The GrowOrtho Podcast

Episode: What Is My Practice Worth When Selling To An OSO Or DSO In 2026? Show: GrowOrtho Podcast, Host: Luke Infinger, CEO and co-founder, HIP Creative Guest: Brian Christensen, CFA, Chief Development Officer, 7 Pillars Published: Summary: Selling an orthodontic or dental practice to a DSO or OSO usually takes about six months from signing with an M&A advisor to closing, according to Brian Christensen, CFA, Chief Development Officer at 7 Pillars, and 60 to 90 days of that is due diligence after the letter of intent. Buyers price the practice on adjusted EBITDA, which is revenue minus true go-forward operating expenses minus market-rate doctor pay, and multiples start to climb at roughly $1 million of EBITDA. Christensen estimates a one-doctor practice with $2 million of EBITDA an hour outside Atlanta would trade at about 7.5x to 8.5x, while very high EBITDA concentrated in one provider creates key-person risk that lowers the multiple. Earnouts only count if the targets are achievable, and buyers weigh the last three to six months of performance heavily. In 2026 the DSO market is shifting toward large groups buying smaller groups, sponsor-led platform mergers, and IPOs as alternatives to the traditional private equity recapitalization. Topics covered: practice sale timeline, M&A advisor engagement letters and success fees, adjusted EBITDA and add-backs, buyer selection and letters of intent, due diligence, exit multiples, earnouts, key-person risk, DSO consolidation, private equity recapitalizations, dental IPOs, the orthodontic M&A market. Key entities: 7 Pillars, Brian Christensen, Brett Pierce, Christy Ratcliff, Luke Infinger, HIP Creative, GrowOrtho Podcast, US Oral Surgery Management (USOSM), MB2 Dental, Heartland Dental, Foundation Dental Partners, Smile Doctors, myOrthos, Paradigm Oral Health, BlackRock Long Term Private Capital, Warburg Pincus, Thurston Group, SGA Dental Partners, Gen4 Dental Partners, Modis Dental Partners, Tyree & D’Angelo Partners, Park Dental Partners, Blackstone, KKR, Invisalign. About The Author Luke Infinger CEO and co-founder, HIP Creative | Host, GrowOrtho Podcast Luke Infinger leads HIP Creative, a growth partner for orthodontic, dental, oral surgery, and multi-specialty practices, and hosts the GrowOrtho Podcast, where he interviews the advisors, operators, and doctors behind growing orthodontic practices. Profile: [AUTHOR PROFILE URL] Featured Expert Brian Christensen, CFA Chief Development Officer, 7 Pillars Brian Christensen oversees client development at 7 Pillars, an M&A advisory firm that represents healthcare business owners. He previously worked in M&A at US Oral Surgery Management and as Vice President of Business Development at BOND Orthodontic Partners, and he holds an MBA from Southern Methodist University. Profile: https://www.7pillarsadvisory.com/our-practice/meet-our-doctors/brian-christensen/ Selling to a DSO or OSO takes about six months once the process starts, according to Brian Christensen, CFA, Chief Development Officer at 7 Pillars, and many practice owners start the conversation later than they should. Christensen has worked both sides of these deals. He did M&A for US Oral Surgery Management, helped a West Coast orthodontic support organization grow from 3 locations to 50 in about two years, and now represents sellers at 7 Pillars, a healthcare M&A advisory firm that completes 20 to 25 DSO and private equity transactions a year. In this GrowOrtho Podcast episode, Luke Infinger, CEO and co-founder of HIP Creative, asks Christensen to walk through a sale from the first signature to closing. They cover how buyers calculate adjusted EBITDA, which add-backs raise it, what multiples a single-doctor practice can expect, why an earnout can make an $8 million offer look like $10 million, and how the DSO market is moving toward platform mergers and public offerings. Christensen’s main advice for sellers is to know your numbers the way a buyer will calculate them, and to keep growing after you sign with an advisor, because the last three to six months of performance can move your multiple. Key Takeaways A practice sale run by 7 Pillars typically takes about six months from engagement to closing, with 60 to 90 days of due diligence after the letter of intent; the fastest deal Christensen cited closed in five and a half months. Adjusted EBITDA for a practice sale equals revenue, minus true go-forward operating expenses after personal and one-time add-backs, minus market-rate doctor compensation, which most groups set as a percentage of collections. Christensen said EBITDA multiples start to rise at about $1 million of EBITDA, and he estimated a one-doctor practice with $2 million of EBITDA an hour outside Atlanta would trade at roughly 7.5x to 8.5x. Very high EBITDA produced by a single doctor creates key-person risk, and 7 Pillars has advised owners in that position to add an associate or partner because the higher multiple can outweigh the lower profit. An $8 million offer with a $2 million growth bonus is an $8 million offer if the growth target is unrealistic, so sellers should compare cash at closing. Buyers start with trailing 12-month EBITDA but weigh the last 3 to 6 months heavily, and an unexplained dip during the process can cost the seller negotiating power or the buyer altogether. The deal blockers Christensen sees most often are bringing in a financial advisor or CPA too late and taking advice from too many people outside a small core team. When Should A Practice Owner Start Talking To An M&A Advisor About Selling To A DSO? Brian Christensen of 7 Pillars tells practice owners he would rather they start the conversation slightly too early than too late. Waiting too long narrows the pool of dental support organizations (DSOs) and orthodontic support organizations (OSOs) willing to bid, and it lowers the price. He also separates timing from motive. Christensen’s rule is to never sell out of fear and never sell because a friend did. Start with what you are trying to solve for. When owners say the answer is money, the follow-up is what the money is for, and Christensen points out that if money alone were the goal, more orthodontists would be working Fridays and Saturdays. An early conversation does not commit anyone to a sale. 7 Pillars regularly talks with owners who only want to understand current deal structures and what buyers are paying for, and some owners go to market just to test their value. Christensen’s view is that when several buyers independently give the same feedback, such as growing new patients, hiring more treatment coordinators (TCs), expanding the footprint, or closing underperforming locations, the feedback is probably right and worth acting on. How Long Does It Take To Sell A Dental Or Orthodontic Practice To A DSO? According to Brian Christensen of 7 Pillars, a practice sale usually takes about six months from signing the engagement letter to closing when the seller, advisor, and buyer all move quickly. The fastest deal he cited closed in five and a half months. Roughly 60 to 90 days of that window is due diligence after the letter of intent (LOI) is signed. Delays come from ordinary life as often as from deal problems. One 7 Pillars client left for a month-long trip to Japan, and the process paused while he was gone. Christensen describes a push and pull: buyers have momentum and their own pipelines, and a seller who stalls risks losing that momentum. Longer timelines happen. Christensen described a non-dental operating business that engaged 7 Pillars in December 2024, went to market in spring 2025, accepted an LOI in July 2025, and was still expected to close at the end of 2026, close to two years in total. He also described a general dentist (GP) who signed with 7 Pillars in 2024, found a dental support organization (DSO) he liked, and then spent another year fixing staff turnover and growing cash flow and EBITDA before closing with MB2 Dental. Waiting the extra year let him close with the group he had wanted from the start. What Does An M&A Advisor’s Engagement Letter Cover, And What Is A Tail? An engagement letter is the contract a practice owner signs with an M&A advisor before any analysis begins. Brian Christensen of 7 Pillars describes it as a long document that sets out the advisor’s responsibilities, the seller’s responsibilities, and the economic arrangement. At 7 Pillars, the economics are usually a success fee, meaning a percentage of the transaction paid only if the deal closes. The firm typically charges no retainer or upfront fee. Christensen’s reasoning is that when the seller gets paid, the advisor gets paid, and if the process ends without a deal, both sides lose only time. A tail is the clause that protects the advisor if the seller walks away. Under 7 Pillars’ usual terms, Christensen said, a seller who terminates the engagement or decides not to transact cannot pursue a deal with any buyer 7 Pillars talked to on the seller’s behalf for about one year. He noted that other advisors use breakup fees or longer tails, so sellers should compare those terms before signing. How Is Adjusted EBITDA Calculated When You Sell A Dental Practice? EBITDA (earnings before interest, taxes, depreciation, and amortization) is the cash-flow number that dental support organizations (DSOs) and orthodontic support organizations (OSOs) use to price a practice. Brian Christensen’s working formula for a practice sale is revenue, minus the true go-forward operating expenses of the business, minus market-rate compensation for the doctor. The go-forward adjustment is where add-backs come in. Add-backs are expenses on the current books that a buyer will not carry after closing, so they get added back to profit. Christensen splits them into two groups. Personal add-backs include pay for a spouse or children who do not actually work in the practice, a boat, a country club membership, sports tickets (he has seen 49ers tickets on the books)

More than 90% of dentists and orthodontists negotiate their office real estate with no representation, and it costs them. Colin Carr explains that lease renewals are the single transaction where healthcare providers lose the most money, with the average practice leaving a couple hundred thousand dollars on the table, and roughly $300,000 on a standard 10-year lease for a 3,000-square-foot space. He walks through why savvy landlords treat an unrepresented doctor as an easy target, why ChatGPT and a family-law attorney friend cannot substitute for a healthcare-specialized broker, and why the broker commission is already built into every deal whether the tenant uses it or not. The episode closes with clear timing: start a renewal, relocation, or purchase conversation 18 months out, a ground-up build 18 to 24 months out, and a startup 9 to 12 months out.

Most orthodontic and dental websites rank fine and still bring in almost no new patients. Luke Infinger and James Kuck break down what separates the best orthodontic websites from the ones costing practice owners money every month. Here's what they cover: - The SEO basics most practice sites still get wrong, starting with page titles that just say "Home" - Why the doctor page is the second-most-visited page on almost every practice site, and how to build real trust on it - The design and mobile checks that decide whether a patient books or leaves - The one question most owners can't answer: how many new patients did your site produce last month?

Episode: The 6 Treatment Coordinator Mindset Shifts That Take Close Rates to 75% Show: GrowOrtho Host: Luke Infinger, Founder and CEO, HIP Creative Guests: None (solo episode) Published: [07-13-2026] Last updated: [07-13-2026] Summary: Luke Infinger argues that treatment coordinator performance is a mindset problem before it is a training problem, and he lays out six shifts that change it. Only 20 to 30% of dental and orthodontic offices staff a dedicated treatment coordinator, which means most practices are asking an admin or the doctor to sell, and conversion suffers. The core reframe is that the patient who booked, showed up, and sat down is already pre-sold, so the consult exists to remove fear and friction rather than to convince. Practices that install these shifts can move from the roughly 52% average close rate to 75% or higher, add up to $1,000 in production per new patient start, and double daily consult capacity by cutting the new patient consult from 60 minutes to 30. Luke also covers pay structure, recommending low hourly with heavy commission upside rather than the high-hourly, low-commission model most practices default to. Topics covered: treatment coordinator role, case acceptance, close rate, consult length and scheduling capacity, sales mindset, patient objections and no-shows, softening language and tone, film review for sales teams, TC compensation and commission structure. Entities named: HIP Creative, GrowOrtho, Luke Infinger, George Bernard Shaw, Brian Tracy, Buckle, Amazon, Invisalign, HIPAA. AUTHOR BLOCK By Luke Infinger CEO & Co-Founder, HIP Creative | Author | Luke Infinger has spent more than 12 years helping dental and orthodontic practices grow through marketing, software, and education. He is the founder of HIP Creative, which works with 580+ dental and specialty practices across the country, and the creator of Practice Beacon, a lead-tracking CRM built specifically for dental and orthodontic teams. His work has included taking practices from regional obscurity to nationally recognized growth benchmarks, among them helping an orthodontist become the fastest-growing in the country by 2018. He is also the author of multiple books on practice growth and a sought-after speaker for dental continuing education events. LinkedIn: https://www.linkedin.com/in/luke-infinger-b36a001b/ Most practices try to fix case acceptance with a new script. The treatment coordinator mindset is what actually moves the number, and it moves before anyone opens their mouth in the consult room. What your treatment coordinator believes about the patient walking through the door determines how they open, how hard they push, and whether they ask for the start at all. Luke Infinger opens this episode with a line from George Bernard Shaw: those who cannot change their minds cannot change anything. It sounds like a poster on a wall until you watch two coordinators with identical training produce a 45% close rate and a 78% close rate. The scripts were the same. The belief about the patient was not. Six shifts follow. They cover who should hold the role, what to assume about the person in the chair, how to hold your own certainty when leads go quiet, how to lower a guarded patient’s defenses, how to build consult capacity out of thin air, and how to pay a top performer so they never take a call from a competitor. Key takeaways Only 20 to 30% of dental and orthodontic offices staff a dedicated treatment coordinator (TC), and it is rarer on the dental side than in orthodontics. Putting a generalist in a sales role produces poor conversion. Luke’s view is that a salesperson can survive at the front desk, but an admin moved into treatment presentation usually cannot survive as a closer. The average practice close rate sits around 52%. Practices that treat every patient as pre-sold can reach 75% or higher. A one-hour new patient consult can be cut to 30 minutes with a defined format, which takes a practice from roughly three consults per day to six without adding chairs or hours. Over-explaining kills starts. Luke’s rule is that details are the enemy of execution, and he points to Brian Tracy’s “-er factor”: faster, better, easier, cheaper. Most practices pay treatment coordinators too much hourly and too little commission. Luke recommends flipping it toward minimum wage or near it, with significant upside tied to starts and revenue added. Installing these shifts can add up to $1,000 in production per new patient start. Free Growth Session   Why should an orthodontic practice hire a dedicated treatment coordinator? A treatment coordinator (TC) is a specialized sales role, and only 20 to 30% of dental and orthodontic offices actually staff one. In orthodontics it is more common. In general dentistry, Luke says a dedicated TC is genuinely rare. The cost of not having one shows up as broken flow state. When the doctor has to sell, the doctor stops doing the only thing the doctor can do, which is diagnose, treat, and move to the next chair. Pull that same doctor into payroll, time-off approvals, and team conflict, and you get a stressed owner with operational chaos underneath them. The same principle applies to the coordinator. A strong TC who is skilled at sales, extroverted, and genuinely empathetic should be presenting treatment, closing treatment, and moving to the next patient. Break that rhythm by handing them administrative work and their numbers drop, partly because they are not happy doing it. Luke’s argument on direction of movement is worth sitting with. Take a salesperson and put them at the front desk or in an admin seat and they will probably be fine. Take an admin and put them in a sales seat and conversion tends to fall apart. The skills do not travel both ways. For a small or startup practice, Luke still treats the TC as a key hire. His build order is one administrative assistant, one clinical assistant, and one treatment coordinator. As the practice grows, that administrative assistant becomes the office manager. What does “the patient is pre-sold” actually mean? It means the patient already decided something before they arrived, and the consult is not where the decision gets made. Luke sees practices operating from the opposite belief. They act like the patient is on the fence, like there is a long warming-up process, like the start is genuinely in doubt until the last minute. Then he asks the obvious question: who takes two hours off work, gets the kids ready, and drives to an orthodontic office for the fun of it? Most patients who need treatment are insecure about their smile. That insecurity is what motivates them to move fast. They want confidence. They picked your practice out of the options available to them, booked the appointment, and showed up. Very few of them want to repeat that process at two more offices next month. Luke pulls the analogy from his own retail days at Buckle in the mall. Plenty of people walked past. But the ones who came in were touching product, picking up jeans, holding shirts against themselves. He closed at a high rate because he believed those signals meant intent. If he had assumed those people did not want to buy, he would have performed like someone who assumed that. When a treatment coordinator treats every patient as ready to move forward, the close rate can move from the roughly 52% average to 75% and above. The belief changes the ask, and the ask changes the number. Free Growth Session   How do you build certainty before a consult when leads go quiet? Luke’s third shift is a three-question check a treatment coordinator (TC) runs on themselves whenever their confidence slips. He calls it truth, fact, and reality. The truth. What does this person actually want? Straight teeth. Teeth that let them eat normally. Confidence. To stop hiding their smile in photographs. That desire existed before your practice showed up in their feed. The fact. They clicked on something. They called your practice. They booked an appointment. Nobody forced them to do any of it. That fact does not evaporate because they went quiet afterward. The reality. Everyone is guarded, and people are busy. A no-show does not mean a bad patient, and it does not automatically warrant a fee or a booking block. In a dental practice, the patient may be carrying real fear about pain. In an orthodontic practice, they may be scared of what it costs. They may have simply forgotten. The practical payoff is in follow-up. A practice that varies its outreach across call, voicemail, text, and email eventually reconnects the dots for the patient. They recognize the name, remember the person who was kind on the phone, and remember that they do want braces or Invisalign after all. Luke’s point is that the no-show can become your best patient once the guard comes down. Any time a coordinator catches themselves believing a lead is dead, running truth, fact, and reality restores the accurate picture. How do you lower a guarded patient’s defenses? Luke frames the treatment coordinator (TC) as a disarmament agent. The job in the first minutes of contact is to lower the guard, and guard comes down through words, tone, and body language. Start with the words. Here is a transactional version of a same-day start offer: “We offer same day starts, so we can start today if you’re interested.” Here is the softened version Luke prefers: “We offer same day starts, so you could begin today without another visit, if that might possibly work for you and your schedule.” The content is identical. The second one gives the patient room to breathe. Softening words and connecting phrases lower guard where a direct push raises it. Delivery carries more weight than word choice. Luke cites the widely repeated Mehrabian research, which found that in situations of ambiguous emoti

Most practice owners think they have a marketing problem. In this GrowDental session, HIP co-founder and CEO Luke Infinger argues they have a congruence problem: a gap between how good a practice actually is and how good patients think it is before they ever walk in. He calls the fix the congruence effect, the alignment between your clinical reality and your brand perception. When the two match, patients show up already convinced and case acceptance becomes a conversation, not a sales pitch. When they don't, you burn chair time rebuilding trust you should have earned online. Luke backs it with patient behavior data, including that 89.7% of patients start their search online, 72% start on Google, and businesses with 100+ images on their Google Business Profile get 500% more calls. The throughline is sequence. Luke lays out the order that actually drives growth, brand first, then findability, then amplification, and names the most expensive mistake in dental marketing: pointing paid ads at a foundation that isn't ready, which is why 30 to 40% of ad budget gets wasted on poor conversions. Along the way he covers the 72-hour rule for booking digital leads before no-shows climb, the 6x cost gap between organic and paid leads ($30 versus $180), and why your brand is a clinical asset, not a line item. He closes with the question worth sitting with: if your best patient's friend searched for you the way they'd search for anyone else, would they find you, and would what they saw do justice to the care you deliver?