Rising Tide blog

By Dr. Steve Albert, Founding Partner & Executive Chairman, Rising Tide Dental Partners

Somewhere around 2005, the dental industry settled on a narrative that’s been running unchallenged for two decades: if you own a practice, your future comes down to two options. Stay solo and carry everything yourself. Or sell to a DSO and get liquidity in exchange for control.

That framing has shaped the careers of tens of thousands of dentists. It’s influenced how practice owners think about growth, transition, and what’s possible for their businesses. And for most of those two decades, it was functionally true. Those really were the only two options on the table.

They’re not anymore.

The real cost of Option A

Let’s be honest about what staying fully independent actually looks like in 2026.

If you’re a solo practice owner running one to three locations, you’re likely paying full retail on labs, supplies, and vendor contracts. You don’t have meaningful leverage with any supplier because you’re one account among thousands. Your lab costs are probably anchored to whatever your first lab charged you a decade ago, plus inflation. And you have no way to benchmark whether that’s competitive because you don’t know what the practice down the street is paying.

Your financial reporting is whatever your CPA hands you in April. You might have a monthly P&L, but it’s delivered 30 to 60 days late. It’s not standardized against any benchmark, and it doesn’t tell you what it should tell you, which is where your money is going and what you should do differently.

You’re handling HR, compliance, marketing, IT, and vendor management yourself or with a small team that’s learning on the job. Every operational problem is a first-time problem, because you don’t have a network of operators who’ve already solved it.

And the hardest part: you’re the only person in your building who understands the weight of ownership. Your team is great, but they can’t share the burden of the decisions that keep you up at night.

None of this means you’re failing. Many solo practice owners are doing extremely well. But they’re doing well in spite of the structural disadvantages, not because of them. And the overhead, be it financial or emotional, compounds every year.

What about option B?

On the other end, the traditional DSO sale has a well-understood upside: liquidity. You get paid. For many late-career owners, that’s life-changing money that funds retirement, pays off debt, or provides security their families have never had.

But the costs of that liquidity have become increasingly well-documented. Here’s what practice owners who’ve been through traditional DSO transactions report most often.

Clinical autonomy erodes faster than promised. The first year usually feels fine. By year two, supply chain decisions are being made by suits and ties. By year three, insurance participation, staffing models, and in some cases clinical protocols are being standardized by people who have never treated a patient or ran a dental practice.

Team continuity suffers. The culture you built over a decade doesn’t survive a change in operating philosophy. The long-tenure team members start to leave and by year three, the practice that carries your name may not feel like your practice anymore.

Your earn-out is tied to metrics you don’t fully control. If your payout is structured over three to five years and tied to performance targets, the acquirer has significant influence over whether those targets are met. Decisions made in rooms you are never invited to. Things like a new software system that disrupts workflows, a staffing change that affects production, or an insurance renegotiation that changes your payer mix.

Again, this isn’t universal. Some DSOs are excellent stewards. Some transactions go well for everyone involved. But the structural incentives in a typical private equity-backed acquisition are aligned with maximizing return on invested capital within a defined fund timeline…and that alignment doesn’t always point in the same direction as “preserve what the founder built.”

The new direction

The third option is a dental partnership organization: a structure where dentists maintain real ownership and clinical autonomy while gaining the operational support, leverage, and peer relationships that come from being part of a larger network.

This isn’t a new idea in concept. Dentists have been forming study clubs, buying groups, and informal partnerships for decades. What’s new is the institutional infrastructure that makes it work at scale. This is found in the legal structures, the shared-services models, and the governance frameworks that protect dentist control while delivering real operational value.

At Rising Tide, it looks like this: Our partner doctors hold real equity in their practices. Our board has dentist-majority voting control. Clinical decisions are made at the practice level by practicing dentists and our leadership team reports to dentists, not to a fund.

The operational support is real: institutional-grade financial reporting, vendor consolidation, HR infrastructure, marketing, IT, compliance. But it’s support that rolls up to dentist-controlled governance, not support that comes with strings attached.

The peer network is real: 15 founding partners (and growing!) sharing play books, benchmarking each other’s numbers, solving problems together in real time. This is a working network of operators with skin in the game.

And the transition model is real: for late-career owners, a partnership-based transition that protects team continuity, patient experience, and practice identity in ways that a traditional sale typically doesn’t.

How to evaluate any “third option”

The existence of Option C doesn’t mean every organization claiming it is the real thing. The same problem that afflicts “dentist-led” claims applies here: the language is being used by organizations with very different structures.

When evaluating any partnership organization, the questions that matter are structural: Who holds the equity? If it’s a financial sponsor, you’re looking at a DSO with partnership language. If it’s the dentists, you’re looking at something genuinely different.

Who controls the board? Advisory participation isn’t control. Voting majority is.

What happens when a corporate priority conflicts with a clinical one? The answer to this question in practice, not in the pitch deck, tells you everything about whether the organization’s incentives are aligned with yours.

What does the exit look like if you’re unhappy? If unwinding from the partnership requires giving back equity at a discount or navigating a complex claw-back structure, the partnership may be harder to leave than it was to enter.

Can you talk to existing partners freely, without the leadership team in the room? The willingness to facilitate that conversation is one of the clearest signals of confidence in the model.

The market is shifting

The dental industry is in a transitional moment. DSO consolidation has slowed but private equity dry powder hasn’t and capital is still looking for deployment. Overhead is up across the board. Hiring is the hardest it’s been in a generation. And practice owners at every career stage are re-evaluating “what’s next” more actively than they were even two years ago.

In that environment, the two-option binary that’s been the default framework for two decades is breaking down. Practice owners are looking for structures that give them leverage without requiring them to give up control. They want the operational support of a larger organization without the cultural compromises of a traditional sale.

That’s not a niche. It’s a market shift. And the organizations that are building real infrastructure around Option C are the ones that will define the next era of dental ownership.

The bottom line

You don’t have to choose between staying solo and selling to a DSO. That was the framework of 2005, and the industry has moved beyond it.

The right question in 2026 isn’t “should I sell?” It’s “what structure gives me the support I need while protecting what I’ve built?”

For some owners, the answer may still be a traditional sale. For others, it may be staying fully solo. But for a growing number of practice owners who are profitable, growth-minded, and unwilling to trade autonomy for support, the answer is a partnership model that didn’t exist a decade ago and is now becoming the default for the best practices in the country.

If you’ve been stuck between Option A and Option B and neither one felt right, Option C is worth a conversation. And maybe Rising Tide is just what you’ve been looking for.