Ready to Retire but No One to Take Over Your Dental Practice

For about fifteen years, a lot of owners ran the same plan.

Hire a young associate. Bring them along.

Sell them the practice when the time comes, probably on friendly terms, probably with some seller financing. Everyone wins.

The patients keep their dentist, the team keeps their jobs, and the owner walks away knowing the thing they built continues.

It is a good plan. It worked for a generation.

It is failing now, and not because owners are choosing badly. The pool of people who would have said yes has changed shape underneath the plan.

Key takeaways

• This is structural, not personal. Only 9% of dentists more than 25 years out of school are DSO-affiliated, against 27% of those less than 10 years out. The younger cohort is choosing employment.
• The constraint is usually financing, not willingness. An individual buyer is limited by what a bank will lend, and that ceiling sits below what a funded group can pay.
• A failed internal succession is expensive twice. It costs the years you spent on it, and it often leaves you selling later, from weakness.
• You have more options than “find someone” or “give up.” Partial sales, partnership structures and phased exits all keep you involved without requiring a single successor.
• Waiting is the one option that reliably gets worse. Every year of delay narrows the runway and reduces your ability to walk away.

What do you do when there is no one to take over your dental practice? The realistic options are selling to a DSO or doctor-partnership organization, selling a minority stake while continuing to practise, recruiting an associate with a structured multi-year buy-in, or a phased exit where you sell and stay on clinically. Waiting for a successor to appear is the option that most often ends badly.

The data behind why this keeps happening

I want to show you the numbers, because owners in this position tend to assume they did something wrong.

Practice ownership among US dentists fell from 84.7% in 2005 to 72.5% in 2023. That is not a small drift. That is roughly one in eight owners leaving ownership over less than two decades.

At the same time, DSO affiliation climbed from 8.8% of dentists in 2017 to 16.1% in 2024.

Now the split that actually explains your problem. 27% of dentists less than 10 years out of dental school are affiliated with a DSO. Among those more than 25 years out, it is 9%.

The dentists you would hire as an associate come from the first group. Roughly one in four of them has already chosen an employment model, and many more are weighing it.

Add debt. New graduates leave school owing amounts that make a seven-figure practice acquisition loan feel like a second mortgage on a house they have not bought yet.

Add that the ADA has noted newer generations become practice owners later in their careers than previous ones did.

None of that is about you or your practice. It is a generational shift in what a dental career looks like.

Why the associate route keeps stalling

When I unpick a failed internal succession with an owner, it is usually one of four things.

They could not finance it. The most common by far. Your practice may be worth several million.

A bank lending to one dentist is underwriting one person’s income and balance sheet. That ceiling is real, and it frequently sits well below what the practice is genuinely worth.

The associate is not rejecting the practice. They cannot raise the money.

They wanted the income without the ownership. Some associates have looked closely at what you do after hours and decided they would rather not. Given the administrative and staffing load in 2026, that is a rational position rather than a lazy one.

The timeline never got specific. “One day this will be yours” is not a plan, and after four or five years of it an associate starts taking calls from recruiters. Vagueness reads as never.

They left before it happened. With hiring as tight as it is, associates have options. If a competitor or a group offers more money and a defined partnership track, an undefined promise loses.

The mistake that turns a problem into a crisis

Here is the pattern that costs the most, and I see it repeatedly.

An owner at 60 decides they will sell to an associate. They hire one.

It does not work out. They hire another.

That takes two years. It also does not work out.

Now they are 66. They have spent six years on a plan that did not happen.

They are tired, and the practice has drifted, because an owner focused on succession is often not focused on growth. Production has softened.

They did not shift to associate-led production because they were waiting for a specific associate.

And now they need to sell, fairly quickly, from a position where the practice is worth less than it was six years earlier and they have no ability to walk away.

The failed succession did not just fail. It consumed the years in which the alternative would have gone well.

If you are in year two or three of this, that is the outcome worth avoiding. Not by abandoning the plan, but by running something else alongside it.

What the associate was actually thinking

It helps to hear the other side, because owners rarely do.

I have talked to a number of associates who walked away from buying a practice. Their reasons cluster tightly.

“I ran the numbers and they did not work.” They compared the loan payment against their take-home and realised that for five years they would earn less as an owner than as an employee, while carrying all the risk. That is frequently true.

Declining is not irrational.

“I did not want the second job.” They watched their principal spend evenings on insurance appeals, hiring and payroll. The dentistry was never the deterrent.

Everything wrapped around it was.

“Nobody ever told me the price.” Years of “one day this will be yours” with no number, no date and no method for arriving at either. Eventually they concluded it was not real.

“I got a better offer with less risk.” A group offered more money, a defined partnership track, and someone else handling administration. Against an undefined promise, that is not a close contest.

Notice how many of those are fixable. Vagueness is fixable.

A structured buy-in with third-party financing is fixable.

What no individual owner can fix is the underlying economics of one dentist borrowing against one income to buy a multi-million-dollar asset. If you try the associate route again, solve the fixable ones and be honest about the one that is not.

What the alternatives actually are

The good news is that the buyer side of this market is deep, and several of the structures available now did not really exist when your original plan was formed.

Sell to a DSO or private equity-backed group. The Association of Dental Support Organizations counts 80-plus member companies, roughly 130 private equity-backed groups operate in the US, and Becker’s tracked more than 200 DSO affiliations in 2025. These buyers are not constrained by individual lending capacity, which is precisely the constraint that stopped your associate.

Sell to a doctor-partnership organization. A DPO is a dental partnership organization, where the selling dentist keeps a meaningful ownership stake and the local practice brand usually survives rather than being converted to a house banner. This is the fastest-growing structure in dental consolidation, and for an owner whose real objection to selling is “I do not want my practice to disappear,” it is often the closest fit.

Sell a minority stake and keep going. Takes money off the table, keeps you in control, and creates a second payout later when the buyer recapitalizes. Useful when you are not actually ready to stop.

Sell and stay on clinically. Post-sale clinical roles are standard, and their length, hours and compensation are all negotiable. A number of owners sell, drop to three days, hand off every administrative task, and describe it as the best part of their career.

The exhaustion was rarely the dentistry.

Recruit an associate with a real, structured buy-in. Not abandoned, just done properly: a defined timeline, a defined valuation method, and a financing path worked out before the associate starts. Sometimes with a group’s capital behind it, which solves the lending ceiling.

The one that solves both problems at once

There is a structure worth understanding specifically, because it addresses the exact thing you were trying to achieve.

If your goal was continuity, a sale to a group that then recruits and supports associates gets you closer to it than a failed internal succession does.

Groups have recruiting infrastructure, employment brand, and the ability to offer partnership tracks funded by someone other than the individual dentist.

Put plainly: the thing you could not do alone, which was find and finance a successor, is a function these organizations perform at scale.

That does not make every group the right home for your practice. It does mean the choice is not between “my associate takes over” and “my practice loses its identity.”

Which group, and on what terms, is where this gets decided. And that is entirely a function of how many of them are competing for you.

A single buyer approaching you directly has no pressure to accommodate anything about continuity, your team or your name. Several vetted buyers, aware of each other, negotiate very differently.

This is what the Elite Selling System is built to produce.

We hand-select and vet every buyer who gets to bid on your practice, the way a doorman with a velvet rope lets in only the right people, then run a private competitive window inside that group.

Continuity terms are among the things that move most under competition.

What continuity actually means

It is worth being precise about the thing you are trying to protect, because owners often have not defined it.

For some it is the practice name staying on the building. For some it is the team keeping their jobs and their hours.

For some it is patients continuing to be treated the way they were. For some it is a clinical philosophy surviving.

Those are different, and they are protected by different structures. A doctor-partnership organization usually preserves the name.

Almost any buyer retains the team, because the team is most of what they are acquiring. Clinical philosophy is the hardest to protect and the most worth asking pointed questions about.

Write down which of those actually matters to you. Then you can negotiate for it specifically, rather than hoping a successor would have delivered all four by default.

What to do if you are in the middle of this

Keep the succession plan, but stop making it the only plan. Run a parallel track. If the associate comes through, excellent.

If not, you have not lost three years.

Get the practice valued now. Not to sell it. To know what you are actually negotiating about, with the associate as much as anyone else.

Owners frequently discover the gap between what a bank will lend one dentist and what the practice is worth, and that single number reframes the whole conversation.

Do the value work regardless. Shifting production toward associates, getting hygiene up, cleaning the financials. All of it makes the practice both easier to hand over and worth more to any buyer.

Put a date on it. Not “when the right person comes along.” A date. Then work backwards.

Three to five years before you want to stop is the right window, because it leaves enough runway to prepare and enough leverage to say no.

And be honest about the emotional part. For a lot of owners the resistance to selling externally is not financial. It is that handing the practice to a person you trained feels like continuity, and selling to an organization feels like an ending.

That is a real feeling and worth naming. It is also worth testing against what actually happens to practices whose owners waited too long.

If you want a straight assessment of where you stand and what the realistic paths are, we will give you one with no obligation. It starts with a free, confidential practice value estimate.

Our fee varies depending on the value of the practice and is entirely success-based. If we do not get you a result, we do not get paid.

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Frequently asked questions

Why can’t I find someone to take over my dental practice?

It is largely structural. Practice ownership among US dentists fell from 84.7% in 2005 to 72.5% in 2023, and only about 9% of dentists more than 25 years out are DSO-affiliated against 27% of those less than 10 years out.

Younger dentists are entering employment models, often carrying substantial education debt.

Can my associate buy my practice if they want to?

Sometimes, but financing is the usual constraint. A bank lending to an individual dentist underwrites one person’s income and balance sheet, and that ceiling frequently sits below what a well-run practice is genuinely worth.

Structures backed by a group’s capital can bridge that gap.

What are my options if there is no successor?

Selling to a DSO or doctor-partnership organization, selling a minority stake while continuing to practise, a phased exit where you sell and stay on clinically, or recruiting an associate with a properly structured and financed buy-in.

What is a DPO and why does it suit this situation?

A dental partnership organization keeps the selling dentist as a meaningful owner and usually preserves the local practice brand rather than rebranding. For an owner whose main concern is continuity rather than exit, it often fits better than a conventional full sale.

How long should I keep trying to find an associate successor?

Keep trying, but run a parallel plan from the start. The costly pattern is spending five or six years on successive attempts and then needing to sell quickly, with less runway, softer production and no ability to walk away.

Will selling to a group mean my practice loses its identity?

Not necessarily. Many groups, particularly doctor-partnership organizations, retain local practice branding deliberately.

How your name, team and clinical approach are treated is a negotiable term, and it moves considerably more when several buyers are competing.

Can I still protect my team if I sell externally?

Yes, and it is one of the terms most worth negotiating for. In most dental transactions the clinical and front-office team stays, and a buyer trying to win a competitive process will accommodate commitments that a sole bidder will not.

Is it too late if I am already in my late sixties?

No, but the runway matters. Average dentist retirement age reached 68.7 in 2024, so you are not unusual.

The practical issue is that less time means less preparation and less leverage, which is why starting the conversation now rather than next year is worth something real.

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Sources

Ownership trends and workforce

1. ADA Health Policy Institute. “Practice Ownership Trends in Dentistry: A New Look at Old Data.” ada.org
2. ADA News. “More dentists affiliating with DSOs.” adanews.ada.org
3. ADA Health Policy Institute. “Dentist Workforce.” ada.org
4. ADA Health Policy Institute. “U.S. Dentist Workforce — 2025 Update.” ada.org
5. ADA Health Policy Institute. “Dentist Retirements Increase.” ada.org
6. ADA Health Policy Institute. “Trends in Dentists’ Income, Revenue and Hours Worked.” ada.org
7. American Dental Association. “Dental Industry Predictions for 2026.” Dental Sound Bites, Season 7 Episode 2. ada.org

Buyer landscape

8. Association of Dental Support Organizations. “About ADSO.” theadso.org
9. Becker’s Dental Review. “200+ DSO affiliations in 2025: State-by-state breakdown.” beckersdental.com
10. Becker’s Dental Review. “69% of DSOs plan to boost acquisitions in 2026: Report.” beckersdental.com
11. Becker’s Dental Review. “The largest DSOs headed into 2026.” beckersdental.com
12. Becker’s Dental Review. “52 DSOs to know: 2026.” beckersdental.com
13. Group Dentistry Now. “DSO Deal Roundup — July 2026.” groupdentistrynow.com

Transaction structure

14. Mandelbaum Barrett PC. “The Four-Phase DSO Transaction Process: What to Expect When Selling a Dental Practice.” mblawfirm.com
15. Cranfill Sumner LLP. “Selling Your Dental Practice to a DSO.” cshlaw.com
16. ADA Health Policy Institute. “Dental Practice Research.” ada.org