A surgical division in a large multispecialty practice faced heavy turnover among its certified medical assistants (CMAs), sagging staff morale and a budget that allowed 1.2 fewer FTEs than the clinic had. In this paper, Paul L. Wooderson, MHSM, FACMPE, uses that situation to argue that staffing should be reviewed continuously, not set from last year’s budget.

Drawing on a literature search and interviews, the paper covers three areas:

• Leadership communication: two-way communication about goals, and trust between front-line staff and leaders
• A positive culture: motivation, peer accountability and conflict resolution
• Tools for change: lean methods such as value stream mapping, huddle boards and standard work

In the clinic, mapping the check-in to check-out process turned up enough efficiencies that a CMA who later left was not replaced, and the author reports productivity did not suffer.

About ACMPE Fellowship papers

Fellowship (FACMPE) is the highest designation offered by the American College of Medical Practice Executives (ACMPE). Fellowship candidates wrote papers like this one to show command of a practice management topic through original research or a detailed business plan.

About this content

This paper was published in 2018 and has not been updated. Labor markets, wages and administrative technology have changed since then, so check figures against current sources before acting on them. For more recent data, a July 2026 MGMA Stat poll found 63% of medical groups kept the same ratio of support staff to physicians in 2026; 18% saw it rise and 19% saw it fall.