If you are an oral and maxillofacial surgeon exploring a DSO partnership, the most important step is getting clear on what changes after close. Not all DSOs operate the same way, and for OMS, those differences show up fast in high acuity operations, anesthesia compliance, and complex scheduling.
This guide is a practical set of questions to help you evaluate fit, protect the patient experience, and avoid surprises later.
Start with your why
Most specialists explore partnerships because they want something specific, such as more time focused on patient care, relief from staffing and administrative burden, better systems, growth support, or a thoughtful transition plan.
Before you compare offers, define what success looks like for you. Then use the questions below to test whether a partner can deliver it.
Clinical autonomy: do you stay the surgeon?
For specialists, autonomy is not negotiable. Diagnosis, treatment planning, and clinical protocols must remain clinician led.
1. Where is clinical decision making protected in writing?
Ask to see the exact contract language, then ask how it works in real scenarios.
- Who has final authority on diagnosis, case selection, and treatment planning?
- How are changes to clinical protocols handled, and who approves them?
- Are there any production expectations that could influence clinical judgment?
If the answer relies on culture alone, push for language and a clear enforcement mechanism.
2. Who controls your anesthesia model and clinical standards?
OMS is not like general dentistry with add on sedation. Your model may include IV sedation, deep sedation, or general anesthesia workflows that require strict standards.
Ask:
- Who sets anesthesia protocols and emergency preparedness standards?
- Who is responsible for compliance oversight, audits, and documentation?
- How are anesthesia related staffing requirements handled, including hiring, training, and coverage?
3. Who controls your surgery schedule, block time, and case flow?
Complex scheduling is a core OMS reality. Ask:
- Who designs schedule templates, appointment lengths, and block time?
- Can you protect room availability for high acuity cases without constant rescheduling pressure?
- If scheduling is centralized, how is the team trained on OMS triage and surgical case types?
4. What happens to equipment and vendor choices?
Outcomes and efficiency depend on the tools you trust. Ask:
- Do you control implant systems, fixation choices, sedation equipment, and preferred vendors?
- Are you required to standardize supplies across the platform?
- What is the process for approving substitutions, and who makes the final call?
Culture: will your team and referral relationships thrive?
A partnership should not disrupt what makes your practice work. Look for respect for your practice identity, your referral community, and your team, supported by a clear transition plan and ongoing people development.
5. Will your practice identity remain intact?
Ask:
- Will the practice name remain, along with your local reputation?
- How are patient communications handled after close?
- Will branding changes affect referral trust or patient expectations?
6. What is the plan for your team, especially surgical assistants and anesthesia support?
Ask for specifics:
- How will recruitment and retention be supported?
- What training standards exist for OMS specific roles?
- Who owns staffing stability, and what happens if turnover spikes?
7. How will you protect and strengthen referral relationships?
OMS referrals are built on responsiveness, clear communication, and predictable handoffs. Ask:
- Who owns referral outreach and relationship management?
- What is the standard for post op communication and report turnaround?
- How do you handle a dissatisfied referring office, and what does escalation look like?
Capability: Can they actually improve operations?
True support goes beyond dashboards and monthly calls. Specialists benefit most from hands-on expertise in scheduling, staffing, revenue cycle management, and referral driven marketing.
8. What operational work will they take off your plate, and when?
Ask for a clear list with owners and timelines:
- Scheduling and call handling
- Insurance verification and preauthorization workflows
- Billing, collections, and denial management
- HR, recruiting, onboarding, and training
- Procurement, equipment planning, and vendor management
Then ask: how is success measured, and what happens if outcomes do not improve?
9. Do they have OMS specific operational expertise?
Ask them to walk through exactly how they support high acuity operations and complex scheduling, because those are not generic capabilities.
A simple test is to ask how they handle:
- Same week surgical needs while protecting block time
- Anesthesia documentation and compliance workflows
- Surgical cancellations, add-ons, and last-minute case changes
10. What systems will change, and what is the transition plan?
System changes can create downtime if mishandled. Ask:
- Which systems are required, including phones, scheduling, PMS, imaging, and billing?
- What is the conversion timeline, and what support is on site during go live?
- How is data integrity protected, including referral source history and clinical documentation?
Capital and Terms: is the partnership aligned long term?
Headline valuation matters, but so does what happens next. Transparency around compensation, governance, equity participation, and exit options is essential.
11. How will compensation work after close, in plain language?
Ask:
- Is compensation production based or collections based?
- How are expenses allocated, and what are the assumptions used?
- How do write offs, refunds, and bad debt affect pay?
- What can change over time, and who controls those changes?
12. What clinician governance exists, and what decisions are surgeon led?
Ask:
- How do OMS doctors influence decisions that affect clinical operations and patient experience?
- Is there clinician leadership or shared governance?
- How are disagreements handled, and who has final authority?
13. What does equity mean here, and what are the real exit options?
If equity is part of the offer, ask:
- What percentage is rolled, and is it required or optional?
- What entity are you investing in, and how is it valued?
- What do liquidity events look like, and what are realistic timelines?
- What happens if you reduce clinical days, relocate, or retire?
14. What happens if the partnership is not a fit?
Ask directly:
- What is the non-compete scope and duration?
- What are the termination clauses, with cause and without cause?
- What happens to your equity if you leave?
- What happens to your staff and operations if you exit?
A practical way to compare offers
After you get answers, summarize each partner in four sentences.
Clinical autonomy: How is your decision making protected, and where is it written?
Culture: What happens to your identity, your people, and your referral relationships?
Capability: What hands-on support do you get in scheduling, staffing, and revenue cycle execution?
Capital and Terms: How do compensation, governance, equity, and exit options work?
If a group cannot give clear answers in these areas, the risk usually shows up after close.
Learn More
Specialized Dental Partners is built specifically around specialty dentistry, with a doctor led model designed to preserve clinical autonomy, protect practice identity, and deliver operational support aligned to the realities of surgical complexity, anesthesia compliance, and high acuity OMS workflows. If you are exploring a partnership and want to understand what a specialty aligned approach looks like for oral and maxillofacial surgery, start a confidential conversation.