Phones across a DSO: one standard, many front desks

Group practices are a growing share of US dentistry. The ADA Health Policy Institute reports that the share of dentists affiliated with a Dental Support Organization more than doubled, from 7.2% in 2015 to 16.1% in 2024. Among dentists up to ten years out of school, it reached 26.5% ¹. Each of those locations still has a front desk, a phone that rings, and patients who expect their own office to pick up. This post covers how to run phones across locations without losing what makes each one work.

Decide what is central and what is local

Groups often argue about whether to centralize the phones. A more useful question: which parts of a call should be the same everywhere, and which belong to the location? Here is a split that holds up:

The left column is what a patient can count on at any of your offices. The right column is what makes a patient feel they reached their own office.

Plan for the staffing you have

A standard that assumes every desk is fully staffed will fail on the first sick day. In the ADA Health Policy Institute’s December 2025 survey, 24.7% of dentists had recruited administrative staff in the previous three months. Of those, 32.0% called it extremely challenging ². Write the standard so a location can meet it short-handed. Name a backup seat. Set up an overflow route that captures every caller’s details. Add a clear rule for when calls move to another location or a shared line.

Keep the phone at the center of the plan. In a 2024 online panel survey, 56.4% of US adults named the phone as their main way of booking a medical appointment ³. That study covers medical care, not dentistry. It is still the best evidence available, and it says not to assume patients have moved online.

One database, many locations

If your group runs Open Dental, its Clinics feature lets several locations share one database and still report separately ⁴. That helps with phones. A central team or tool can see every location’s schedule, while each location’s chairs, providers and hours stay distinct. Two cautions. Agree on names for chairs and appointment types before you add the next location. And if you use eServices, the manual advises contacting Open Dental’s support before you turn on Clinics ⁴.

Access by role, not by convenience

A shared phone team can see more patients’ information than a single front desk ever did. HIPAA’s minimum-necessary standard asks you to make reasonable efforts to limit access to protected health information to what the task requires ⁵. For phones, that means access by role. A central agent sees the schedule and the caller’s basic record, not clinical notes or ledgers. Review each person’s access when their role changes. Put every shared phone tool and vendor into your risk analysis, which the HIPAA Security Rule requires to be accurate and thorough ⁶.

Sign vendor agreements once, and read them for every location

A phone vendor, an answering service or a voice agent that stores call content is a business associate. Each needs a business associate agreement. Sign those centrally, so every location’s patients are covered by the same terms. If your locations sit in different legal entities, make sure each agreement names them. Then keep one list: vendor, what it stores, which locations use it, the signed agreement and its review date. When you add a location, the list shows which agreements it inherits and which need an amendment.

Adding a location: a phone checklist

1. Name the primary and backup seats before the first day.
2. Load local hours, holidays and the on-call rotation into every tool that answers the phone.
3. Name the chairs and appointment types to the group convention.
4. Add the location to each vendor agreement and to the risk analysis.
5. Run test calls for each route: a routine booking, a billing question, an urgent call and an after-hours call.
6. Start the scorecard in week one, so the location has its own baseline.

One scorecard, the same definitions everywhere

A scorecard works across locations only if every location counts the same way. Write the definitions down before the first report. What counts as answered by a person? When is a callback same-day? What counts as booked on the call? Then review five numbers each week, per location:

1. Calls answered by a person.
2. Calls sent to voicemail, and the share called back the same day.
3. Calls abandoned before answer.
4. Appointments booked on the call.
5. After-hours calls, by route: emergency, on-call, next-day queue.

Compare each location with its own last month before you compare it with its neighbors. A location with more new patients, more children or more Medicaid patients will look different for reasons the phone cannot fix.

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