When a DSO makes an offer, the number gets most of the attention.
It’s understandable. For many owners, this is the largest financial decision they’ve ever made. The purchase price feels like the clearest signal of success.
But the offer price is only one part of the decision — and often not the most important one.
The real question isn’t what a DSO is willing to pay.
It’s what life looks like after you say yes.
One of the first things sellers should try to understand is how decisions are actually made inside the organization.
Every DSO has a structure. Some are centralized. Some are regional. Some operate with strong clinical leadership. Others are heavily operational.
None of these models are inherently right or wrong. What matters is whether the decision-making style fits how you prefer to work.
If decisions that affect your day-to-day practice are made far away, you need to be comfortable with that distance. If decisions are collaborative, you need to understand how input is gathered and acted on.
The smoother transitions tend to happen when sellers understand this before closing — not after.
Another critical factor is how performance is measured and managed.
Most DSOs track performance closely. That’s part of how they operate at scale.
Sellers should understand what metrics matter, how often they’re reviewed, and how they influence expectations. More importantly, sellers should understand how those metrics are affected by system-level decisions.
Performance feels very different when you’re accountable for results but don’t control all the inputs.
Clarity here prevents frustration later.
Culture is another area that’s difficult to quantify but impossible to ignore.
DSOs vary widely in pace, communication style, tolerance for flexibility, and appetite for change. Some move quickly. Some are methodical. Some expect tight adherence to process. Others allow more local variation.
Sellers who focus only on economics often underestimate how much culture affects daily experience.
You’re not just selling a business. You’re entering a relationship.
Support structure deserves careful consideration.
Many DSOs promote centralized support as a benefit — and it often is. HR, marketing, IT, compliance, and procurement support can remove significant burden from owners.
But support can look very different in practice.
Sellers should understand what support actually feels like. Is it responsive? Is it proactive? Is it standardized? How does it integrate with the clinic?
Support that works on paper doesn’t always feel supportive in reality.
Another overlooked aspect is how the DSO handles change over time.
Organizations evolve. Leadership changes. Strategies shift.
Sellers should understand how adaptable their agreement is. How are disputes resolved? What happens if assumptions change? How is feedback handled?
Contracts should anticipate evolution, not assume stability.
Financial structure matters beyond the headline number.
Deferred payments, holdbacks, earn-outs, equity rollovers, and performance incentives all affect the real value of the deal. Sellers should understand not just how much they’re being offered, but how and when they’ll actually receive it.
Liquidity timing matters. Risk allocation matters.
A higher number with more uncertainty may be less attractive than a lower number with clarity.
Sellers should also evaluate how the DSO treats its existing partners.
Speaking with other sellers who have been in the system for a few years is often more informative than any presentation. These conversations reveal how expectations change after closing and how issues are handled when things don’t go perfectly.
Patterns matter more than promises.
Another important consideration is personal fit.
Some owners thrive in structured environments. They appreciate clear rules, defined processes, and shared accountability. Others value autonomy and flexibility more highly.
Neither preference is wrong. But mismatch creates friction.
Evaluating a DSO means evaluating yourself as much as the organization.
One of the biggest mistakes sellers make is assuming that all DSOs operate similarly.
They don’t.
Differences in governance, culture, and philosophy can lead to very different experiences, even with similar offer prices.
Taking the time to understand those differences pays dividends long after the deal closes.
The goal of evaluating a DSO isn’t to find a perfect partner.
It’s to find a compatible one.
Compatibility reduces stress, protects relationships, and improves long-term satisfaction.
Offer price matters.
But it’s not the decision.
The decision is about the next phase of your life, your work, and your relationship to a clinic you built over years.
Sellers who evaluate DSOs beyond the number tend to make decisions they feel good about — not just at closing, but years later.
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