Six months into ownership, Colten Butler’s wife looked at him and said: “This has not been worth it.”
She wasn’t wrong. Not yet.
The insurance companies were still sending payments to the old DSO. His office manager was spending hours on the phone fighting for money that had already been earned. The nest egg he and his wife had spent years building was draining faster than he expected. He had switched practice management software mid-stream (which ended up being a $10,000 lesson he didn’t see coming.) He was waking up at 3am thinking about flooring and computers and whether the business loan was going to hold.
By January — five months into ownership — he would not have told you it was worth it. Not in February either. But by March, things started to turn.
The Practice He Was Already Running
Colten moved from St. George, Utah to Greensboro, North Carolina with a specific plan: work for a DSO, turn and burn, and not feel guilty about it.
What he found instead was a practice with an absentee owner — an 80-year-old orthodontist in Indiana — and a DSO acting as a management company that nobody had much confidence in. Within six months, Colten was hearing whispers that the DSO wanted to pull out.
He made a quiet decision to stay.
“I was essentially already the owner doctor,” he said. “I was doing a lot of the things and just not getting paid like I was the owner.”
The patients knew him. The staff knew him. He knew every corner of the practice. When the opportunity to buy finally became real, he wasn’t weighing an abstract decision about some practice he’d toured once. He was deciding whether to buy something he had already built.
Buying a Dental Practice From a DSO That Wouldn’t Let Go.
Buying from a DSO is not like buying from a retiring solo doc. There is no handshake, no seller who cares about the legacy, no straightforward negotiation.
The DSO Colten was dealing with had been acquired by another DSO, which had been acquired by another DSO. Three layers of corporate structure between him and a simple transaction.
“They were intentionally mucking it up,” he said. “They were trying to drag their feet and just milk the office for as long as they could.”
He spent roughly double what he should have in legal fees. There were moments when he genuinely wasn’t sure the deal was going to happen. He looked at other offices in Greensboro. He flew down to take a startup course, keeping his options open.
But he kept coming back to the same reality: the patients knew him. The practice was already his in every way except the paperwork.
The deal eventually closed in August 2025.
The First Year Nobody Talks About
The closing documents were signed. The keys were his. And then the real work started.
The insurance companies hadn’t gotten the memo. Even with a new tax ID on file, claims were routing through his NPI number — and landing in the DSO’s accounts. His office manager spent hours every week on the phone, practice by practice, insurance company by insurance company, correcting the error.
“We are still getting payments from almost a year ago that went to the DSO,” he said. “And of course, the DSO didn’t care. They were happy to pocket that money.”
He also discovered, the expensive way, that not all practice management software is equal. A $10,000 switch to Open Dental later, he had systems he could actually use to track the numbers that mattered.
By January, the business account was looking thin. His wife’s six-month verdict hung in the air.
“Six months in, my wife told me: this has not been worth it,” he said. “This has been way stressful.”
She was right. It had been.
February. March. Then Something Shifted.
By February and March, the insurance fights were mostly resolved. Money was flowing correctly. He started paying himself better. The cushion in the business account grew back.
He stopped waking up at 3am.
Nearly a year out from closing, he is hiring an associate. Vacations are on the calendar. The practice is growing.
“Had you asked me in January or February, I probably would have said heck no,” he said. “But now I would say yes.”
When asked what he’d tell an associate who keeps waiting, he didn’t talk about readiness or timing or finding the perfect practice.
“If you wait another two years, that’s just two years down the drain that you could have been investing in your own office and going through these bumps along the road,” he said. “You just gotta rip the bandaid off and jump in.”
A Word to the Dentist Who Is Still Waiting
Colten’s story is different from the others in this series. He wasn’t scared to buy. He knew he wanted to own from the beginning. What he didn’t know was how hard the first year would actually be — and that it would be worth it anyway.
If you’re waiting because you’re afraid of what happens after the close, Colten’s honest answer is: some of it will be hard. You’ll have moments where you’re not sure. Your spouse might tell you it wasn’t worth it.
Push through February. Things start to turn.
If any part of this sounds familiar, the first step is simpler than it feels. Download the first chapter of How to Buy a Dental Practice, 5th Edition free, or book a no-pressure consultation at dentalbuyeradvocates.com.
