How a $70M Dental DSO Solved Its Biggest Bottleneck: Recruiting Doctors

Dr. Dave Ensley runs Celebrate Dental & Braces, a doctor-owned DSO with 22 locations across multiple states. They're doing $70 million in group revenue. Not bad for a dentist who started out just wanting to straighten teeth.

But here's the thing about growth: the problems change.

When you're one location, the problem is getting patients. When you're five locations, the problem is hiring enough hygienists. When you're 22 locations doing $70 million, the problem is recruiting orthodontists fast enough to keep expanding.

Dave had hit a wall. His biggest constraint wasn't demand. It wasn't capital. It wasn't real estate. It was talent.

Specifically, finding qualified orthodontists and building the operational infrastructure to support them without inflating overhead.

That's when he found Sagan.

Dave's challenge wasn't unique to dentistry. It's the same challenge every service business faces when scaling: how do you find enough specialized talent to support growth?

For Celebrate Dental, that looked like:

Recruiting Bottleneck Finding qualified orthodontists was the number one constraint on expansion. Every new location required a doctor. But orthodontists don't grow on trees. And the traditional recruiting playbook, post on Indeed, wait, hope, wasn't cutting it.

Operational Overload Insurance billing was a nightmare. Patient coordination was falling through the cracks. The front desk person who was supposed to be greeting patients was also chasing down insurance claims and following up on failed payment processing.

Cost Structure Problems Hiring locally for every administrative function was expensive. Dave needed specialized roles, a dedicated recruiter, a call center team, a billing department, but at $50,000-$80,000 per US-based hire, the math didn't work at their current revenue per location.

"We couldn't grow because we weren't doing the job right," Dave said. "But we didn't have the money to hire the right roles because we weren't big enough yet. It's the classic chicken and egg problem."

Dave didn't need to hire one person. He needed to build specialized teams that could operate at scale without killing his margins.

Through Sagan Passport, Celebrate Dental built three core teams:

1. Recruiting Engine

Dave's biggest growth constraint was finding orthodontists. With Sagan's support, Celebrate Dental built a dedicated recruitment function:

Global Recruitment Coordinators A team that manages job postings across LinkedIn, Indeed, and niche orthodontic job boards. They coordinate outreach, engage candidates, and ensure timely follow-ups. No more orthodontists applying and hearing back three days later.

Employer Branding Content The team created targeted content highlighting Celebrate Dental's doctor-owned model and competitive compensation. They built a Facebook group for orthodontists looking to relocate. They got active in LinkedIn groups at the top 20 orthodontic schools.

Referral Program Management They implemented a referral incentive system for current employees, fully managed by the Sagan team. Existing orthodontists could refer colleagues and the team handled all the logistics.

The result? Faster time-to-hire and a consistent pipeline of qualified candidates.

2. Call Center + Revenue Cycle Management

Patient coordination and insurance billing were eating up time at every location.

15-Person Call Center in Mexico Dave hired a manager in Mexico who built a team of 15 representatives handling appointment scheduling, patient inquiries, and payment follow-ups. Call answer rates increased 25%. Patients who called actually got through.

20-Person Billing Team in the Philippines Insurance claims, payment processing, accounts receivable follow-up—all the soul-sucking work that keeps dental practices running but nobody wants to do. This team reduced claim denials and improved collections without adding overhead at each location.

AI-Powered Automation Sagan helped Celebrate Dental implement tools to detect billing issues early and flag accounts needing follow-up. Instead of manually reviewing every claim, the system surfaces the problems that need attention.

3. Finance + Marketing Teams

Senior Accountant in Pakistan A remote accounting team now handles bookkeeping, closes financials faster, and keeps the books clean. No more waiting until the end of the quarter to know if locations are profitable.

Digital Marketing Team Three people managing paid advertising, SEO, and social media. They're generating leads without increasing domestic payroll. The team includes a paid ads specialist with CMO experience, an SEO expert, and a social media manager.

By integrating Sagan's global workforce, Celebrate Dental didn't just save money. They unlocked capacity.

Faster Recruiting Reduced time-to-hire for orthodontists and support staff. The recruiting function went from Dave posting ads on Indeed to a dedicated team running a full recruiting engine.

Better Patient Experience 25% increase in call answer rates. Proactive appointment scheduling. Patients stopped showing up angry that nobody called them about a failed payment.

Operational Efficiency Cost-effective remote teams freed up on-site staff to focus on patient care. The front desk person stopped doing insurance billing and started greeting patients.

Sustainable Growth Through Labor Arbitrage Here's the strategic win: by saving 60% on administrative and operational roles, Celebrate Dental could offer above-market salaries to orthodontists. They became the most attractive place to work in their markets.

"If you paid orthodontists 25% more in starting salary, would you solve your recruiting problem?" Dave asked himself. "Yes. So let's go find that money."

He found it in the call center. He found it in billing. He found it in accounting. He built a more efficient labor structure and redeployed those savings into attracting top-tier clinical talent.

Most businesses think their recruiting problem is about posting better ads or using fancier software.

Dave figured out the real solution: pay more.

But you can't just inflate payroll without killing your margins. So you need to find the money somewhere else.

Celebrate Dental found it by building specialized global teams for everything that didn't require a dental license. Call center. Billing. Accounting. Marketing. Recruiting coordination.

That gave them the financial flexibility to pay orthodontists above market rates without raising prices or crushing profitability.

Now they're the most attractive employer in their markets. And their growth constraint shifted from "we can't find doctors" to "how fast can we open locations?"

"Money talks," Dave said. "We make so much money in Kansas City because we pay well. It's that simple."

The Challenge:

• $70M doctor-owned DSO across 22 locations
• Recruiting orthodontists was the primary growth constraint
• Insurance billing and patient coordination creating operational drag
• Local hiring too expensive to build specialized teams

The Solution:

• 15-person call center in Mexico for patient coordination
• 20-person billing team in the Philippines for RCM
• Dedicated recruitment team managing outreach and employer branding
• Finance and marketing teams in Pakistan and globally
• AI-powered automation for billing and call quality monitoring

The Outcome:

• Faster time-to-hire for orthodontists and support staff
• 25% increase in call answer rates
• Improved collections and reduced insurance claim denials
• 60% cost savings on administrative roles
• Redeployed savings into above-market orthodontist salaries
• Became most attractive employer in target markets

The Bottom Line: Celebrate Dental didn't just save money with global talent. They solved their recruiting bottleneck by building a more efficient labor structure that let them pay clinical staff more than anyone else, without raising prices or killing margins.