For decades, dentists chose to practice as individuals or in small groups. By and large, they operated on a fee-for-service basis. Dental insurance was rare and relatively few participated in government programs. If patients required specialized care, the general dentist referred them to specialists. This situation created an opportunity. What if general dentists and specialists could work on the same premises, offering patients and one another a seamless process for dental care? Combining forces made sense.

By the 1980s, a few dentists were trying a new approach—house all dental specialties under one roof. An early adopter of the new one-stop shopping model was Reston Dental Arts Center (RDAC), a group of 10 dentists in Reston, Virginia, who banded together to offer patients oral health care services including hygiene, general dentistry, endontics, periodontics, oral surgery, and orthodontics. The group formed in 1987 and quickly found itself in demand.

Over the next decade, the dentists within the practice prospered, both professionally and financially. Patients seemed satisfied as well. But dental profits were attracting another group: dental practice management companies. These firms promised to streamline processes, save purchasing dollars through volume discounts, centralize human resources functions and generally consolidate back-office services to achieve economies of scale. This arrangement could free dentists to focus on clinical procedures, dental practices could become even more profitable—and both the firms and dentists would benefit.

American Dental Partners (ADP) was one of the first companies to enter into such arrangements with individual dental practices. In September 1997, ADP approached Reston Dental with a proposal. The deal was: we will purchase your assets, including your trade name and your existing dental equipment. We will enter into a contract that allows us to run the business side of the practice. You will be free to leave work after your shift and not worry about administrative aspects such as payroll and insurance reimbursements.

For eight months, the 10 Reston Dental doctors wrestled with the decision of whether to accept the ADP offer. On the one hand, it was financially attractive, especially to the older dentists, who likely would be able to access the capital they had invested over the years in their practice ahead of retirement. It also made sense: leave administration to those who knew best business practices. But the dentists had never before partnered with non-dentists. Such an arrangement would change not only the processes, but the culture of the group. The dentists would sacrifice some of their independence; the “family” feel of the practice would change, especially for staff.

On Thursday, May 21, 1998, the group met to debate the proposal. They would have to make a choice: accept the deal, or walk away.