7 numbers to run before you hire or fire anyone

Every open position is a high-stakes bet, and every termination is a balance sheet event, whether the practice books them that way or not. The Society for Human Resource Management puts the average direct cost of a single hire at roughly $4,700, and employers it surveyed estimate the all-in total can reach three to four times the position's salary once training, manager hours and lost productivity are counted.

The stakes keep climbing. MGMA's 2026 Management and Staff Compensation data report finds the market for health care labor uneven in 2026, with wages for the roles that keep patient access, clinical throughput and collections moving still running well above where they sat five years ago. Labor is the largest expense line in nearly every practice, and mistakes in either direction, hiring too fast or holding on too long, compound quietly inside it.

None of that argues for less hiring or for never firing. It argues for arithmetic. Most administrators can recite their denial rate to the decimal, then decide staffing questions on gut feel, and the gut is a poor accountant. Before the next offer letter or termination meeting is scheduled, run the math. Here are seven numbers worth knowing cold.