How to Build a Multi-Practice Group Without a Bank Loan or Private Equity

Most dentists who want to scale assume they have two options: take on a bank loan, or sell a stake to a dental service organization. Those are the two roads dental media tells you exist. Build a group fast on borrowed money, or build it slower with someone else’s money and a three-to-seven-year clock ticking in the background.

There is a third option. It is the one I have used to build Pain-Free Dentistry Group to fourteen practices across Scotland over the last decade. No bank loans secured against the business. No private equity backer. No outside capital. Just longer time horizons, harder acquisition discipline, and a tolerance for slower growth than most groups will accept. The model is the closest thing to a real anti-DSO that exists in UK dentistry, and I think it is going to become more common as more owners realize what the standard playbook is actually costing them.

Why the standard playbook compresses your time horizon

Every form of outside capital comes with a clock attached. A bank loan has a repayment schedule. Private equity has an exit timeline, usually three to seven years from investment to sale. Even debt-free seller financing tends to require structured payments over a defined window. Once you take outside money, the calendar starts moving without you.

That clock affects every decision you make. When you have to hit specific financial targets by a specific date, you start picking acquisitions based on what will move the numbers fastest, not what will fit the culture you are trying to build. You hire to fill seats, not to fit the team. You expand into markets you do not understand because the geography looks good on a pitch deck. You make trade-offs that look small in any individual decision and add up to a group you would not have built if you had been given longer to think about it.

This is not a critique of dentists who take outside money. Some groups are built well on private equity capital and bank debt. But the structural pressure is real, and most owners do not see it until they are already inside it. Once you have signed the term sheet, the timeline is no longer yours.

What “anti-DSO” actually means

The phrase gets thrown around. Most of the time it is just marketing language used by groups that have a slightly different cap table than the big consolidators. The structural difference is not the ownership; it is the time horizon and the discipline that follows from it.

Pain-Free Dentistry Group is owned by registered dentists. We do not have outside investors waiting for a return on a defined schedule. That means we can take our time on acquisitions. We can walk away from practices that are financially attractive but culturally wrong for the group. We can grow slower than our most aggressive competitors and still build something that will be standing in twenty years. We have done that on purpose. We have lost acquisitions to other groups who could move faster and pay more. We were not sorry to lose them.

The standard DSO model is built on roll-up economics. Acquire as many practices as possible, standardize the operations, hit the financial targets, sell the combined entity to a larger DSO or to public markets. That model produces returns for the investors and acceptable outcomes for many practices and patients. It also produces specific kinds of dentistry, specific kinds of associate relationships, and specific kinds of patient experiences. If you want to build something different, you need a different financial structure underneath it.

How the math actually works without outside capital

The honest answer is that you grow slower and you grow with the cash you have generated, reinvested deliberately. The first practice has to be profitable enough that the surplus can sit aside for the second acquisition. The second practice has to be profitable enough that the surplus from both can sit aside for the third. Compounding takes time, and the compounding only works if you are running the existing practices well enough to produce real surplus, not just covering costs.

At Pain-Free Dentistry Group, the partnership model accelerates this. When a new partner buys in, their capital becomes part of how we fund growth. They are not just buying a stake in their own practice; they are taking shareholdings in future acquisitions across the group, which means new partner capital and group surplus together fund the next deal. The partners are aligned with the long-term thinking because they are not getting an exit either. They are building something they want to be part of in ten years, not something they want to flip in three.

We are also disciplined about what we will not do. We will not borrow against the business. We will not bring in outside investors. We will not chase practices that do not fit the culture, even when the price is right. We have walked away from acquisitions that looked good on paper because the team at the practice was clearly not going to fit the group. We can do that because nobody is making us hit a deal-flow number this quarter.

What the model gives up

Slower growth is not a hardship in itself, but it does mean you watch other groups expand faster than you. It means some of your best associates will leave because they want a faster route to ownership somewhere else. It means you will lose acquisition opportunities to better-capitalized competitors. It means you have to be patient in years where everyone around you is growing aggressively, and you have to be confident that the slow build will produce a better long-term outcome than the fast roll-up. That confidence is harder to hold than most owners admit.

The model also depends on running the existing practices well enough to generate real surplus. If the practices are profitable but not very profitable, the compounding stalls. The 20/80 rule and the systems work and the culture document all matter here not because they are nice things to have but because they are what makes the math work. A group that does not run its individual practices well cannot self-fund growth. The operational excellence and the financial structure are the same problem.

If you are thinking about building or joining a group and you are tempted by the speed that bank debt or outside investment promises, do the math on what you are actually giving up. Faster growth on a compressed timeline is not the same thing as a better group at year ten. Sometimes the slower road builds something the faster road cannot.

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I recently joined Dr. Reza Ardalan on The Dental Slang Podcast to talk about the self-funded model behind Pain-Free Dentistry Group, the 20/80 rule that shapes how we audit the patient experience, and the partnership model that turns A-player associates into shareholders across every acquisition.

Tune in!

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About the Author

Dr. Mark Skimming is the Managing Partner of the Pain-Free Dentistry Group, a fast-growing network of private dental practices across Scotland and the North of England, currently operating 14 sites with ambitions to expand to 35–50 over the coming years but only practices of the ‘right fit'.

His journey into building the group wasn’t straightforward. After opening his first squat practice, Mark quickly realised that patients don’t just “turn up”—and was forced to rapidly develop his skills in leadership, systems, marketing, and team culture to survive. That early experience shaped his belief that great dentistry isn’t just clinical—it’s operational.

His vision for Pain-Free Dentistry was also deeply personal. After experiencing acceptable care but a poor patient experience himself as a teenager following a traumatic dental injury, Mark became driven to create a model that delivers a genuinely elevated patient experience—one that goes beyond what traditional systems, particularly within the NHS, often allow, both clinically and non-clinically.

Today, the group is known for combining high clinical standards with a strong commercial engine, built around systems, training, and accountability. A key differentiator is its partnership model, where clinicians can take share ownership in practices—aligning incentives, building long-term careers, and giving them a genuine voice in the direction of the business.

Mark is particularly focused on developing clinicians into high performers—often supporting them from early in their careers through advanced training, mentoring, and ultimately into partnership. The group places a strong emphasis on culture, coaching, and what he describes as “A players”—people who take ownership, continuously improve, and contribute to a high-performance environment.

He is a firm believer that dentistry is fundamentally undervalued in the UK, and that the future of the profession lies in moving away from outdated models and towards systems that properly reward clinical excellence, patient experience, and team development.

Outside of dentistry, Mark is focused on continuous improvement, but doesn’t take himself too seriously—valuing humour, family time, and balance. Much of his time outside work is spent with his children, whether that’s football, drama, music, or the occasional round of golf, and with his wife and extended family and friends, often including time on the Mediterranean coast in the south of Spain.