Primary care new-patient waits stretch as practices lean on APPs, MGMA's Swanson says

New primary care patients now wait 13.5 days for the third-next-available appointment, up from 9.5 days, according to MGMA data, and the practices working hardest to fix it keep hitting the same wall: There aren't enough physicians to go around.

Andrew Swanson, M.P.A., FACMPE, chief customer success officer at the Medical Group Management Association (MGMA), shared those figures with Physicians Practice at the 2026 MGMA Annual Conference in San Antonio. In a wide-ranging interview, he also warned that the raises most groups budgeted for staff this year will not hold onto their best people.

Access is slipping, even as practices work harder

Swanson said existing primary care patients now wait 8 days for the third-next-available visit, up from 5. Surgical care has not moved as dramatically, but new-patient waits there rose from 8.4 days to 9.6 days and existing-patient waits from 5.5 days to 7.5 days.

"I believe we're seeing the aging population really hitting our care management system," Swanson said.

The picture from MGMA's own members is mixed. A July 14 MGMA Stat poll found 28 percent of groups said new-patient waits were longer than a year earlier, 22 percent said shorter and 46 percent said they had not changed. Respondents in every camp described the same moves: hiring providers, adding APPs, extending hours and reworking templates.

Swanson said cancellations are falling and no-shows are ticking up only slightly, which suggests practices are getting better at throughput. The hours keep stretching too. A decade ago, he said, the question was whether a group opened for half a day on Saturdays; now the debate is whether to stay open until 7 p.m. instead of 6 p.m., or open at 7 a.m. instead of 8:30 a.m.

"There's only so many physicians coming out of training every year," he said, "and we're back to square one again."

'Hire a doctor' is becoming 'hire an APP'

That supply problem is reshaping care teams. Nearly half of medical groups, 48 percent, added advanced practice providers relative to physicians in 2025, according to a November 2025 MGMA Stat poll. Swanson said early adopters have already worked out the workflow and patient steering, while many groups are only now rethinking their ratios.

"There's more PAs than there are doctors available, so groups are going to have to be forced into that model," he said.

The shift shows up in pay. MGMA's benchmarks show APP compensation rising nearly 20 percent over five years, outpacing physicians, and Swanson said that ends the era of the untouched comp plan.

"What was a set-it-and-forget-it model, it's not good enough anymore," he said. He wants groups to review provider compensation every year, with separate plans for physicians and for PAs and NPs. "One plan is not good enough."

He also suggested groups take a fresh look at total visit volume alongside RVUs. Chronic care and surgical episodes are more standardized than they used to be, he said, so practices now have better benchmarks for how many touches a patient actually needs.

Pay up, productivity down, but don't panic yet

MGMA's 2026 Provider Compensation and Productivity Data Report found physician pay kept rising in 2025 even as work RVUs fell in 16 of 23 specialties and total encounters fell in all 23. Swanson cautioned against reading too much into a single year, noting that productivity had outpaced pay for a long stretch before this.

"Employers of physicians should not be racing out and panicking over this," he said.

His advice is to look at physician and APP productivity together, and to make sure physicians are seeing patients whose acuity justifies their time.

Staff raises of 1 to 3 percent won't cut it

Nearly two-thirds of groups, 64 percent, targeted 1 to 3 percent base-pay increases for staff in their 2026 budgets, according to a September 2025 MGMA Stat poll. Asked whether that will be enough next year, Swanson did not hesitate: "I don't think so."

That range roughly tracks physician pay, he said, but support staff pay has climbed close to 15 percent over three years in some roles, and minimum wages are rising faster than 1 to 3 percent a year.

"Peanut butter spreading a 1 to 3 percent increase across all staff members, I don't think is going to be enough," Swanson said. He expects groups to differentiate, giving top performers 4, 5 or 6 percent while others get less. "I think people are lowballing that estimate."

Turnover explains the urgency. In a May 26 MGMA Stat poll, 28 percent of groups said staff turnover was higher than last year, while 39 percent said it was about the same and 30 percent said lower. Swanson said the churn is concentrated among medical assistants, front-desk schedulers and revenue cycle staff such as billers and coders, and that skilled workers are now jumping between medical groups rather than leaving health care.

"Pre-COVID, I was seeing people leave from the front office of a medical group to go work at Walmart for a 50-cent-an-hour raise or dollar-an-hour raise," he said. "I hear less of that."

Physician and APP turnover, by contrast, has settled since the burnout and early retirements of the pandemic years, he said.

AI isn't replacing staff yet

Groups are piloting AI in coding and at the front desk, but Swanson said the hiring data shows health care is "still throwing people at problems." For now, he said, adopting the technology creates demand for skilled workers who can check its output.

"There has to be a person at the end of that technology making sense, not just of its implementation, but of its output as well," he said.

The one number to benchmark

Pressed to name a single metric for administrators to benchmark next year, Swanson pointed to the issue MGMA members rank first: reimbursement. He would start by comparing gross charges with net medical revenue.

"What am I charging for? What am I actually collecting? And what's the delta?" he said. A wide gap is the cue to dig through the revenue cycle for the cause.

On physician pay, he said the real test comes next year: whether the 2025 split between pay and productivity repeats in 2026 data, which practices will see in 2027.