For DSO partnerships,
traditional dental brokers are
By representing only practices with clear DSO appeal,
fully redesigning how we are compensated,
and eliminating every expense that adds to client cost without adding client value,
we can deliver professional M&A advisory at a materially lower total cost.
Why are traditional brokers so expensive?
Every expense a business takes on is embedded in the price of its service. Some costs are obvious. Others less so.
Risk
The largest and least obvious of those costs is risk. Brokers take all the risk — and they’re quick to highlight it as a selling point. You only pay if you transact. That sounds great — but risking months of unpaid work requires substantial upside. What would you need to charge if the next several months of your dentistry might go unpaid for reasons outside your control?
Sales
As long as its profitable, there is no practical limit on sales and marketing spend. Conference booths, Google ads, marketing teams—the more they spend, the more they must charge. Some brokers even fly out to meet doctors. Persuasive? Yes. That’s the point. But while they’re traversing the country, on planes and in hotels, pursuing new clients, who is working on their current client deals? Did you meet your advisor, or a salesperson?
Overhead
As organizations grow, clients pay for more than just the product. The fee is divided between your broker, financial analysts, management layers, HR, IT, offices, etc. As a result, the broker you actually work with receives less than half your fee. Meaning the total fee has to be large enough that less than half of it compensates months of work and justifies all the risk. Brokers aren't expensive by choice. It’s structural.
Why do doctors DIY their biggest transaction?
Doctors DIY DSO affiliations for understandable reasons: cost, broker skepticism, and pressure from buyers and sometimes even peers. And many still think of this like a traditional doctor-to-doctor sale, where the broker’s biggest job is “finding” a buyer. So when DSOs are already interested, going direct can feel rational—like the broker’s job is already mostly done. But DSO affiliations are real M&A transactions: competitive auction processes with dozens of consequential terms and interdependent tradeoffs, all negotiated against highly sophisticated investors. Without equally matched representation, “direct” isn’t saving a fee; it’s accepting a structural disadvantage in the most consequential transaction of their career.
01
Cost
Broker fees are quoted on total transaction value but paid at close from the initial cash proceeds. And in DSO deals, total value is almost always a mix of cash and equity—so a single-digit fee on total deal value can quickly become a double-digit percentage of the cash proceeds. Some doctors catch this immediately; others don’t fully internalize it until the end. Either way, once you understand the fee as a double-digit share of cash at close, the expense feels even more pronounced.
02
Value
Traditional brokerage was built for relationship-driven, doctor-to-doctor sales where “finding” a buyer is a core part of the job. Look at enough broker profiles and you’ll see the pattern—dental supply sales, real estate, lending—network-driven backgrounds suited to sourcing buyers and sellers in those deals. But DSO affiliations are complex M&A transactions against professional buyers. The required skillset is different, so doctors are understandably uneasy about paying premium fees for representation more suited to a simpler transaction.
03
Pressure
DSOs invest heavily in keeping deals “direct”—teams, marketing, data tools, and playbooks designed to make “no advisor” feel sensible. Their critiques of traditional brokers have merit, but everyone in the M&A world knows that buyers get better deals when the seller negotiates alone. And in DSO affiliations, the focus isn’t just the initial headline number; it’s the terms and structure that govern the partnership into the future. When the other side insists you don’t need an advisor, see it for what it is: self-interest, not altruism.
04
Referrals
Like all investors, DSOs have a walk-away price—an “all-in” cost ceiling where the investment no longer makes sense. And like every other transaction cost, referral fees sit under that ceiling and reduce what’s available to you in valuation and terms. Most doctors are happy about a friend getting a referral fee, but these fees are substantial. Often six figures. Not about questioning anyone’s motives—just important to understand that every dollar paid to a referrer is a dollar that could have gone to you.
How we're different
A modern M&A advisory for DSO transactions
The traditional dental brokerage model breaks down in DSO transactions. It was built for relationship-driven, doctor-to-doctor sales—then expanded into a very different kind of deal: negotiated M&A transactions against sophisticated investors. That mismatch creates predictable dysfunction: high fees, uneven transaction expertise, and doctors incentivized to run their own process because the available representation doesn’t feel like a good value.
The mismatch is structural. The solution has to be, too.
DSO Advisors is a modern M&A advisory built specifically for DSO transactions. We rebuilt the model from first principles around what these deals actually require: real transaction expertise, direct senior-led execution, and economics that make professional representation rational instead of hard to justify. The result is sophisticated M&A advisory at materially lower cost.
Our Process
There is a correct way to sell a company.
We run the same process top investment banks use to sell billion-dollar businesses: meticulous preparation, a real competitive auction, and uncompromising defense of value through closing. It requires more work on our end, but when a transaction is this significant, you do not want to look back and wonder whether you handled it with the seriousness it deserved.
part 1
Preparation
Through forensic reconstruction of your financials, we establish your practice’s true profitability—an art as much as a science—then craft a presentation that blends numbers with narrative, giving investors everything they need to quickly understand, properly assess, and accurately value your business.
part 2
Auction
A company’s value is not a mathematical equation. It is the price the highest bidder is willing to pay at a given moment in time. The only way to discover it is through a competitive auction process. We engage every conceivably interested investor and create the competitive tension needed to draw out their best offers.
part 3
Closing
The hardest part often begins after a buyer is selected and the headline numbers have been negotiated. Buyers deploy accountants, attorneys, and sophisticated tactics to reduce their cost, shift risk, and improve terms in their favor. Without experienced guidance, significant value can be lost through renegotiations, recalculations, and subtle contract changes.
What doctors say about working with us...
Each doctor comes with a different practice, different priorities, and different concerns. But the principle is the same: a better process leads to a better deal—and clarity and conviction in choosing the right partner.
"Well, it turns out, the DSO I was certain I would partner with was not the DSO I partnered with..." - Dr. V
"Nicolas saw the potential in my rural practice and got me a premium deal that felt more like what you hear about in bigger cities like Dallas or Salt Lake City...." - Dr. L
"It is obvious he used to sit on the other side of the table, knows the playbook, and feels very comfortable calling their bluff...." - Drs. J & M
FAQ
questions & answers
Are your services a fit for my practice?
If you are interested in exploring a DSO partnership and your practice has at least $1.3 million in revenue, your practice may be a fit for our process.
A quick call or the valuation calculator is usually enough for us to determine fit.
Who will I be working with?
We are not a volume-driven brokerage.
We intentionally take on a limited number of clients each year because these are high-stakes transactions best handled personally, from beginning to end, by an experienced M&A professional.
As such, you will work directly with our founder throughout the process.
Before spending the last several years advising dentists on sell-side DSO transactions, he spent most of his career on the buy-side in M&A, executing deals as large as nine figures in value.
He knows the buyer playbook from the inside and exactly how to defend against it.
Why not just go direct to a DSO?
Most succinctly, negotiating an M&A deal by yourself against a professional investor is like entering a legal dispute without an attorney. The odds and the rules favor the side that plays this game every day.
Going direct means much more work, much less leverage, and a very real chance you never even speak with the group you would have chosen had you run a process.
I already have an offer. Should I still run a process?
An offer by itself does not tell you very much. It is simply one buyer telling you what they would ideally love to pay for your company.
Investors want direct deals because avoiding competition means a lower price and better terms. One or two interested buyers and their offers do not tell you whether the valuation is right, whether the terms are competitive, or whether a better-fit partner exists.
At the very least, a real process will improve that offer. More importantly, it creates a variety of offers and an opportunity to find the group that most aligns with your values.
Either way, you gain leverage, information, and clarity and conviction in choosing the right partner.
Which DSO is right for me?
There is no way to know in advance. Different DSOs fit different doctors.
DSOs vary meaningfully in culture, structure, support model, growth expectations, and partnership style. Doctors vary in priorities, personalities, and vision for the future.
The only way to know which group is right for you is to run a broad process, see who is interested, and compare the options side by side to find the best fit.
When should I start this process?
You should start now.
In DSO transactions, buyers want a meaningful future commitment from the doctor, which is part of why they can pay so much. Waiting too long can narrow the buyer pool or eliminate the DSO option entirely.
We’ve had to break it to more than a few doctors that they had left too little time before retirement or relocation for a DSO deal to work. A couple of years earlier, they would have secured very lucrative deals.
We have also had clients partner with DSOs in their early 30s. Younger doctors are increasingly exploring this route for work-life balance, liquidity, debt reduction, or long-term equity positions in fast-growing DSOs.
Whether you are decades away or already thinking seriously about a transition, the prudent move is the same: learn your options early enough to preserve flexibility and prepare for the path you ultimately choose.
How are you compensated?
We use a proprietary fee structure designed to align our incentives with yours while costing materially less than traditional dental brokers.
For most practices we work with, it can work out to the low single digits as a percentage of valuation.
We are happy to walk through the details on a call.
How are DSO deals valued, and what is adjusted EBITDA?
Investors need a way to compare businesses with different financial profiles on an apples-to-apples basis. They use EBITDA as a proxy for cash flow because it removes distortions tied to debt, tax structure, and accounting practices.
Adjusted EBITDA takes that one step further by normalizing for owner-specific expenses, non-market compensation or rent, one-time items, and other costs included in your financials for personal tax optimization that will disappear once an investor is involved.
Getting that number right is one of the most important parts of the process.
Because DSO valuations are based on EBITDA and the multiple applied to it, even relatively small changes in adjusted EBITDA can drive large changes in valuation.
Why can EBITDA multiples be misleading?
Because the multiple is only half the equation.
The other half is the EBITDA it is being applied to. If that EBITDA is not being calculated correctly, the headline multiple can be deeply misleading.
Buyers and brokers know that most doctors focus on the multiple, so they can make an ordinary deal sound extraordinary by quoting the same valuation against a lower, less optimized EBITDA number.
That is how 6x or 7x deals turn into 10x or 12x stories.
Multiples only mean something when the EBITDA behind them is being calculated correctly.
Can I speak with one of your former clients?
Once we have determined there is a real fit and serious mutual interest, we are happy to make those introductions.
Reach out to learn more
How to get started
valuation
calculator
For doctors exploring DSO affiliation, our algorithm delivers the most accurate valuation estimate available on the web.
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We’ll answer DSO questions, evaluate your situation, explain our methodology, and determine if your practice fits our unique approach.
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