How private practice owners can weigh staff raises against the cost of turnover

More than a quarter of medical group leaders (28%) said staff turnover was higher in 2026 than in 2025, according to a May Stat poll by the Medical Group Management Association (MGMA). The departures were concentrated among medical assistants, nursing and clinical support staff, and front-desk workers. When those jobs go unfilled, refills, rooming and prior authorizations can land on physicians.

Rachel Brace and Nicole Hart are co-founders of BackPocket Talent, an on-demand human resources firm for private practices and small businesses. Brace spent more than 15 years as a medical practice administrator. Hart has more than 20 years in human resources and operations leadership, including six years at Cigna Healthcare.

The two present "Beyond the Typical Bonus: Innovative Compensation Strategies for Private Medical Practices" on Sept. 29 at the 2026 MGMA Annual Conference in San Antonio.

What turnover costs a practice

Brace cited a national average of 16% to 20% of salary to replace a medical industry employee earning under $75,000. That figure counts recruiting fees, job ads and the cost of covering the gap.

When turnover costs 18% and a retention bonus paid at six and 12 months costs $2,000, she said, the bonus is the better use of the money. At her own practice, Brace said, "we never really looked at how much it costs when somebody walks out the door, because you're usually scrambling and you're not thinking straight."

Hart said retention bonuses work best for hard-to-fill roles when the terms are written into the offer letter. Examples include a one-time bonus for earning a certification or a raise in base pay after six months on the job.

Why good staff leave profitable practices

A practice can be profitable, pay well and still lose its best medical assistant after years in the same title at the same pay, Brace said. "People leave because they can't see where the job's going to go," she said. Her alternative is a few levels for each role, each with its own pay step, overlapping pay ranges and performance targets for moving up.

Hart recommends paying for specific skills only when staff use them. In her example, an employee who speaks Portuguese earns a differential for the hours worked at a satellite office where patients need it. Payroll tracks those hours, so the extra pay ends when the duty does.

Sharing profits with staff

Hart favors telling staff the practice's growth target and setting aside a share of the gain for nonmedical employees, 3% in her example, paid out if the practice hits the goal. "I firmly believe the best businesses are fully transparent," she said.

Brace said that from her years as an administrator, she knows "a lot of doctors keep that stuff close to the chest." Part of the reason, she said, is concern that staff who see the practice's numbers will compare them with their own pay. She suggests tying the payout to something employees can see and influence, such as the number of reviews the practice receives.

Hart said BackPocket Talent is also working with an artificial intelligence partner on how practices can reshape staff roles, rather than cut them, as they automate billing and other tasks.