DSOs Are Copying Amazon's Playbook. Most Will Fail.

DSOs Are Copying Amazon's Playbook. Most Will Fail.

The DSO platforms buying their way to scale aren't building anything defensible. They're just accumulating practices. The successful ones—Aspen, Heartland—aren't adding practices at the same clip. They're optimizing supply chains and shared services instead.

Why this matters: If your DSO is in acquisition overdrive without operational integration, you're burning cash on overhead that doesn't translate to better case acceptance or reimbursement. You're just paying more in platform fees.

The winners this year consolidated 40-50 practices max and focused on back-office automation, group purchasing, and associate equity retention. The losers are still chasing 200-practice portfolios.