Medical practices seek new pay strategies to retain staff
More than half of medical practices (56%) reported increased difficulty hiring medical assistants in the past year, according to a MGMA Stat poll. A separate MGMA Stat poll a week later found practices with lower staff turnover invested in pay adjustments, onboarding and training, predictable scheduling, and clearer career paths.
Rachel Brace and Nicole Hart, co-founders of BackPocket Talent, a Massachusetts-based on-demand HR firm for medical practices and small businesses, will present “Beyond the Typical Bonus: Innovative Compensation Strategies for Private Medical Practices” on September 29 at the 2026 MGMA Annual Conference in San Antonio.
Building Career Ladders for Retention
Brace, with over 15 years in medical practice administration, and Hart, with 20+ years in HR leadership, emphasize the need for structured career paths. “People leave because they can’t see where the job is going to go, and that’s really what it looks like in a practice,” Brace notes. Her expertise spans dermatology, orthopedics, and multisite practices, where she managed HR, billing, compliance, and credentialing.
They advocate for defined levels with pay steps, allowing staff to progress without necessarily becoming managers. “You just have to have the ladder,” Brace says, highlighting the importance of overlapping pay scales and cross-training opportunities.
A practice example highlights skills-based pay, compensating staff only when using specific skills like Portuguese language proficiency, particularly in offices with a high Portuguese-speaking population.
Retention Bonuses and Profit Sharing
Hart, whose experience includes six years at Cigna Healthcare, suggests tying retention bonuses to milestones, like certifications, rather than making them expected. “It shouldn’t be a fire drill because you don’t want somebody to leave,” she says, emphasizing strategic planning for critical roles.
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For profit sharing, they recommend transparency. “The best businesses are fully transparent,” Hart argues, suggesting practices share growth goals and allocate a percentage of profits to staff bonuses. For instance, setting aside funds for nonmedical staff bonuses when specific targets are met.
Brace acknowledges cultural challenges in medical practices but stresses the importance of aligning staff with practice goals. “Everyone has to have a common goal,” she says, advocating for tying bonuses to measurable practice achievements.
They urge practices to calculate turnover costs and compare them to retention investments. Maybe you say, “We’re going to take 3% of that money and set it aside for nonmedical positions,” so not for the doctors, but for the employees.
Post-conference, Brace recommends implementing career paths, while Hart suggests standardized performance reviews to ensure equitable treatment, moving away from anniversary-based evaluations.
Implementing Career Paths and Performance Reviews
Brace and Hart emphasize creating career paths for staff, allowing them to visualize growth within the practice. They suggest defining levels with pay steps, ensuring staff can progress without necessarily becoming managers. For example, a front-desk role could have levels like receptionist one, two, and three, each with specific pay scales and overlapping responsibilities.
Skills-Based Pay and Retention Strategies
The co-founders advocate for skills-based pay, compensating staff only when they utilize specific skills. For example, an employee fluent in Portuguese might receive additional pay when working in an office with a high Portuguese-speaking population. This approach ensures fair compensation for specialized skills without permanently increasing base pay.
