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5 tips for identifying a toxic DSO—and finding a job you'll love

May 24, 2023
There is no such thing as a perfect DSO, or private practice for that matter. But keeping an eye out for these toxic trends will ensure you're investing your time and energy in the right place.

Dental service organizations (DSOs) have been around for years, but have become a polarizing topic in dentistry as they have become direct and top competition to private practice offices. It’s not just patients who are curious about giving DSOs a try—it’s also dental professionals seeking a new career path.

If you’re interested, there’s no harm in trying out a DSO, but you need to find what’s right for you. Benefits, incentives, and opportunities to “get out of the op” are appealing, but how do you know it’s is not just smoke and mirrors? How do you know it isn't a toxic environment?

Vibes don’t lie

When you head into your interview, working interview (which I highly recommend), or first day on the job, pay close attention to the demeanor of the employees you're working with. I don’t mean just one of them, I mean the whole team. Do they seem happy? Are they eager to bring you into their team, or do they treat you like a number because they see so many candidates come and go? Do they seem overworked and frustrated? I am shocked by how instantly open employees are about their feelings toward their job. One more time: vibes don’t lie!

You might also be interested in: Why being part of a DSO might be the right decision

The who’s who

Successful DSOs depend on clear and consistent communication through their set chain of command. What does this mean for a new hire? It means you should feel that you understand who you manager is, who you should go to with questions (especially when it’s about your pay or hours), and who can help you with anything you might need. In a toxic DSO, it's unclear who is really in charge of what. This may be because of turnover or because job titles are changing by the day. Either way, it’s common trend you will see in toxic DSOs.

It’s broke, but nobody fixed it

If you are on your working interview or new to a DSO, look around and see if you notice critical equipment broken or in disrepair. This includes instruments and supplies. Is there duct tape holding equipment together? Does the chair work? Usually you can ask the team to tell you right away if there’s anything you need to know about. Toxic DSOs spread their funds as far as possible, keeping budgets slim and trim. So, when it comes to repairs and replacing broken equipment, that will be put on the back burner.

The revolving door

“Has there been a lot of turnover in this position?” is a question you should not come right out and ask because you will likely get a sugar-coated answer. Instead ask, “how long was the previous hygienist at this location?” If it was just a short time, then follow up and ask about the hygienist before that, and so on. Casually asking employees how long they have been with the company is fair question and will tell you quite a bit. If it seems like there has been a lot of turn over, it is not typically a good sign.

If it walks like a duck and talks like a duck ...

During a working interview or in your new position, take note if proper procedures, practices, and protocols are being followed. Are perio patients being treated as a basic prophy? Are patients complaining about their dental work and feeling like they’re not being heard? Are medical histories current, not being updated, or maybe not even present? Are HIPAA rules being followed? Are x-rays current? If you are not seeing proper practices and protocols in place, it's a sign of a toxic environment.

There is no such thing as a perfect DSO, or private practice for that matter. But, keeping an eye out for toxic trends will ensure that you are investing your time and energy in the right place. When working in a toxic DSO, you simply work there until you can’t do it anymore, no more no less. When working in a thriving DSO, you feel a sense of culture, see a path to future opportunities, and feel proud to be with that particular company. 

Editor's note: Originally posted in 2020 and updated regularly

About the Author

Amanda Graham, BSDH, RDH

Amanda Graham, BSDH, RDH, has been a part of the dental industry for 20 years and enjoys using her experience to bring value to other dental professionals. Amanda became a registered dental hygienist in 2007 and went on to earn her bachelor’s degree in dental hygiene in 2012. Amanda has vast leadership skills and dynamic background in various practice settings that range from private practice and DSO to educational, and more. Amanda remains a dedicated "student" of her profession because she believes an individual skill set is like a work of art, it is never finished. Amanda lives in the suburbs of Chicago, with her family, and enjoys maintaining a bustling work-life balance.