Rising student debt is changing who can buy a practice, and what that means whether you’re looking to buy, sell, or hire.
A generation ago, the path from associate to owner was mostly a question of patience. A young orthodontist put in a few years, saved what they could, and eventually bought into or bought out a practice. That path still exists, but fewer doctors are walking it. Practice ownership among orthodontists has fallen from 80% in 2018 to 68% today, and the drop is steepest among younger doctors, who are now more likely to join a DSO as their very first career move than to pursue ownership at all.¹ That is not a small shift. It is a structural change in who is even in the market to buy a practice, and it is accelerating for reasons that have little to do with how much a young doctor wants to own.
The Debt Trend
The single biggest driver is debt, and it has grown well past what most established owners carried at the same career stage.
Dental school costs have climbed for two decades running, and orthodontic residency adds another two to three years of tuition and lost income on top of it. The result is that many orthodontists now enter practice already carrying debt loads in the mid-six-figure range before they have written a single mortgage or practice loan application. That debt does not just delay ownership. It changes the math on it.
A young doctor already carrying six figures in student loans is a generally a harder credit risk for a bank loan, has less capacity to take on the additional debt a practice purchase requires, and often needs several years of associate income just to get their personal balance sheet into a position where a lender or a seller will take them seriously.
Where a doctor a generation ago might have targeted ownership within a few years of graduation, it is now common for that timeline to stretch closer to five or more, depending on the market.
The Buyer Squeeze
Meanwhile, the buyer pool a young doctor is competing in has changed underneath them.
Orthodontics has one of the highest rates of DSO and OSO affiliation of any dental specialty, and that is not incidental. It is a direct byproduct of the debt trend above.² Young doctors face pressure from two directions at once, and both trace back to the same cause.
As buyers, they are increasingly outmatched. An institutional buyer, whether a traditional DSO or a doctor-owned OSO, can move with cash on hand, a dedicated acquisition team, and a valuation model built for scale. A young associate trying to assemble financing for a single practice simply cannot match that speed or certainty, especially when a retiring owner wants a clean, fast, and lucrative close.
As job candidates, those same organizations are often the first ones in the door. DSOs and OSOs recruit directly out of residency, sometimes before a new graduate has had time to consider ownership as a near-term option at all. For a doctor still carrying resident-level debt, a salaried associate position with no capital outlay can look far more attractive than a purchase they are not yet financially positioned to make, even if ownership was the original goal. The effect compounds industry-wide: dental support organizations have grown roughly twentyfold over the past decade and a half, and they are actively targeting specialty practices like orthodontics as that growth continues.³
What This Means If You’re Selling
If you are an established owner thinking about a sale or transition, this shift shows up first in your buyer pool.
Ten or fifteen years ago, a retiring orthodontist could reasonably expect several individual doctors to be in the market for their practice. Today, that pool of individual buyers is thinner, and it is increasingly crowded out by institutional buyers who are ready to transact on their own timeline.
That does not mean a doctor-to-doctor sale is off the table. It means the negotiation looks different depending on who is on the other side of it. An individual buyer needs financing, needs time to get comfortable with the practice’s operations and patient base, and is personally exposed to the debt they are taking on to buy you out. An institutional buyer brings capital and speed, but the deal structure, the valuation methodology, and what happens to your team afterward will look nothing like a traditional handoff to another doctor. Knowing which kind of buyer you are actually negotiating with, before you get deep into a term sheet, changes how you should be preparing your practice and your expectations.
Comparing Outcomes: Doctor-to-Doctor vs. Partnership Models
The valuation gap between these two kinds of buyers is one of the clearest signals of why this shift is happening.
A traditional doctor-to-doctor sale is priced against a single practice’s own earnings. An institutional buyer, DSO or OSO alike, is typically willing to pay more, because that same practice’s earnings become more valuable once they are folded into a larger, aggregated business with its own scale. That gap is a large part of why individual buyers struggle to compete on price, and why institutional buyers keep expanding their reach into specialties like orthodontics.
Where the models genuinely diverge is in how that higher valuation gets paid out, not just what the number is. A doctor-to-doctor sale is a straightforward cash transaction. A short-hold, roll-up-style DSO sale will trade at least a portion of the total valuation for cash, but the seller usually stays on as an employed associate to satisfy an earn-out period, at which point their stake in the practice is gone for good. A partnership model like Corus structures the transaction differently: rather than a full cash payout, part of the deal offers equity in the broader network, so the doctor becomes a shareholder instead of just an employee. This means that their financial outcome is tied to the partnership’s collective growth going forward instead of ending at the closing table. What the number is made of, and what stake you retain in what happens next, is the part worth slowing down for.
What This Means If You’re Buying
If you are the young doctor on the other side of this equation, a ready institutional partner changes the debt-and-timeline math in your favor, provided the model is structured to bring you in rather than simply hire you.
A traditional acquisition loan requires you to qualify for financing against your own balance sheet, debt and all, on your own timeline. A structured partnership path removes that hurdle by design: a defined route into a practice, typically starting with a mentored associateship rather than an immediate purchase, that lets you build clinical and financial footing before you are asked to buy in. Because the equity stake is funded as part of the partnership structure rather than through a separate loan you have to qualify for, the debt you are already carrying from school stops being the gatekeeping factor it would be in a traditional purchase.
That distinction matters most for the doctors this shift affects hardest: the ones who want ownership, not just an associate paycheck, but whose timeline to get there under a traditional purchase model keeps stretching further out of reach.
The Bottom Line
The orthodontists buying and selling practices today are not the same population they were a decade ago, and the shift is still underway. Debt is reshaping who can compete for ownership, institutional buyers are filling the gap that creates on both the buy side and the hiring side, and the practices caught in the middle, on either end of a transition, need a clear-eyed read on which kind of buyer or partner they are actually dealing with.
Corus Orthodontists: A Unique OSO Model
Whether you’re preparing to transition or working toward ownership, Corus offers a path that doesn’t force a choice between liquidity and equity. Established owners can transition while keeping a stake in what comes next, and associates get a defined route into ownership without a traditional practice loan standing in the way.
Book a Discovery Call to see what that path could look like from your side of the table.
Related Reading
How to Value Your Orthodontic Practice
How Long Does an Orthodontic Practice Transition Take?
How Does a DSO/OSO Make Money?
How to Sell Your Orthodontic Practice and Whether You Actually Should
¹ Becker’s Dental Review, “Orthodontist Practice Ownership Declines: AAO Report.”
² Becker’s Dental Review, “The Shifting Orthodontics Landscape,” April 2, 2026.
³ North Dakota Dental Society, “The Rise of DSOs in Dentistry: The Pros and Cons of Joining a Dental Service Organization,” April 11, 2025.
