How career paths and skills-based pay can keep medical practice staff from leaving

More than half of medical practices (56%) said hiring medical assistants had gotten harder over the past year, according to a May Stat poll by the Medical Group Management Association (MGMA). Rachel Brace and Nicole Hart, co-founders of BackPocket Talent, an on-demand human resources (HR) firm for private medical practices and small businesses, argue that practices lose many of the staff they do hire because the job offers no visible way up.

Brace, the company's chief operating officer, spent more than 15 years as a medical practice administrator. Hart, its CEO, has more than 20 years of HR and operations leadership.

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.

Career ladders with overlapping pay steps

In most practices, Brace said, everyone in a role shares one job description, and the only promotion staff can see is into management. She recommends a short ladder for each role instead, such as receptionist one, two and three. Each level carries its own pay step, and the pay ranges overlap. Key performance indicators spell out what an employee must do to move up. A five-year receptionist who is happy where she is can stay put. "Not everybody has to climb the ladder," Brace said.

Hart said practices should build those levels even with a single front-desk employee, if they plan to add locations or physicians. She said tying advancement to performance indicators also keeps pay decisions consistent and limits unconscious bias, a common thread in efforts to reduce medical practice staff turnover.

Paying for skills, and for staying

Hart described skill-based pay through a fictional practice with an office outside Boston that serves a large Portuguese-speaking population. An employee who speaks Portuguese earns a differential for the hours worked in that office, and payroll applies the rate automatically. She said the alternative, a raise granted for an added duty, is hard to take back once the duty ends.

For hard-to-fill roles, Hart recommends writing retention bonuses into the offer letter and tying them to milestones. Examples include a one-time bonus for earning a certification or a base raise after six months.

Weighing turnover against retention

Brace put the cost of replacing a medical industry employee who earns under $75,000 at 16% to 20% of salary. She said practices can build their own figure from recruiting fees, job ads and the cost of covering the open shifts. When turnover costs 18% and a retention bonus at six and 12 months costs $2,000, she said, the choice is clear.

"You're paying the money regardless," Brace said. That math also applies to modest raises and other retention tools.

Hart's first recommendation after the conference is a focal review, in which every employee is reviewed on the same date each year rather than on individual hire anniversaries. She said this makes it possible to pay for performance on equal terms.

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