint points and who is proactively working on your behalf to help you grow, across initiatives, is invaluable. The time savings and peace of mind are invaluable. Envista has the resources, expertise and experience to help our DSO partners and scale.
“Amy has a deep understanding of market dynamics, coupled with an innovative approach to partnership development. Her ability to identify new opportunities, negotiate mutually beneficial agreements, and align partnerships with the company’s broader objectives has directly resulted in significant achievements for Heartland. Her leadership has had a profound impact on DSOs,” adds Dr. Anna Singh, Senior Vice President of Clinical Operations at Heartland Dental.
Amy envisions continued growth and innovation for Envista. A significant focus is on advanced training and education, with customized programs for partners like Heartland Dental and Smile Brands to help providers grow their implant practices.
“Envista has been a great partner to Smile Brands for many years and has evolved with our changing needs, always with long-term success in mind for our providers, their patients, and us as an organization. We look forward to continuing this journey together,” shares Steve Bilt, CEO of Smile Brands.
Fleet management technology is another area of focus. Envista’s suite of tools helps DSOs track and optimize equipment usage, improving efficiency and effectiveness. The DTX Studio Imaging Suite is also revolutionizing workflows by integrating diagnostics, imaging, and treatment planning into a seamless experience.
“It’s changing the way dental offices operate. The best part is, it’s an open platform that works with any existing technology, making DSOs more agile and effective,” Amy says.
For Amy, Envista’s success is about more than business — it’s about solving problems and growing relationships.
“I’m never satisfied with the status quo. There’s always room to grow, innovate, and improve. That’s what keeps me going,” she says.
Under Amy’s leadership, Envista is setting a new standard for partnership in the dental industry — offering DSOs not just the tools
to succeed but a vision for growth, innovation, and meaningful collaboration that drives long- term impact.
Procurement reports and staffing dashboards are essential decision-making tools for any growing dental support organization (DSO). They help identify gaps, reduce inefficiencies, and unlock growth opportunities. Darby Dental excels in this space by acting as a steadfast partner for DSOs, bringing proven solutions and personalized support to the forefront. Whether the goal is to refine operational workflows, meet evolving patient expectations, or leverage data to optimize costs, Darby provides innovative, tailored solutions that empower DSOs to achieve sustainable success.
Traditionally, the growth strategies of DSOs have centered on mergers and acquisitions. The pace of merger and acquisition activity has slowed due to recent market shifts, causing DSOs to shift their focus towards same-store growth.
“The trend we’re seeing now is a greater emphasis on profitability and efficiency within existing locations,” said Andrea Hight, Director, Strategic Accounts/DSOs at Darby. “This shift has created an opportunity for us to introduce solutions that directly impact operational performance and drive sustainable growth.”
For example, Children’s Surgical Centers is a network of ambulatory surgery centers with a mission to serve underserved children and individuals with special needs. Facing the challenge of scaling operations while maintaining affordable and accessible care, they turned to Darby. Using Darby’s procurement best practices, Children’s Surgical Centers consolidated purchasing processes, optimized inventory, and significantly reduced costs.
“Working with Darby has made life so easy,” says James Walters, VP of Operations at Children’s Surgical Centers. “My supply costs were cut down substantially. Plus, I have everything I need on a convenient list that Darby provides — eliminating the time and energy it takes to track down the right products and prices. We were able to get top-of-the-line products that have led to happier doctors and happier patients.”
Debbie Kessler, Darby’s Director of Strategic Accounts for DSOs, collaborated closely with James Walters and the Children’s Surgical Centers team, delivering cost-effective solutions that aligned with their specific needs. She was instrumental in helping them identify the right products — at the right price — so they could spend more time focusing on their mission.
Now, Children’s Surgical Centers can better focus on filling a nationwide gap in coverage for those who need access to dental procedures under general anesthesia far more urgently than extensive hospital wait times can accommodate.
Darby’s unique ability to provide innovative tools with tailored, hand son support ensures DSOs can optimize operations while dedicating more resources to their core missions. By enabling DSOs to simplify operations and allocate resources more effectively, Darby ensures their partners can prioritize their core mission: delivering exceptional patient care.
Centralized Processes:
Simplify purchasing across
multiple locations.
Cost Optimization:
Reduce supply costs with
bulk purchasing and
streamlined inventory.
Tailored Tools:
Customized procurement
dashboards for real-time
insights.
Darby uses advanced analytics to uncover opportunities for improvement. The company’s industry-leading AI-driven tools evaluate spend data interactively, helping DSOs identify best practices and pinpoint areas for improvement.
“We don’t just look at pricing,” explains Scott Walsh, Vice President, Sales at Darby. “We analyze product mix, duplication, inventory management, and even private-label adoption to create holistic strategies tailored to each DSO.”
This approach played a pivotal role in helping one large DSO struggling with high supply costs. Using Darby’s analytics tools, the team uncovered inefficiencies like product duplication and non-standardized purchasing.
The DSO significantly reduced costs and improved scalability by implementing changes such as streamlined inventory management and cost-effective private-label products, realizing financial and operational benefits that aligned with its growth strategy.
As operational efficiencies are crucial for DSOs to thrive, addressing workforce and equipment maintenance challenges has become equally vital. The dental industry’s staffing shortages as well as availability of equipment repair technicians have posed significant challenges for DSOs nationwide. Darby has solutions for both.
Darby Dispatch is the innovative approach to comprehensive, technology-driven access to essential equipment repairs, capital inventory management, regulatory compliance, and data to support expansion and EBITDA demands.
Darby’s partnership with onDiem offers a proactive solution for its DSOs by connecting practices with pre-vetted dental professionals and simplifying onboarding processes.
“It’s about more than just filling a position. It’s about finding the right fit and alleviating administrative burdens so DSOs can focus on growth,” shares Scott.
The onDiem platform offers comprehensive services, handling everything from payroll taxes to ensuring compliance with state and federal laws. By centralizing staffing needs and reducing the complexities associated with hiring, onDiem allows DSOs to maintain staffing levels without administrative strain.
Additionally, quickly onboarding temporary and permanent staff has helped many DSOs bridge staffing gaps during peak times or unexpected absences, ensuring that patient care remains uninterrupted. onDiem’s combination of efficiency and reliability exemplifies Darby’s commitment to empowering its partners with practical, high-impact solutions.
Beyond procurement and staffing, Darby provides DSOs with a comprehensive suite of services designed to drive efficiency and scalability. From IT integration to subscription management platforms, Darby’s offerings align with the evolving needs of tomorrow’s DSOs.
Method Procurement – amplifies savings and provides purchasing transparency through one modern dental spend management platform.
TechForce – delivers tailormade, dental-specific and HIPAA compliant technology solutions fromdesktop support to network security, and everything in between.
Dispatch – provides cutting-edge software solutions and equipment repair services to minimize downtime, ensure compliance, and improve operational efficiency.
onDiem – connects practices with temporary and long-term dental hygienists, assistants, and front office professionals2through an on-demand staffing platform and proprietary onboarding process.
Subscribili – allows dental practices to increase access to care, strengthen their customer base, and improve patient outcomes.
Darby TechForce, for example, provides tailored cybersecurity and IT solutions. TechForce seamlessly integrates with hardware and software while protecting patient data. As DSOs expand, this offering is especially valuable as robust IT infrastructures are required to connect multiple locations securely and efficiently. With automated monitoring, system backups, compliance-driven support, and more, TechForce empowers DSOs to focus on operational excellence without worrying about IT disruptions.
Subscribili is another Darby offering that allows DSOs to implement in-house subscription plans, boosting patient retention and generating recurring revenue streams. Patients on these plans are 25% more likely to return for care and three times more likely to accept treatment. This tool improves financial stability and enhances patient satisfaction, making it a win-win for the organization and its patients.
Combined, these solutions reflect Darby’s commitment to understanding its clients’ challenges and delivering tools that enhance operational efficiency while fostering long-term growth. Darby is a tremendous partner for DSOs as it anticipates industry trends and remains responsive to DSO needs.
By combining cutting-edge technology with personalized service, Darby empowers DSOs to overcome challenges and capitalize on growth opportunities.
“As they scale, DSOs face unique challenges that require innovative solutions. Vendors have a critical opportunity to act as strategic partners in overcoming these obstacles — the top three being recruiting and retaining skilled dental professionals, navigating regulatory compliance, and adapting to changing patient expectations,” says Kim McCrady, RDH, of Signature Dental Partners.
Darby’s unwavering commitment to empowering DSOs through innovative solutions and personalized support underscores their value as a true partner in navigating these challenges.
Staffing Shortages: Addressed
with onDiem’s simplified
staffing solutions.
Rising Costs: Tackled with
AI-driven analytics and cost-saving
private-label products.
Regulatory Compliance:
Supported by tailored IT and
HR solutions.
“Darby’s commitment to
solving these challenges
ensures DSOs remain
focused on their mission of
exceptional patient care.”
“By addressing these key challenges, vendors can position themselves as indispensable allies to DSOs, helping them improve operational efficiency, patient care, and overall success,” Kim adds.
Darby addresses immediate challenges while actively supporting long-term growth strategies.
Beyond serving merely as a vendor and viewing themselves as a true partner ensures its commitment to maximizing impact for growing DSOs.
Remarkable women across the industry are supporting great organizations with outstanding achievements, and well-deserved promotions. Join us in recognizing these Women in DSO® members and the empowering organizations that recognize their brilliance.
In the dynamic world of DSOs, financial leadership has never been more critical. CFOs stand at the intersection of strategy, operations, and care, tasked with steering organizations through an intricate maze of challenges—rising costs, shifting patient demographics, and the pressure to innovate. As the financial stewards of their organizations, they manage budgets, navigate economic uncertainties, and champion long-term sustainability. But the role of a CFO extends far beyond crunching numbers. It demands a delicate balance between fiscal responsibility and strategic foresight.
Today’s CFOs are not only focused on financial health but also on fostering collaboration, driving innovation, and ensuring that financial strategies align seamlessly with clinical priorities. Their work shapes how care is delivered and how businesses grow.
To better understand the complexities of this role, we interviewed four accomplished CFOS — Crissy Fiscus from PepperPointe, Karen Friar from Benco Dental, Victoria Garcia from Dental Care Alliance and Marie-Claude Tardif from iFinance. We covered everything from navigating workforce challenges to the latest books of interest. Each perspective offers invaluable insights. Here’s what they had to say.
What are the most significant financial challenges facing DSOs in your region? How are you addressing them?
I believe the most significant financial challenge facing DSOs continues to be elevated interest rates. It is imperative to properly forecast cash flow and only invest in projects that generate positive cash flow after accounting for debt.
What approach do you use to balance cost management with maintaining high-quality patient care?
AT DCA patient care always comes first. We pride ourselves in delivering high quality care. We look for ways to create efficiencies using technology and process improvement to manage costs, while maintaining high quality care.
How do you collaborate with the clinical leadership to ensure financial decisions align with patient care priorities?
I see myself as a highly operations-focused CFO. I partner closely with the CCO and COO to gain clear understanding of clinical
and operational priorities before making any significant financial decisions. I get deeply involved in the operational strategy of the company to ensure financial strategy is aligned and complementary.
What trends are you observing in patient demographics and behavior? How are DSOs adapting to meet these trends?
Rising inflation and increasing cost of living have made access to care more challenging. We partner with organizations that help patients with their financing needs to be able to afford the care that they need.
What challenges do you face in communicating the financial story to investors and leaders in your company?
Investors and Leaders in the company have varying levels of financial expertise or depth of knowledge of our business and industry. Simplifying complex financial data and providing enough detail to instill confidence is key in communicating the financial story.
What advice can you offer to leaders on managing workforce challenges?
Managing workforce in DSOs is paramount, especially with today’s clinician shortages and wage pressures. It is important to invest resources in Strategic Workforce Planning that is multifaceted and focuses on employee development, communication and culture.
What key financial metrics do you prioritize to gauge health of an organization?
CFOs are responsible for managing a wide range of financial metrics. I would say the ones that I focus on the most in our current environment are Cash Flow and EBITDA growth.
What significant challenges do you face as a CFO?
The most significant challenge that I face as a CFO is finding a balance between communicating urgency and financial responsibility,
while still instilling confidence and excitement across varying stakeholders of the organization.
What’s a book, article, or podcast that has recently influenced or inspired you?
What challenges do you face in communicating the financial story to investors and leaders in your company?
One of the biggest challenges I face is ensuring that everyone, regardless of their background, understands not just the numbers, but the ‘why’ behind them. Financial data is often complex and filled with technical terms, so I focus on simplifying it, using clear visuals, and avoiding unnecessary jargon to ensure the message resonates with different audiences. I carefully tie every financial update back to our strategic goals, providing a clear view not only of our current performance but also of where we’re headed.
Additionally, I prioritize open, two-way conversations to address questions, clarify uncertainties, and build trust and alignment across all stakeholders. My ultimate goal is to make financial information easy to understand and directly connected to our broader strategic objectives. In the end, I want every stakeholder to feel informed, confident, and aligned with our financial direction.
What advice can you offer to leaders on managing workforce challenges?
One of the most important lessons I’ve learned in managing workforce challenges is the power of active listening and adaptability. Listening isn’t just about hearing words, it’s about truly understanding concerns, acknowledging unspoken challenges, and showing genuine
care for your team’s input. Leaders who listen create trust, foster transparency, and build a culture where employees feel valued and empowered to contribute. At the same time, adaptability has become non-negotiable. Whether it’s adjusting to remote work, embracing evolving technologies, or responding to shifting employee expectations, leaders must remain flexible and open to change. This balance of listening and adapting helps address challenges proactively rather than reactively.
Equally important is clear and transparent communication, especially when every suggestion or idea can’t be implemented. Explaining the why behind decisions helps employees feel respected and reduces feelings of dismissal, even if they disagree.
Beyond that, investing in employee well-being, offering growth opportunities, and fostering an environment of trust and accountability ensure teams remain engaged and aligned with the organization’s goals. At the end of the day, successful workforce management isn’t about having all the answers, it’s about creating a culture where people feel heard, valued, and motivated to contribute to a shared purpose.
What are the most significant financial challenges facing DSOs in your region? How are you addressing them?
Managing several different issues that can negatively impact profitability is our most significant financial challenge:
Managing and controlling overhead costs, which includes staff salaries, supplies, equipment costs, etc. The recent rise in inflation has resulted in an increase in all business costs. As with any other business, it is a challenge to manage costs in this environment and maintain our profit margin. There are two specific areas that have impacted our business costs the most – staff salaries and interest.
Staff salaries have increased significantly in the past 3-4 years. The increase in salaries is also coupled with a labor shortage. This
has created a perfect storm of staffing in the dental industry. We are investing in technology to assist our current administrative staff with their duties. By investing in technology and training our people to use these technologies, we are seeing increased efficiency with our teams. Investments in technology will be a continued focus for us.
Rising interest rates impact so many different areas of our business, our cost of capital has increased, and our suppliers’ costs have also increased, which then gets passed on to us. Again, everyone in business is feeling the impact of rising interest rates. We are not as impacted as a lot of businesses, but it still definitely has an impact.
Rising inflation impacts our patients’ discretionary income, which impacts their ability to accept treatment. If patients cannot pay for treatment, that is a problem on many levels. Therefore, we are working to offer more ways to break down financial barriers for patients to accept treatment – offering more financing options, etc.
What approach do you use to balance cost management with maintaining high-quality patient care?
Staff Training – We are putting additional emphasis on staff training, which includes clinical and nonclinical staff in all our practices, as well as staff at the PepperPointe office. Highly trained staff create a better patient experience and a more efficient practice. The same goes for the team at PepperPointe, if the PepperPointe team is highly trained we can provide better, more efficient support for our practices.
Data Analytics – The PepperPointe data analytics team is focused on providing data that can be used by the PepperPointe team, our doctors and our practice level staff to provide insights into their business. We have recently implemented several different dashboards to assist our staff in effectively managing their practices. Using data to monitor financial performance, practice efficiency, and patient outcomes allows us to make real time adjustments to create better outcomes for our patients and the financial performance of our practices.
Patient Payment Options – To improve patient access to care while managing our cash flow, we are utilizing more payment options for our patients. These options include various third-party financing options. We are also using technology such as text to pay to make it as easy as possible for patients to pay.
Staying competitive: Evaluating UCR and Fee Negotiations in Dental Practices – We regularly evaluate our practice’s usual, customary and reasonable fees, as that is crucial to ensure alignment with industry standards and competitiveness within our local market. This strikes a balance between offering a competitive rate that attracts patients and maintaining profitability, which is a vital aspect of practice management.
Fee negotiations with third-party payers are equally important. We focus these discussions on optimizing contracts to benefit both the
practice and the payer. Building and maintaining strong relationships with key third-party payers can open opportunities to reduce administrative burdens and create mutually beneficial solutions.
How do you collaborate with the clinical leadership to ensure financial decisions align with patient care priorities?
Collaborative Budgeting and Planning – The PepperPointe team works closely with the clinical leadership to develop the budget and operational plan for the upcoming year. The financial budget is coupled with a business development roadmap (BDR) developed for each practice. The key performance indicators (KPIs) are outlined in the BDR. The KPIs are both financial and operational. Through this collaborative effort a plan that addresses patient care and financial success is developed.
Shared Data – The financial and nonfinancial KPIs are developed and shared with the clinical leadership. They contributed to the development of the BDR and they also share in the performance against the goals of the BDR throughout the year.
Financial Training for Clinical Leadership – We also invest in financial training for the clinical leadership. The BDR and budgeting process provides the opportunity for clinical leadership to develop their financial skills as well.
What trends are you observing in patient demographics and behavior? How are DSOs adapting to meet these trends?
Digital Health Engagement – Patients are looking for more digital options – online scheduling, text communications, etc. More importantly, they are excited about digital treatment options, especially in orthodontics, where the physical patient visits can be reduced by using technology to send pictures to the orthodontist for review.
Flexible payment options – patients want and need various ways to pay to allow them to get the treatment that they need, this includes payment plans and third-party financing options.
What key financial metrics do you prioritize to gauge the health of an organization?
What’s a book, article, or podcast that has recently influenced or inspired you?
What key financial metrics do you prioritize to gauge health of an organization?
When assessing the financial health of an organization, I prioritize a balanced set of key financial and non-financial metrics that provide both a snapshot of current performance and insight into long-term sustainability. While we consider many metrics, we emphasize revenue growth, market share, EBITDA margins, free cash flow, and customer and associate satisfaction scores. Each of these metrics is important individually, but their full value is realized when analyzed together as part of a broader performance perspective.
Financial health isn’t just about numbers, it’s also about building trust and loyalty with customers and associates. High satisfaction scores indicate repeat business, brand advocacy, and long-term customer retention. Likewise, engaged and satisfied employees are the driving force behind operational excellence and innovation, offering insights into organizational culture and long-term productivity.
What is a significant challenge you faced as a CFO and the lessons it taught you?
One of the most significant challenges I faced was of course navigating the CV19 pandemic. Practically overnight, we were faced with disruptions in operations, supply chains, and customer demand. During those moments, two key lessons stood out: the importance of resilience and the power of proactive communication. We focused on optimizing cash flow without compromising long-term goals and supporting our teams with clarity and transparency. At the same time, we doubled down on serving our customers, ensuring they had the resources needed to weather the crisis.
Perhaps the most important takeaway was that during times of uncertainty, financial leadership isn’t just about spreadsheets and forecasts, it’s about trust, adaptability, and courage. By staying focused on our core strengths and maintaining open communication across all levels, we emerged from the pandemic not just stable but in a position to grow and invest in the businesses. CV19 reinforced that true financial health isn’t established during periods of stability, it’s revealed and tested by how you navigate the most challenging moments.
What’s a book, article, or podcast that has influenced or inspired you?
A book that shaped how we hold our organization accountable ‘Measure What Matters: How Google, Bono, and the Gates Foundation Rock the World with OKRs’.
A classic book that has influenced me early in my executive career is ‘Lean In: Women, Work, and the Will to Lead’.
My go-to podcast is ‘CFO Thought Leader’ because it shares real-world stories from finance leaders, offering valuable insights on resilience, strategic decision-making, and driving meaningful change within organizations. I love listening and learning from many amazing leaders, gaining fresh perspectives, and finding inspiration to enhance my own approach.
What challenges do you face in communicating the financial story to investors and leaders in your company?
Simplification without oversimplifying! One of the main challenges is translating complex financial data into clear, concise, and accessible narratives. Financial topics often involve intricate details—such as the underperformance of a project or deteriorating relationships with external partners—that require careful explanation. However, investors and leaders typically seek a high-level understanding rather than a deep dive into every detail. Striking the right balance between clarity and comprehensiveness is crucial and a daily challenge for CFOs. Another challenge is prioritizing key insights, by determining which elements are most critical to highlight. Investors and executives are primarily interested in the facts that impact the organization’s overall performance and long-term strategy. For example, when explaining why a project underperformed, it’s essential to not only share the contributing factors but also connect these to the broader financial impact and lessons learned. In other words: audience adaptation is key: tailoring the message to the audience’s role and perspective. Leaders focus on strategic decisions, while finance teams handle day-to-day operational details. Recognizing this distinction and adapting the narrative to ensure that messages are both impactful and aligned with the audience’s strategic priorities.
What advice can you offer to leaders on managing workforce challenges?
Listen actively: The first and most essential piece of advice is to truly listen to your employees. Make time to understand their concerns, ideas, and feedback. Active listening fosters trust, encourages open communication, and helps leaders stay connected to the pulse of their workforce. After, balance employee needs with organizational goals. A key challenge in leadership is finding the right balance between prioritizing the well-being of employees and achieving the company’s objectives. These two priorities can sometimes feel at odds, but they are not mutually exclusive. A great leader listens to and values their team while making decisions that align with both the team’s needs and the organization’s strategic goals, and they are also skilled at clearly communicating the bigger picture to their team, ensuring everyone is aligned and onboard. To achieve this, make sure to foster a shared vision. A leader must clearly communicate the company’s vision and how individual and team efforts contribute to achieving it. This alignment helps employees understand the bigger picture and the rationale behind decisions, especially when those decisions are difficult. A leader who can inspire their team while staying transparent about challenges is more likely to maintain morale and engagement.
What key financial metrics do you prioritize to gauge health of an organization?
The metrics I prioritize depend on the nature of the business, as every organization has unique key performance indicators (KPIs). However, there are three broad areas I consistently focus on:
What is a significant challenge you faced as a CFO and the lessons it taught you?
One significant challenge faced as a CFO was effectively sharing the enthusiasm of the management team with external financial partners—particularly when presenting a new project or expansion plan. While the benefits of such initiatives might seem obvious to those deeply involved, communicating this vision in a way that resonates with external stakeholders requires a different skill set. As CFOs, we are often more accustomed to analyzing and presenting data than crafting narratives. However, I learned that storytelling is just as crucial as the numbers themselves. It’s not enough to simply present financial projections; you must create a compelling narrative that explains the broader impact of the project on the organization—both financially and strategically. This experience taught me three key lessons: master the art of communication, focusing on tailored messaging and bridge passion with data! Enthusiasm alone isn’t enough; it needs to be backed by solid numbers.
What’s a book, article, or podcast that has recently influenced or inspired you?
A foundation for sustainable success, Women In DSO® launched its Wellness Program in 2024. The program was built on the belief that thriving individuals lead thriving organizations. By addressing financial, professional, personal, and relational wellness, this program empowers members to achieve sustainable success both in and outside their careers.
The year unfolded with dynamic workshops, thought-provoking blogs, interactive challenges, and signature events aimed at inspiring members to take charge of their wellness.
The momentum continues with new initiatives coming in 2025. Building on the success of last year, Women In DSO® plans to expand with the following initiatives:
Women In DSO® is equipping women with tools to lead authentically and prioritize holistic well-being. Get involved today.
With a unique background in healthcare and medical technology, Kristin Dietzler takes on her role as president of Patterson Dental with a clear vision and the drive to deliver transformative change. Having recently stepped into her position, her insights and aspirations reflect her unique background.
Kristin has deep Midwestern roots and values. Born and raised in Minnesota, she began her career in the state working as a sales representative for a small medical device firm. She was quickly promoted to regional management, then national account management, and ultimately executive leadership roles. She has held positions such as zone vice president and vice president of sales. Later, Kristin worked for Carestream — not in its dental division but in medical imaging — where she ran operations for the Americas.
Patterson’s mission aligned perfectly with Kristin’s background, offering her the chance to leverage her expertise to address the complexities of dentistry.
As Patterson prides itself on having a multi-segment approach to the dental market, bringing technology and business services to the different customers they serve, from single location to multi-location organizations of all sizes, they are also excited to utilize Kristen’s vast experience leading multi-faceted sales organizations.
Reflecting on her approach to leadership, Kristin says, “The people around me are the most important thing when you’re driving a business. Trust and collaboration with the team are crucial.”
Her vision for Patterson centers on this principle: fostering collaboration and building meaningful relationships within the team to drive the company forward.
In her first weeks at Patterson, Kristin met with over 30 customers in person and spent time in the field with technicians and sales representatives. This hands-on approach was more than just an introduction — it was her way of uncovering both the challenges and the opportunities directly from the source.
“I’m very inquisitive,” she explains.
“I’m asking questions to understand where there are opportunities for improvement.”
This focus on understanding has already begun shaping her leadership strategy at Patterson.
Kristin’s early interactions revealed a strong desire for change within the industry.
“I’ve been humbled by how much people want to embrace change,” she says.
“They all see there’s a need for it, but nobody quite knows how to get there yet. The greatest part is that everybody wants to participate and provide ideas. It’s so encouraging and energizing.”
Kristin’s experience in healthcare gives her a refreshing perspective on the dental industry’s current state. She is able to see clear
opportunities to help Patterson bridge the gap between dentistry and other industries. She is determined to position Patterson as a leader in driving these advancements.
Kristin envisions Patterson as a driving force in streamlining operations to help private practices and DSOs build, grow, optimize, and sustain their practices. By tackling challenges like hiring and training staff and navigating reimbursement complexities, she believes the company can equip dentists with the resources they need to focus entirely on their patients and deliver the exceptional care possible.
Patterson is proud to partner with teams to offer guidance and support on how to improve productivity and efficiencies with an eye towards improving overall operations. “We want to streamline a lot of back-office components to help teams and DSO’s thrive,” she explains.
While Patterson has traditionally been a distributor, she envisions the company expanding its portfolio to include innovative tools and
services that address broader industry needs. Their role is to deliver trusted expertise and unrivaled support, transcending products and pricing.
Kristin is determined to elevate Patterson’s offerings with innovations that redefine patient care. One standout example is the Solea All-Tissue Laser by Convergent Dental, a cutting-edge technology designed for anesthesia-, blood-, and pain-free procedures in hard and soft tissue. Solea elevates the patient experience for all ages and also provides practices opportunities to expand into new procedures. By introducing advanced technologies such as this, she aims not just to improve care but to revolutionize how dentists approach their practice, ensuring patients experience better and more effective treatments.
“We want to partner with DSO leaders by showing them solutions to improve their lives, their practices and their patients’ lives — we will provide tools that modernize what they are already doing.”
She also sees potential for Patterson to play a role in addressing some of the dental industry’s most pressing challenges, such as the shortage of hygienists and the need for greater public understanding of oral health’s impact on overall health.
“Even if the percentage of people in the U.S. regularly seeing a dentist rises from 40% to 60%, we still wouldn’t have enough people to meet that demand,” she explains. “How do we get more people involved in this crucial industry to supply necessary care?”
To get there, Kristin believes trust and collaboration are the cornerstones of effective leadership, and it is how she’s building her team. She wants her team to feel empowered to take calculated risks, deliver bold solutions, and encourage innovation to advance the dental industry.
This openness to experimentation has already sparked conversations with manufacturers about new approaches to address shared challenges.
“When you have that type of open conversation with people as a leader, there is no limit,” she remarks.
Kristin is setting an ambitious course for Patterson, driving a new go-to-market strategy that sharpens its competitive edge. She is assembling specialized teams to deliver tailored support for dentists and harnessing the power of data and artificial intelligence to revolutionize decision-making across the organization and in the dental industry.
Kristin’s approach to leadership reflects her drive to inspire others and make a tangible impact. In particular, for women and aspiring leaders, she emphasizes the importance of seizing opportunities without waiting for everything to be perfectly in place. Be ready to try new things and stretch ourselves.
“Years ago, I had a job opening for a VP of marketing, I knew exactly who I wanted for the job,” she recalls.
“But that person didn’t apply because she didn’t think she met every requirement. So, I walked down to her office and said, ‘Why aren’t you applying?’”
“No one gets a job and knows everything about it. That’s not how it works,” she says. “You learn in jobs. Anytime you can do something outside your comfort zone to get exposure and experience, do it.”
Kristin encourages others to take on challenges outside their comfort zones and seek mentorship and growth opportunities.
As Kristin settles into her role at Patterson, her vision and determination are evident. She is on the ground, embracing the opportunities and challenges ahead. Her hands-on approach, forward-thinking vision, and focus on collaboration position her to drive meaningful change at Patterson, for DSOs, and in the dental industry at large.
“At the end of the day, my strongest motivation is to see the people around me succeed. I love a team that sees the vision and knows exactly what we’re doing and why we’re doing it. That’s how you build success.”
Dr. Aman Kaur
Founder and President
Women In DSO®
The dental industry has witnessed a remarkable surge in growth and innovation driven by the emergence of Dental Service Organizations (DSOs). As a result, more dentists and investors are attempting to create DSOs. However, a successful solo or small group practice does not guarantee the successful operation of a DSO, and similarly, the days of purchasing practices and later selling them for a large profit without ever understanding the business of dentistry are also over. A thorough understanding of the underlying business of dentistry and the challenges of scaling a successful DSO is critical to success.
In response to the rising costs of operating solo or small group practices, DSOs have continued to grow. However, nearly 65% of the dental industry remains fragmented, providing a significant runway for further consolidation and growth of DSOs.
DSOs have reshaped the traditional model of dental practices by centralizing administrative support functions, leveraging economies of scale, and providing dentists access to advanced technology and resources. This model allows dentists to focus primarily on patient care while benefiting from enhanced operational efficiency and financial stability of the DSO. As a result, DSOs have become an attractive option for established practitioners seeking long-term stability and success and recent dental graduates seeking career opportunities, professional growth and work-life balance.
A DSO’s true customer is its affiliated dentists.
At the heart of every successful DSO is a commitment to providing exceptional dental care and helping its providers grow as clinicians and as leaders. DSO leaders who are genuinely passionate about dentistry can then inspire their teams to deliver the highest standard of patient care while upholding shared values and professional integrity. This passion drives clinical excellence and fosters a sense of purpose and fulfillment among dental professionals, enhancing job satisfaction and patient loyalty. Investing in ongoing education and professional development for dentists and clinical team members helps to ensure they stay abreast of the latest advancements in dental
technology, techniques, and patient care practices. Pouring into teams helps teams pour out to patients.
By nurturing a culture of continuous learning and improvement, DSOs can differentiate themselves in a competitive market and attract top talent who share their commitment to excellence. This approach bolsters clinical outcomes and reinforces a supportive and positive work environment, ultimately driving the organization’s long-term success and sustainability.
Even though the dental industry presents significant opportunities for financial success, navigating the complexities of running a DSO requires more than basic business understanding of dental practice operations and clinical expertise. As a result, private equity and other business partners are often critical to the short-term and long-term success of DSOs. Effective partnership requires a keen understanding of financial management, strategic planning, and market dynamics for patients and providers – in addition to unwavering commitment to quality patient care.
The dental landscape is constantly evolving, with shifts in reimbursement models, regulatory requirements, and patient preferences. Teams leading the DSOs must be able to look beyond what’s in front of them while also analyzing data, identifying growth opportunities, and implementing sustainable business strategies. The most successful DSO leaders stay abreast of these changes, adapt accordingly, and foster a culture of innovation within their organizations. By embracing technology, exploring new revenue streams, and optimizing operational efficiency, DSOs can position themselves for long-term financial growth and sustainability. Furthermore, having the right business partner can help integrate new technologies to alleviate pain points and maximize the value of the investment.
The success of a DSO hinges not only on financial performance but also on its ability to attract, engage, and retain talented dentists and team members at all levels. Cultivating a positive organizational culture starts by building trust, transparency, and mutual respect. Influential leaders prioritize their team members’ well-being and professional development, fostering a supportive environment where individuals feel valued, empowered, and motivated to excel.
Dental office staff positions are often a stepping stone to many; in order to retain and develop talented teams internally, well-defined career paths in dental organizations are critical. A career path is essential for anyone who wants to scale up a DSO by retaining talent with institutional knowledge. These initiatives must be proactive and embrace diversity of thought, background, and experiences.
Cultivating a culture of open communication and transparency also enables leaders to address challenges proactively, resolve conflicts constructively, and build consensus around shared goals and values. It is imperative to have processes to understand how front-line culture compares to corporate culture and how the two should share common principles.
Retaining talented practitioners is very important to all DSO’s success in today’s competitive market. While competitive compensation and benefits are important, they are not the sole determinants of retention. Leaders must also create a supportive work environment where dentists feel personally valued, professionally challenged, intellectually stimulated, and emotionally fulfilled.
Many dentists today seek flexible work schedules or shorter work weeks. Flexible work schedules allow dentists to partner with other clinicians at the practice, promoting collegiality and the ability to partner on patient care. At the same time, entrepreneurship is growing among the future generation of dentists, along with their desire to have well-balanced lifestyles. This provides DSOs with a great advantage by offering affiliated dentists ownership opportunities or joint ventures to attract and retain these dentists.
The dental industry continues to be an attractive industry offering ample opportunities for financial growth, professional development, and clinical excellence, but it is a marathon and not a sprint. Realizing these opportunities requires visionary leadership equipped with the necessary skills to successfully navigate the intersection of dentistry and business. The dental landscape is changing quicker than most can keep up, and it’s not for the faint of heart or the novice. It’s a journey that demands resilience, dedication, and a strategic vision along with a passion for dentistry. The silver lining is that you can count on support throughout the process by partnering with experienced people who have done this successfully.
