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From $280k to $520k EBITDA – Then a Top-of-Market DSO Exit
DSO's pay top of market for practices that are predictable, sustainable, and still growing. Sellers want to maximize their exit. This practice did both - with systems and infrastructure.
Results at a Glance
$280K → $520K
EBITDA (Nearly Doubled)
$190 → $250
Hygiene PPH
67% → 87%
Pre-scheduled hygiene ($350k annual lift)
The Situation
This 3-partner general practice in Calgary, Alberta wanted to partner with a DSO for two reasons:
1. Maximize the value of practice at sale;
2. Accommodate 3 different career timelines
A DSO partnership offered the flexibility for 1 or 2 principals to exit, while the 3rd staying on long term.
The doctors knew the practice was under optimized with a lot of growth potential: hygiene department potential, charts were still on paper, the schedule had holes despite a large patient base.
What We Did (3 Levers That Changed Everything)
1) Leadership Shift: Hiring a Director of Operations
Problem: The doctors were running operations themselves — posting job ads, chasing metrics, putting out fires — without the time or skills to do it well.
Actions:
- Hired a Director of Operations, 5 days a week in the practice
- Coached the doctors on what to delegate and how to hold the role accountable
- Setup a weekly metrics scoreboard and a monthly review with the doctors
Impact: Operations moved off the doctors’ plates. Data went from scattered to specific.
2) Hygiene Recalibration: From an Under-Optimized Department to the Engine That Funded the Exit
Problem: No standard of care among hygienists, no pre-scheduling system, and low team morale.
Actions:
- Built a clear, team aligned standard of care they can be proud of
- Created a pre-scheduling system and process for the hygiene team and OM (what we do today affects our schedule in 3, 6 and 9 months)
- Educated on how changing these 2 things can dramatically improve patient outcomes
Result: Hygiene PPH $190 → $250 (~$350K/yr). Pre-scheduling 67% → 87%. Empty slots dropped to ~29%.
3) New Patient Engine: Building a Practice a DSO Wants to Buy
Problem: New patients were trickling in at 3.8/week. No clear roles. Missed same-day treatment. Unanswered patient messages.
Actions:
- Refined the new patient experience and activated internal referrals — zero external marketing
- Wrote clear job descriptions and prioritized checklists for every admin and clinical role
- Built a morning chart-audit process so the team walked in prepared, not reactive
Result: New patients 3.8/week → 6/week (~140 annualized), with zero external marketing spend.
"The process proved as valuable as the outcome. It took longer than expected to get the team bought in, but once we did with Steph's help, the improvements came quickly and felt easy."
Why This Worked
The partners knew they had a strong practice with more potential — they committed fully to the process and brought the team along. By leveraging the new Director of Operations to do the heavy lifting, they were able to focus on dentistry — out of the weeds, focused on patients – while enjoying the growth of the practice for their sale.
- Leadership that didn’t depend on the owners — a Director of Operations running the day-to-day, with the partners coaching from above
- Hygiene that ran on standards, not personalities — a defensible standard of care and pre-scheduling discipline across the team
- A new-patient flow that proved repeatable — clear roles, daily chart audits, and scheduling rules that protected high-value dentistry
Looking Ahead
EBITDA moved from $280K to $520K. The practice sold to a DSO at a top-of-market multiple. The team was intact and the systems were still running.
The lesson for any owner considering a DSO transition: the work that maximizes your sale price doesn’t happen at the negotiating table. It happens 12–24 months earlier — in the leader you hire, the systems you build, and the standards you make non-negotiable.
What was once a stalled practice is now a closed deal — and a blueprint for the next one.
Want the Same Outcome in Your Practice?
This is exactly what we implement inside the DDA Growth Advisory Program (GAP)—a hands-on execution framework for practices ready to scale without burnout.
To get started, book your complimentary 30-minute discovery call with DDA founder and CEO, Stephanie Richardson.
