Can I Sell My Dental Practice and Keep Practicing?

The question almost always arrives sideways.

We will be 40 minutes into a conversation about what a practice is worth, and the owner stops. Then some version of this:

I’m not trying to retire. I like Tuesdays. I just don’t want to be the person who calls the payroll company anymore.

That is not a footnote to the conversation. That is the actual thing they came to ask.

Most owners ask it apologetically, as though they are requesting something unusual. They are not.

It is the single most common situation in the entire market, and buyers are built for it.

What varies enormously is the deal you get on the way in.

Key takeaways

• Staying on is the norm, not the exception. Most buyers require it. A seller who wants to leave immediately is the harder conversation, not the one who wants to keep treating patients.
• The employment agreement is a second negotiation, and it is worth real money. Term length, days per week, and the denominator your pay percentage attaches to are all live terms, not house rules.
• Percentage of collections, adjusted production and production are not the same deal. On one $1,500 crown at the same 30%, the three formulas pay $285, $300 and $450.
• You keep clinical judgment and hand over the operating decisions. Scheduling, fee schedules, payer contracts, hiring and marketing move to the buyer, and most owners underestimate how much of their day that was.
• A 3-to-5-year term ends long before most dentists do. The average US dentist now retires at 68.7. The question nobody negotiates is what happens in year six.

Can you sell a dental practice and keep working? Yes, and in most transactions the buyer requires it. A typical arrangement keeps the selling dentist clinically active for 3 to 5 years on a negotiated number of days, paid a percentage of production or collections rather than practice profit, with the administrative side of ownership handed over at closing.

Why buyers want you to stay

Start with the buyer’s arithmetic, because it explains everything that follows.

A buyer is not purchasing your operatories. They are purchasing a stream of earnings, and in a dental practice that stream walks in on two legs every morning wearing loupes.

If you leave at closing, a meaningful share of production leaves with you. Patients who have seen the same dentist for 18 years do not transfer to a stranger at the same rate.

Buyers know this, price it, and protect against it.

So the request that owners find embarrassing to make is the request buyers were going to make anyway.

The scale of the market backs this up. The Association of Dental Support Organizations reports member companies supporting more than 15,000 dentists across roughly 8,500 practices in 48 states, and Becker’s Dental Review counted over 200 affiliation transactions in 2025 alone.

Appetite has not cooled. In a 2026 survey reported by Becker’s, 69% of DSOs said they expected to increase acquisitions that year.

A DSO is a dental support organization. It is the management company that owns the non-clinical side of a practice and handles everything outside the operatory, while a licensed dentist keeps ownership of the clinical entity.

That structure exists for a legal reason, and it matters to you personally.

Most states restrict who may own or control a dental practice under the corporate practice of dentistry doctrine. That is why the clinical entity stays in dentist hands while the management company sits alongside it.

Which means that after you sell, you are frequently still the licensed owner of the professional entity. You are simply no longer the person running the enterprise around it.

What “staying on” actually means

Here is the part almost nobody explains before the letter of intent arrives.

You will sign two documents that matter to your daily life. One transfers the practice.

The other is an employment agreement that governs what your Tuesdays look like for the next several years.

Owners spend 11 weeks negotiating the first and 11 minutes on the second. That is backwards, and it is expensive.

Four things in that agreement decide everything.

The term. Cranfill Sumner’s guidance to selling dentists puts the typical requirement at a minimum of 3 to 5 years of post-closing employment. Shorter terms exist.

They are usually paired with a lower price, because the buyer is absorbing more transfer risk.

The days. How many clinical days per week, and whether that number can be changed by either side. A commitment to “full-time clinical practice” with no number attached is not a term.

It is an argument waiting to happen in month seven.

The compensation formula. This is where the real money hides, and it is the section owners read fastest.

The restrictive covenants. Where you may practise, for how long, and what happens if you want out early. More on that below, because it is genuinely counterintuitive.

The three ways to get paid, and why they are not equivalent

Every associate compensation formula in dentistry attaches a percentage to one of three numbers. The ADA sets the definitions out plainly, and the difference between them is not academic.

Take one crown at a fee of $1,500 on your own schedule.

The denominator	What it means	On this crown
Total production	The full fee on your office schedule	$1,500
Adjusted production	The fee after the payer’s contractual write-down	$1,000
Collections	What actually lands in the bank	$950

Now apply the same 30% to each.

Production pays you $450. Adjusted production pays $300.

Collections pays $285.

Same tooth. Same hour of your life.

A spread of $165, decided entirely by which word appears in one sentence of your employment agreement.

Scale that. An owner producing $1.2 million a year, with the write-downs and the collection lag every PPO practice lives with, can see six figures separate the top formula from the bottom one.

Across a 4-year term, that is a number worth reading one sentence for.

The honest complication: the three are rarely offered at the same percentage. A collections-based deal usually carries a higher percentage precisely because the denominator is smaller.

Which is the actual lesson. The percentage on its own tells you nothing. A 35% offer and a 28% offer cannot be compared until you know what each one multiplies.

There is a fourth structure worth asking about, particularly for owners cutting back.

A guaranteed daily rate or base salary, with the percentage operating as a floor or a bonus above it, removes the risk that a slow quarter you did not cause lands in your household budget.

What changes on day one, and what does not

The most useful thing I can tell an owner considering this is that the change is not gradual. It happens on a Monday.

The decision	Who owns it after closing
Diagnosis, treatment planning, clinical judgment	You
Which patients you treat and how you treat them	You
Clinical standard of care and record-keeping	You, as the licensed provider
Payroll, benefits administration, HR	The buyer
Fee schedule and payer contracting	The buyer
Hiring, firing and staff compensation	The buyer, with clinical input
Supply ordering, equipment approval, IT	The buyer
Marketing, branding and the website	The buyer
Your own schedule and days	Whatever the agreement says

Read that last row again, because it is the one that surprises people.

The clinical column is protected, and increasingly protected by statute rather than custom. What sits in the buyer’s column is everything you used to do after 6pm.

For an owner exhausted by administration, that trade is the entire point.

Group Dentistry Now’s retention coverage makes the same observation from the other direction. Dentists leave when administrative weight is piled on top of the clinical day, not when the clinical day is hard.

But be honest with yourself about the second-order effects.

You will not choose the composite you like. You may not choose the lab.

If the practice drops a PPO contract or adds one, that decision arrives as information rather than as a discussion, and it changes your production mix.

I have watched owners handle the loss of payroll with relief and the loss of supply ordering with genuine irritation. It is rarely the big things.

Who decides your schedule now

This is the single question I would put in writing before signing anything.

In most of the country, the answer is: whatever your employment agreement says. There is no statutory backstop.

If the agreement is silent on days per week, the buyer’s operating team fills the silence.

California is now the exception, and it is worth understanding because other states are watching it.

SB 351 took effect on 1 January 2026. It bars private equity and hedge fund controlled management companies from determining how many patients a dentist sees in a given period, or how many hours are worked.

The same law reaches further than scheduling. Under Goodwin’s reading, restricted investors may not own the patient records, make coding and billing decisions, control payer contracting, or approve equipment and supply selections.

Benesch’s analysis of the statute and Nixon Peabody’s alert on California’s broader oversight expansion both land in the same place. The state has decided that clinical autonomy needs to be a rule, not a promise in a recruitment brochure.

Everywhere else, it is a contract term. Which means it is negotiable, and which means silence is a choice you are making.

A pattern we see often enough to name: an owner 2 or 3 years into a term discovers that the sentence he skimmed about clinical days reads very differently to the operations team than it ever did to him.

Nobody acted in bad faith. The sentence was simply vague, and vague sentences get filled in later by whoever is holding the pen.

What is negotiable, and routinely is

Owners assume the employment agreement is a form. Nixon Peabody’s guidance to both sides of these transactions treats the post-closing provider role as a drafting exercise, not a template, and that matches what we see.

Here is what actually moves.

Days per week, in a number. 3, 4, or a stated range. Also worth pinning: whether the buyer can add a day, and whether you can drop one, and with how much notice.

Your hygiene column. Some owners have built their week around checking their own hygiene patients. If that matters to you, say so before signing.

It is far easier to write in than to reclaim later.

Holiday, continuing education and time off. Continuing education days and the budget attached to them are frequently left blank and are almost always available.

Emergency and after-hours coverage. Who takes the Saturday call once there are 4 other offices in the region. Unwritten, this quietly expands.

The notice period and the early exit. What happens if life changes in year two. This is the one owners never ask about and the one they later wish they had.

The renewal. What the arrangement becomes when the initial term ends, and whether you have a right to continue at all.

Your team. You cannot guarantee anyone’s job. You can negotiate transition protections, retention arrangements, and a seat in the conversation before changes are made to the people who built the place with you.

None of that is exotic. It is ordinary drafting, and the reason it usually does not happen is that the seller has no leverage left by the time the employment agreement is circulated.

Which is the whole argument for negotiating both documents at once.

The transition-period trap

Now the uncomfortable one.

If part of your price is an earnout, meaning a portion paid later only if the practice hits agreed targets after closing, and your employment term runs alongside it, you have a structural problem.

Your remaining payout depends on performance. You no longer control most of the inputs to that performance.

You do not set the fee schedule. You do not choose which payer contracts to keep.

You do not decide the hygiene staffing level, or the marketing budget, or whether the practice takes on a new associate who competes with you for chair time.

Most earnout targets are measured against adjusted EBITDA, which is what the practice earns in pure operating profit after paying a market-rate dentist to do the work you currently do yourself, and every one of those inputs now sits with somebody else.

The mechanics of how those targets get measured, and how the arithmetic can move without anyone acting in bad faith, are worked through properly in our piece on rollover equity and earnouts in a DSO deal. I will not re-derive them here.

What belongs in this article is the interaction. An earnout tied to an employment term converts your working conditions into a financial instrument.

Every operating decision the buyer makes now carries a number for you, and you are on the wrong side of the table for that conversation.

Two defences work.

The first is to price the earnout at what you genuinely believe it is worth, not at face value, and negotiate the cash at closing accordingly.

The second is to write protective covenants into the agreement, so the metric is defined against a baseline you can actually verify.

Both are much easier when more than one buyer is interested.

The non-compete nobody explains properly

Here is the piece of this that catches sophisticated people.

A dentist reads that California bans non-compete agreements, or that Washington has now passed a near-total ban effective 30 June 2027, or that Virginia expanded its restrictions from 1 July 2026, and reasonably concludes that the covenant in the employment agreement is unenforceable.

Frequently it is not, because it is not an employment covenant.

When you sell a practice, the restriction you sign is usually a sale-of-business covenant, and it sits in a different legal category. Goodwin’s analysis of SB 351 notes explicitly that the law leaves an otherwise enforceable sale-of-business non-compete alone.

That distinction is worth reading twice. The very state that most aggressively voids employee non-competes still permits the one you signed as a seller.

Nixon Peabody’s position is the right one to adopt generally: enforceability should be analysed under the law of each applicable jurisdiction rather than assumed. Benesch’s tracking of restrictive covenant law across the states shows how quickly the ground is moving.

Practically, this means three things. Read the radius and measure it on a map against where you actually live.

Read the duration, and check whether it starts at closing or at the end of your employment. Those are very different sentences.

Then check whether leaving early extends it.

How long owners actually stay

Now the question the 3-to-5-year term never answers.

The average US dentist retires at 68.7, up from 64.7 in 2001, and the average career now spans 41.3 years. Those numbers come from ADA Health Policy Institute’s workforce research, and they have been moving in one direction for two decades.

Do the subtraction. An owner who sells at 58 and signs a 4-year term arrives at the end of it at 62, with something like 6 or 7 years of career left by the averages.

So the real planning question is not “can I keep working.” It is what year six looks like.

In practice, owners land in 4 places.

Some renew, often on better terms than the original, because by then they have proven they are not a flight risk and the buyer has learned what the practice loses without them.

Some drop to 2 days, or to a per-diem arrangement covering holidays and vacations. This is more common than owners expect and is usually welcomed.

Some move to a different office in the same group, closer to home or with a case mix they prefer.

And some finish. They discover that without the ownership piece, the clinical work alone was not the thing holding them there, which is a completely legitimate discovery to make at 62 with the money already banked.

Plans change, and that is not a failure of planning. What makes the difference is whether the agreement gives you an exit ramp or a wall.

The ownership trend underneath all this is worth knowing.

ADA Health Policy Institute’s research shows practice ownership among US dentists falling from roughly 85% two decades ago to around 72% more recently, and the appetite for affiliation is concentrated at the start of a career rather than the end of one.

On its 2024 figures, 27% of dentists fewer than 10 years out of school were affiliated with a DSO, against 9% of those more than 25 years out.

Meaning the associate you might have sold to in 1998 has a different set of expectations now. That is a large part of why this arrangement became the default in the first place.

The version where you keep more than the chair

There is a variant of this that owners rarely raise, and it changes the arrangement meaningfully.

Instead of selling all of it, you sell most of it and keep a slice. Rollover equity means keeping a piece of ownership in the buyer’s company rather than taking all cash at close.

A doctor-partnership organization, or DPO, is a structure built around dentists who want to stay owners of something while shedding the operating load.

The effect on your working life is real. You are now three people at once: a seller who has been paid, an employee under an agreement, and a shareholder in the buyer.

Those three want different things. The employee wants a manageable schedule.

The shareholder wants the platform to grow, which sometimes means the schedule is not manageable.

It also changes the temperature of disagreements. Owners with equity tend to get a longer hearing on operating decisions, partly because their incentives are visibly aligned, and partly because a shareholder who resigns is a worse outcome for the buyer than an employee who does.

What that equity is actually worth, where it sits in the capital structure, and what ranks above it are the substance of the rollover equity article, not this one. Read it before you agree to roll anything.

Before you agree to any of it

Four things, in this order.

Find out what the practice is worth first. Not because you are selling tomorrow. Because the employment agreement you can negotiate is a direct function of how much competition exists for the practice, and you cannot know that from one approach.

Write down your ideal week. Days, hours, hygiene, call, holidays, the works. Owners who negotiate from a specific picture get a specific answer.

Owners who say “I’d like to stay on for a while” get a template.

Get both documents reviewed together, by a lawyer who does dental transactions. Benesch, Mandelbaum Barrett and Cranfill Sumner all publish freely on this precisely because the traps are structural and repeatable. The purchase agreement and the employment agreement interact, and reviewing them separately is how owners miss the interaction.

Ask the year-six question out loud, in the room. What does this look like when the term ends. If the answer is vague, that is information.

What actually decides the terms you get

I want to end on the thing that determines all of it, because it is not what owners expect.

The generosity of your post-sale arrangement is not really a function of which buyer you pick, or how well you get on with the person across the table, though both help.

It is a function of how many people wanted the practice.

A buyer negotiating alone has no reason to write 3 days a week into an agreement. A buyer who knows two other credible parties would take the practice on Friday has every reason.

The terms follow the leverage, every single time. And the terms are where the quality of your next five years lives.

That is what the Elite Selling System exists to produce. We hand-select and vet every buyer allowed to bid, the way a doorman with a velvet rope admits only the right people.

Then we run a private competitive window inside that group, so the working arrangement gets negotiated in daylight rather than accepted in the dark.

If you want to understand where you stand before anyone knows you are thinking about it, that is a conversation with nothing attached to it.

It starts with a free, confidential practice value estimate, and it frequently ends with us telling an owner that the right move is to stay exactly as they are for another two years.

Our fee depends on the value of the practice and is entirely success-based, so we have no reason to talk anyone into a transaction that does not suit them.

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Frequently asked questions

Can I sell my dental practice and keep working?

Yes, and in most transactions the buyer requires it. A typical arrangement keeps the selling dentist clinically active for 3 to 5 years on a negotiated number of days, paid a percentage of production or collections, with the administrative side of ownership transferring at closing.

How long do I have to stay after selling my dental practice?

Guidance published for selling dentists puts the typical post-closing employment requirement at 3 to 5 years. Shorter terms are possible and are usually reflected in the price, because a faster departure transfers more patient-retention risk to the buyer.

How am I paid after I sell my practice?

Usually a percentage attached to production, adjusted production or collections, sometimes with a guaranteed daily rate or base salary underneath it. The three denominators are not equivalent, so a percentage alone is not comparable between offers until you know what it multiplies.

Can I reduce my clinical days after selling?

Days per week are negotiable, and the time to negotiate them is before signing, not afterwards. Put the number in the agreement, along with whether either side may change it and with how much notice.

An agreement that says only “full-time clinical practice” leaves the definition to the buyer.

Do I still control clinical decisions after a DSO acquires my practice?

Yes. Treatment planning, diagnosis and standard of care remain with the licensed dentist, and state corporate practice of dentistry laws are built around that division.

California’s SB 351, effective 1 January 2026, goes further and bars restricted investors from setting how many patients a dentist sees or how many hours are worked.

What happens if I want to leave before my employment term ends?

That depends entirely on drafting. Leaving early can put an unpaid earnout, unvested rollover equity or a holdback at risk, and the restrictive covenant usually keeps running.

Negotiate the notice period and the early-exit consequences before signing, not when you need them.

Is my non-compete enforceable if my state has banned non-competes?

Often yes, because the covenant a seller signs is usually a sale-of-business restriction rather than an employment one, and those are treated differently. California voids most employee non-competes and still permits an otherwise enforceable sale-of-business covenant.

Enforceability should be analysed state by state, never assumed.

Can I keep an ownership stake and still practise?

Yes. Rolling a portion of your proceeds into equity in the buyer, or affiliating with a doctor-partnership organization, keeps you an owner of something while the operating burden transfers.

It also makes you a seller, an employee and a shareholder at the same time, and those three roles do not always want the same thing.

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Sources

Practice ownership, career length and the dentist workforce

1. ADA Health Policy Institute. “Dentist Workforce.” ada.org
2. ADA Health Policy Institute. “Dentist Retirements Increase.” ada.org
3. ADA Health Policy Institute. “Practice Ownership Trends in Dentistry: A New Look at Old Data.” ada.org
4. ADA Health Policy Institute. “Trends in Dentists’ Income, Revenue and Hours Worked.” ada.org

The buyer market and affiliation trends

5. Association of Dental Support Organizations. “About ADSO.” theadso.org
6. ADA Health Policy Institute. “Practice Ownership Among Dentists Continues to Decline.” ada.org
7. Becker’s Dental Review. “200+ DSO affiliations in 2025: State-by-state breakdown.” beckersdental.com
8. Becker’s Dental Review. “69% of DSOs plan to boost acquisitions in 2026: Report.” beckersdental.com
9. Group Dentistry Now. “Upholding DSO Clinical Standard of Care with Provider Autonomy.” groupdentistrynow.com

The transaction and the post-closing employment agreement

10. Cranfill Sumner LLP. “Selling Your Dental Practice to a DSO: What to Expect Before, During, and After the Deal.” cshlaw.com
11. Mandelbaum Barrett PC. “The Four-Phase DSO Transaction Process: What to Expect When Selling a Dental Practice.” mblawfirm.com
12. Mandelbaum Barrett PC. “A Guide to Selling Your Dental Practice to a Dental Service Organization.” mblawfirm.com
13. Nixon Peabody LLP. “Five issues dentists and DSOs should address before signing a transaction.” nixonpeabody.com
14. Benesch. “Dental/DSO Industry Newsletter, May/June 2026.” beneschlaw.com

How dentists are paid

15. American Dental Association. “Dentist compensation: what every dental associate should know.” ada.org

Clinical autonomy, restrictive covenants and state law

16. Goodwin. “California Governor Signs Bill Codifying Existing Corporate Practice Restrictions and Imposing Certain New Limitations on Noncompetition Restrictions.” goodwinlaw.com
17. Benesch. “California Enacts SB 351: New Restrictions on Private Equity and Hedge Fund Involvement in Physician and Dental Practices.” beneschlaw.com
18. Nixon Peabody LLP. “California expands health care oversight.” nixonpeabody.com
19. Holland & Knight. “Washington State Bans Non-Compete Agreements.” hklaw.com
20. Holland & Knight. “Virginia Expands Restrictions Against Employee Non-Competes.” hklaw.com
21. US House Committee on Oversight. “Survey of State Laws Governing the Corporate Practice of Dentistry.” oversight.house.gov