Recent data on dental practice ownership, career preferences, and education debt suggest that practice succession may become more complex for dentists planning to retire or transition out of ownership in the coming years.
Data from the American Dental Association’s Health Policy Institute and the American Dental Education Association indicate that fewer dentists are pursuing traditional private practice ownership, while a growing proportion of dental students anticipate working in dental support organization (DSO)-affiliated settings. These trends, combined with education debt and the cost of financing a practice acquisition or startup, may influence the pool of potential buyers for independently owned practices.
Private Practice Ownership Continues to Decline
Several measures point to changes in the traditional practice ownership pathway:
- Private dental practice ownership declined from 85% in 2005 to 73% in 2023, according to the American Dental Association’s Health Policy Institute. Solo practice has also declined, from approximately 67% of dentists in 2005 to roughly 50% in 2024.
- According to the American Dental Education Association, the share of dental students who intend to join a DSO-affiliated group increased from 16% in 2018 to 34% in 2023.
- Dentists who graduated before 2010 owned practices early in their careers at rates of 60% to 70%, compared with 21% of dentists who graduated between 2016 and 2020.
- According to the American Dental Education Association, dental school graduates in the class of 2025 carried an average of $297,800 in education debt.
The financial requirements associated with practice ownership may be one factor affecting these career decisions. Establishing a new dental practice can require substantial capital in addition to the education debt carried by many recent graduates. Employment in larger group practices or DSO-affiliated organizations can offer dentists an alternative to assuming the financial responsibilities associated with starting or purchasing a practice, as well as access to administrative infrastructure and structured professional support.
For practice owners considering retirement or another transition, these workforce trends may affect the availability of dentists who are both interested in ownership and financially positioned to purchase a practice.
Associate Turnover Can Affect Succession Planning
Transferring a practice to an associate remains one potential succession pathway, but workforce mobility can add uncertainty to long-term plans built around a specific associate.
DentalPost’s 2025 Dental Industry Salary Report found that 28.8% of associate dentists changed employers in 2024. The report also found that 46.6% of associates were considering or actively pursuing a new position within the year, with income and career opportunities among the factors influencing employment decisions.
As a result, practice owners planning several years ahead may want to account for the possibility that an associate could leave the practice, choose not to pursue ownership or be unable to obtain financing when the owner is ready to transition.
Financing Considerations in Doctor-to-Doctor Transactions
A doctor-to-doctor practice sale can also involve financing considerations that may affect both parties.
Depending on the transaction and lender requirements, a selling dentist may be asked to carry a seller note for a portion of the purchase price, potentially between 10% and 25%. In such an arrangement, the seller receives part of the purchase price over time rather than receiving the entire amount in cash at closing. Repayment consequently depends on the terms of the note and the buyer’s ability to meet those obligations.
Connor Jorgensen, Director of Business Development at TUSK Practice Sales, shares, "I recently spoke with a dentist who was just days away from closing a sale to another doctor when, last minute, they found out that the lender had only approved financing for 80% of the purchase price. They were being asked to carry the remaining 20% as a seller note. They were not comfortable taking on that risk, and decided not to move forward. There was no warning that this was coming, and they were suddenly left having to start the entire process over and consider other sale routes that they were not prepared for."
The example illustrates why financing structure and lender requirements can be important considerations early in succession planning. Even when a prospective buyer has been identified, financing terms may affect whether a transaction can proceed as anticipated.
Practice owners may also want to consider what could happen to the practice following a doctor-to-doctor transaction. A subsequent owner may later decide to sell the practice to another dentist, group practice or DSO. While that possibility does not determine whether an initial transaction is appropriate, it can be relevant to owners for whom the practice’s longer-term ownership structure is an important consideration.
Planning for a Broader Range of Transition Options
Changes in dental workforce preferences do not eliminate doctor-to-doctor transitions as an option. They do, however, underscore the value of evaluating multiple succession pathways rather than assuming that a particular associate or individual dentist will ultimately purchase the practice.
Depending on an owner’s circumstances and objectives, potential pathways can include a sale to another dentist, an associate buyout, a transaction with a group practice or DSO, or other partnership and succession structures. Each can involve different implications for valuation, financing, clinical autonomy, employment after the transaction, tax considerations and the timing of an owner’s eventual exit.
Practice owners considering a transition may benefit from beginning the planning process well before an anticipated retirement or sale and reviewing the financial, legal and operational implications of the available structures with appropriate professional advisers.
TUSK Practice Sales is hosting a live webinar on Thursday, August 27, at 7 p.m. and 9 p.m. ET covering the dental market and practice-transition landscape. Additional information is available through TUSK Practice Sales.
