When the Practice Changes Before You Do: A Dental Leader’s Perspective on Navigating the Shift to a DSO
By the time my team found out we were transitioning from a privately owned dental practice to a larger management group, I had been carrying the weight of that knowledge for nearly four months.
Those were some of the longest months of my leadership career.
Every morning I walked into our practice, greeted the team, ran morning huddle, reviewed the schedule, discussed production goals, and supported patient care — all while knowing that significant change was coming. I was answering questions I couldn’t yet respond to. I was smiling through conversations, knowing the stability everyone felt was temporary.
Keeping that confidence quiet was heavier than I expected.
The Hidden Work Behind the Transition
While maintaining daily operations — hygiene checks, AR follow-ups, staffing coordination, supply management, and patient flow — I was simultaneously compiling extensive documentation for the organization we were preparing to join. Production by provider. Hygiene metrics. Case acceptance trends. Payroll summaries. Compliance documentation. AR aging reports. Vendor contracts.
It felt like operating two practices at once — the one everyone could see and the one forming behind the scenes.
I remember thinking, Leadership can feel lonely in moments like this.
Not because you lack support, but because you must filter your own emotions before they reach your team.
The Announcement and the Aftermath
When we officially joined in January 2025, I expected an adjustment period. What I did not anticipate was the pace.
New reporting systems were introduced. KPIs shifted. Supply ordering platforms changed. HR processes evolved. Compliance protocols tightened. Technology integrations rolled out — sometimes before the previous update had fully stabilized.
Just as the team would start to feel comfortable with one system, another would arrive.
Dentistry thrives on rhythm. Assistants rely on predictable setups. Hygienists depend on schedule flow. Front office teams need confidence in financial systems to communicate clearly with patients. When that rhythm is disrupted repeatedly, even the strongest teams can feel unsettled.
And as the leader, I could feel it.
Holding Steady When You Feel Unsteady
What surprised me most was not the operational pressure — it was the emotional responsibility.
My team watched me closely during that season. They watched how I reacted to new metrics. They listened to how I framed production expectations. They paid attention to whether I seemed anxious, frustrated, or confident.
The truth? There were days I felt all three.
There were moments when I questioned whether we were implementing too much too quickly. Moments I felt overwhelmed by the additional reporting. Moments I worried about change fatigue in the team.
But leadership required something different from what I was feeling. It required steadiness.
I learned that I did not have to pretend everything was easy. In fact, acknowledging that change was hard built more trust than forced positivity ever could. Saying, “I know this is a lot, and I’m feeling it too — but we will figure it out together,” created more unity than presenting a flawless front.
Protecting Culture in a Corporate Structure
One of my greatest concerns was losing what made our practice special. In private practice, culture is deeply personal. Patients know our names. Team members celebrate life events together. Decisions happen quickly and locally.
In a DSO environment, structure expands. Accountability increases. Decision-making becomes layered. What I realized over time is this: systems may change, but culture is still local.
I made it a priority to protect what we could control:
- We kept our morning huddles intentional.
- We continued celebrating wins — even small ones.
- We reinforced that patient care remained our anchor.
- We openly discussed new KPIs and translated them into patient-centered outcomes.
When the team understood that metrics were tools — not replacements for clinical integrity — resistance softened.
The Ongoing Nature of Change
Here we are, more than a year later, and new initiatives are still being introduced.
There are still days that feel heavy. Days when another rollout lands before the previous one feels mastered. Days when I wish I could give the team a long stretch of “normal.” But there is something else I see now that I did not see in the beginning.
Resilience.
Our team is more adaptable. Our financial visibility is stronger. Our systems are more scalable. Conversations about production and profitability are more informed. We are more operationally aware than we were before.
And personally, I have grown as a leader in ways I would not have without this transition.
What I’ve Learned About Leading Through Dental Transitions
If I could offer anything to other dental leaders navigating a shift from private practice to a DSO, it would be this:
- Your tone sets the temperature. Even when you feel uncertain, your composure gives your team safety.
- Honesty builds more trust than perfection. You do not have to have every answer.
- Culture is defended in daily moments, not corporate structures.
- Change fatigue is real — acknowledge it.
- Growth and discomfort often arrive together.
Leading through this transition has stretched me. It has challenged my emotional discipline, my communication skills, and my endurance. But it has also strengthened my leadership muscle in ways comfort never could.
Dentistry is ultimately about people — patients and teams. Systems may evolve, ownership models may shift, reporting structures may expand — but leadership remains deeply human.
And sometimes the most important thing we can offer our teams during constant change is not certainty, but calm.
About the Author
Holly Hatfield, FAADOM
Born and raised in Missouri, Holly Hatfield is a proud Air Force Veteran who swore in on September 11, 2001, and deployed during Operation Enduring Freedom and Operation Iraqi Freedom.
I’m a grateful Mom to an incredible son, wife to a supportive and inspiring husband, and Practice Manager at Tiger Family Dental, where I’m honored to serve alongside an outstanding team.
