The Most Successful DSOs Grow From Within (Learn How) | Ep. 5

"You can't buy your way out of this economic environment. You have to grow from within." In this episode of Beyond The Operatory, host John Stamper sits down with Brian Colao, Director of the DSO Industry Group at Dykema, to discuss the critical shift from "deal-making" to "business-building." With interest rates up and Mergers and Acquisitions activity cooling, the era of rapid buying and selling is over. Brian explains why the most successful dental organizations in 2026 are pivoting to Same-Store Growth as their primary engine for profitability. They dive deep into the "boring but profitable" operational levers that many practices overlook—from fixing a leaky Revenue Cycle Management (RCM) process to optimizing procurement and solving the hygiene staffing crisis. Brian also shares why "Patient Acquisition Cost" (PAC) is the new metric every dentist needs to track and how AI is revolutionizing the front desk. In this episode, we cover: Chapters 00:04:21 The Great Pivot: Why economic headwinds like inflation and staffing shortages have made "Same-Store Growth" the primary priority through 2026. 00:07:23 Closing to Grow: Why the number of offices is a vanity metric and why closing an underperforming location can actually increase an organization's overall EBITDA. 00:10:39 The "TV Remote" Problem: The "Netflix and Disney+" analogy—how the lack of open architecture and integration between software systems creates a "failure to launch" for new dental tech. 00:13:10 Centralization vs. Autonomy: A 31-year history lesson on why the "everything stays the same" promise to selling doctors leads to "indigestion" and difficult conversations down the road. 00:22:04 Procurement Power: Why tackling the "boring" task of formulary consolidation can save solo practices tens of thousands and large DSOs millions. 00:26:30 The Hygiene Crisis: The reality of the "Great Resignation" in hygiene and how staffing shortages are causing practices to lose money on reimbursement rates. 00:28:00 The RCM Crisis: Why Revenue Cycle Management is the "make or break" for dental executives and how to maximize insurance dollars at the lowest possible cost. 00:32:10 Patient Acquisition Cost (PAC): Moving beyond reactive marketing to understand the new metrics of AI-driven patient acquisition. 00:35:01 Chair-Side Financing: How new face-recognition and mobile technology allow patients to get approved for $4,000+ treatments in under five minutes without leaving the chair. About the Guest: Brian Colao is the Director of the DSO Industry Group at Dykema. He is widely regarded as one of the foremost authorities on dental support organizations (DSOs) and has served as counsel to hundreds of dental organizations nationwide. Brian is also the architect behind the annual Dykema DSO Conference, the largest and most influential event in the DSO industry.