On Nov. 1, 1926, a small group of clinic managers gathered at the Madison Club in Madison, Wisconsin, for what was meant to be an informal exchange about the everyday issues of running a medical practice. The agenda was practical and not especially grand: clinic administration, accounting, getting charges to the business office, handling patients more efficiently, collections, personnel problems, office equipment, and comparative statistics.

Even the invitation framed the meeting simply as a chance to discuss “mutual problems,” while leaving open the possibility that, if it proved useful enough, “some kind of permanent organization my eventually result.” That modest gathering of 32 men and women representing 21 medical groups became the starting point for what would evolve into the Medical Group Management Association.¹

As MGMA approaches its centennial in 2026, that first meeting offers a striking place to begin. The managers in the room were not debating abstract theories; they were trying to solve real operating problems: how to move patients through the clinic faster, how to get charges recorded accurately, how to organize records and forms, and how to compare results across groups. In short, from the very start, MGMA’s roots were grounded in the practical work of making medical groups function better.

Given the dramatic progress in clinical medicine over the past 100 years, it would be reasonable to expect comparable advances in practice administration. In some ways, that happened. Medical groups adopted automated billing systems, electronic medical records, digital communications, and increasingly sophisticated information technology. However, those advances in technology did not produce proportional reductions in overhead or a lasting simplification of administration. Instead, many of the core management questions from 1926 still feel surprisingly familiar, almost frozen in time, even as the environment around them has become far more expensive and complex.

The attendees of the first meeting in 1926 recognized the need to share information on practice financial performance and operations and distributed a survey to the 27 known medical groups ahead of the second meeting, held Oct. 17-18, 1927, in Minneapolis.  Seventeen practices responded, providing detailed information on governance and management structures, provisions for practice succession, vacation allowances for physicians and staff, sick leave and disability benefits, office hours, and — most importantly — practice overhead.²

Examining the information presented in the 1927 survey, alongside subsequent MGMA survey data collected from multispecialty groups provides a unique perspective on how medical groups have evolved. While medical practice has changed dramatically, the basic challenge of managing a group practice has not gone away. The tools are more advanced, the scale is larger, and the clinical environment is more complex, but many of the same pressures remain. Practices still must balance patient care, physician productivity, staffing, overhead, and financial sustainability just as they did a century ago.