Heidi Arndt
Where Clinical Leadership Meets EBITDA - and the gap between them gets closed.
24
Years in DSOs
2x
Exits
CEO
PE Backed DSO Platform
2021
Strive - Apex Transaction
ExperienceI've sat on both sides of the table — and the gap between them is where the work gets done.
I served as the CEO of Strive Dental Management, a PE-backed DSO headquartered in Austin, Texas — and led the platform through a successful transaction to Apex Dental Partners in 2021. Over 20 years, I've worked inside DSOs in almost every capacity: as a clinician, an operator, a COO, an advisor, and ultimately as a PE-backed CEO through two successful exits.
That experience — being accountable to a board and to a clinical team simultaneously, with both watching what you do — gives you a particular clarity about where value is really built in a DSO and where it quietly leaks.
ThesisThe gap between the boardroom and the operatory is where EBITDA goes to die.
What I've seen across every platform — the ones that hit their targets and the ones that don't — is the same structural problem.
DSO Executives and PE operating partners are trained to read financial performance and identify operational inefficiency. Clinical leaders understand what drives provider behavior, patient retention, and team culture. But in most DSOs, those two capabilities never fully connect.
And the gap compounds quarterly — in hygiene performance, in associate turnover, in the clinical culture that either supports a multiple or slowly erodes it.
“Most boards have operators who understand business and clinicians who understand care. I understand both — and the gap between them is where healthcare platforms win or lose.”
The WorkI work with PE operating partners and DSO executives as an advisor — focused specifically on the clinical execution layer that most value creation plans don't have language for.
I work with a small number of clients at a time. I don't train hygienists. I don't sell programs. I help leadership teams close the gap between what the value creation plan requires financially and what clinical teams need to deliver it.
Hygiene as a financial asset
30–35% of DSO revenue — treated as a scheduling problem in most platforms. Recall performance, retention, and restorative conversion are the levers that move the multiple.
Clinical culture alignment
The operating variable that most value creation plans don't have language for — and the one that determines whether the financial model materializes in the schedule.
Associate engagement
The autonomy and culture variables that determine whether a provider stays and produces. The $50K earnings gap isn't primarily a comp problem — it's a meaning problem.
Hold period optimization
Working with PE operating partners on clinical execution during the years between close and exit — when the translation gap is most expensive and most fixable.
What This Isn'tIt's worth being direct about what the work is not — because a lot of what gets sold to DSOs sounds similar and delivers something very different.
This Isn’t:
Hygienist training programs or clinical education
Practice management consulting or software implementation
A packaged playbook applied the same way to every platform
A consultant who presents to the board and leaves the execution to someone else
The work is advisory. It's designed to transfer capability and create durable change — not to create dependency.
If your DSO platform is built but your margins aren't moving.
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I'd welcome a conversation about what you're seeing — and whether the gap I work on is the one you're dealing with.
