On Feb. 9, 2016, a text message went out to a short list of medical practice leaders with a simple question: “Is your practice prepared for value-based payment?” One hundred people answered. About one in four (26%) said yes; 66% said no. 

That was the first MGMA Stat poll. I joined MGMA the same year, and MGMA Stat has been part of my work ever since — as a contributor for most of my time here and as the person overseeing it for most of the past five years. This week's poll went out exactly 555 weeks after that first question, as the 2026 MGMA Annual Conference in San Antonio celebrated the association’s 100th anniversary. 

The decade in between produced more than 550 polls, more than 380,000 responses and more than 10,000 individual respondents. MGMA Stat's actual 10th birthday slipped by quietly in February, so I went back through the archives, down to the very first row of our spreadsheet tracking each poll, to take stock of what a decade of questions adds up to. 

If the first decade of MGMA Stat captured the forces reshaping medical practices, this week's poll asked respondents to look ahead to the next one: What will add the most complexity to practices through 2036? Among 228 applicable responses, payment led at 35%, followed by workforce at 25%, technology at 21%, regulation at 17% and other factors at 3%. [Editor's note: The results do not total 100% due to rounding.] 

• Payment often served as a proxy for broader concerns about practice sustainability. Respondents repeatedly pointed to declining reimbursement, rising operating costs, prior authorization requirements, denials and the prospect of additional movement away from fee-for-service payment. Several predicted that continued reimbursement pressure would accelerate consolidation and make it harder for independent practices to survive.  
• Workforce responses reflected concerns familiar to anyone who has followed healthcare since the pandemic: physician and staff shortages, retirements, recruitment difficulties, burnout and changing expectations around work. Respondents anticipated persistent competition for talent and a shrinking pool of experienced workers, while others noted the growing role of advanced practice providers and the need to retrain staff as responsibilities evolve. 
• Technology respondents overwhelmingly focused on artificial intelligence. Some viewed AI as the force that will redefine healthcare delivery, documentation and operations; others worried about privacy, governance, implementation costs and how practices will balance automation with human judgment. Regulation, meanwhile, was less often selected but described in familiar terms: additional CMS requirements, reporting obligations, telehealth rules, prior authorization oversight and other compliance demands. 

What stood out most was how often respondents treated the categories as interconnected. Payment pressures were linked to staffing challenges. Staffing shortages were linked to technology adoption. Technology was expected to create new regulatory questions. A decade of MGMA Stat polling has documented these issues separately, but respondents looking toward 2036 increasingly see them as parts of the same problem: trying to deliver accessible, financially sustainable care amid rising complexity. 

A weekly focus group 

I came to MGMA from journalism, where learning how people from all walks of life do their jobs meant phone calls, voicemails, emails and a lot of waiting to connect to sources. Anyone who has tried to get 15 minutes on a practice administrator or physician's calendar knows how that goes. With MGMA Stat, a question goes out on a Tuesday and the first answers come back within seconds. By the end of the day, hundreds of practice leaders have described what is happening inside their organizations. Reaching that many people one call or one email at a time would take me weeks. 

It has become something like my own weekly focus group, made up of administrators, executives, physician leaders and managers who reply between meetings, over lunch (when they get one) and at the end of long days. Their answers, and especially their written comments on open-ended follow-up questions, have taught me so much of what I know about how practice leaders get through busy, complex jobs: which tasks eat up staff time, which payer rules changed without warning, which fixes worked and which ones flopped. That education shapes nearly every article I write and many of the resources MGMA builds for its members. 

It is a privilege, and a humbling one, to be trusted with a line into thousands of phones each week for the purpose of asking people about their work lives. Nobody owes us a reply. More than 10,000 people have sent one anyway. 

How our questions evolved 

MGMA Stat has moved through roughly five phases this past decade. 

In 2016 and 2017, the poll was finding its voice. Poll No. 4 asked how practices were educating patients about the Zika virus. Prevalence checks (on using credit card on file, scribes, and 12-month strategic plan) ran alongside opinion questions we would be unlikely to field today, such as how much confidence leaders had in Congress to fix healthcare. (In October 2017, 89% said "low.") 

The years 2018 and 2019 were the high-water mark for participation. A typical 2018 poll drew about 1,200 responses. The questions from that stretch read like a census of how practices ran: 90% offered a patient portal, 82% conducted patient satisfaction surveys, 68% texted appointment reminders and, as of November 2019, 89% still used a fax machine. 

Then came 2020, when COVID-19 took over the slate. From 2021 through 2023, the questions followed practices through recovery and into a staffing crisis. Since 2024, the slate has leaned toward year-over-year trackers on costs, revenue, access and turnover; artificial intelligence (AI); and the workflow bottlenecks that tools were supposed to fix, from phones and fax to payer portals and EHR workarounds. 

The format changed as much as the topics. Through 2020, roughly six in 10 MGMA Stat questions were yes/no. In 2025 and 2026, only about three in 10 are, and another third ask respondents to compare this year with last. By 2024, more than nine in 10 polls carried a follow-up question tailored to the respondent's answer. The early polls told us how many practices did something. The current ones show which direction things are moving and, through the open-ended comments, why. 

Those comments are where the real reporting happens. Today's polls may only draw hundreds of responses rather than the 1,000-plus of the peak years, but they bring back far more detail. When we asked in March 2026 which phone work consumes the most staff time, the write-in answers separated prior authorization status checks from eligibility verification — two workflows an outsider might lump together. 

The COVID-19 chronicle 

Beginning March 17, 2020, one poll a week was no longer enough. We fielded 15 polls in the next 11 weeks, five of them outside our usual Tuesday schedule, because the questions could not wait. 

Read in order, those rows work as a diary of that spring: 

• On March 17, 40% of practices reported staff shortages. 
• Two days later, 89% were short on personal protective equipment. 
• By March 31, 97% had expanded telehealth access, and on April 7, 97% reported a drop in patient volume. That poll drew 1,713 responses, the third-largest total in MGMA Stat’s history. 
• By April 14, 76% had applied for a Paycheck Protection Program loan.  
• By May 8, 89% had reopened to in-person visits 
• By June 9, 87% had recovered at least some volume. 

Of the 29 polls we ran from March 17 through Sept. 1 that year, 28 were about the pandemic. By my count, MGMA Stat fielded 51 COVID-specific polls in all, a run that moved from crisis response to vaccination policy in 2021 and then to masking, which refused to fade: A March 2023 question on mask requirements was the most-answered poll of that year. The last of the 51, on COVID-related sick leave, ran in January 2024. 

Staffing at the center 

From 2016 through 2019, by my count, only seven of 216 polls (3%) dealt with recruiting, retention or workforce supply. Since 2021, 66 of 285 have (23%). 

The pressure was visible before the pandemic. In May 2018, 61% of practices reported a shortage of qualified applicants for nonclinical jobs, and that September, 59% said a physician had left in the past year. When we asked in January 2020 what would be the biggest change for organizations that year, staffing topped the list, two months before COVID-19 lockdowns arrived. 

Since 2021, six polls have been about medical assistants specifically. When we asked which role is hardest to recruit, in 2022 and again in 2025, MAs led the list, named by nearly half of respondents in 2025. We have asked five times whether a physician retired early or left because of burnout. The benefits series traces the arc of the labor market: The share of groups adding or increasing employee benefits climbed from 26% in 2021 to 45% in 2022, then eased to 35% in 2023, 21% in 2024 and 16% in 2026. In our “biggest challenge” polls heading into 2022 and 2023, and again in 2025, staffing led the list or ran through the other answers. 

The newest questions show where the strain is heading. In June 2026 we asked whether AI had prompted a role redesign, and in September we asked leaders how many new functions had been added to their own jobs in the past two years. 

Technology, from telehealth to AI 

There’s a time-capsule quality to it all. Telehealth is the clearest before-and-after in our polling archives. The share of practices that said they currently offered it crept from 21% in January 2017 to 26% in 2018 and 29% in 2019. On March 31, 2020, 97% said they had expanded it. 

AI arrived in two steps. The first MGMA Stat question about it, in March 2018, asked respondents as patients whether they would consider receiving medical advice through AI: 35% said yes, 40% said no and 25% were unsure. 

Five years passed before the next one, a March 2023 poll on tools like ChatGPT. Almost two dozen AI polls have run since the start of 2023, and in 2026 about one poll in five has been about AI. The questions have matured along with the tools, from whether anyone was using AI to ambient documentation, the share of visits involving AI, governance policies, coding, clinician productivity and, this September, whether practices are building their own apps with it. 

Regulation and payment 

Regulatory and compliance questions made up about 15% of the slate in MGMA Stat’s first three years, anchored by meaningful use attestation, MACRA and MIPS, and the rollout of new Medicare ID cards. Practice leaders were consistent about federal mandates: 72% opposed mandatory participation in Medicare alternative payment models in 2018, and 76% did in 2020. Since 2022, fewer than one poll in 10 has been regulatory, and those tend to ask about operational effect: good faith estimates under the No Surprises Act, information blocking rules, whether Medicare payment cuts would reduce patient access, and AI governance. 

Payment never left our attention. The first poll was about value-based payment, and the longest trend line in the file asks whether quality metrics are part of physician compensation: 27% in 2016, 36% in 2018, 38% in 2019, nearly half in 2023 and half in 2024. In April 2026, we asked a harder follow-up: whether the quality element of provider compensation changes behavior. 

Prior authorization is the most consistent finding of the decade. In 2016, 82% of respondents said payer requirements had increased. The figure was 86% in 2017 and 2018 and 90% in 2019, and I long ago stopped expecting a different answer. The 2026 questions have moved on to the phone calls and turnaround delays the process generates. In 2019, 67% said Medicare rates fell below the cost of delivering care, a question we repeated in 2021 and 2026. The cost side has been just as steady: 90% said costs were outpacing revenue in 2022, 89% reported higher operating costs in 2023, 92% did in 2024 and 84% did in 2026. 

The personal questions 

The most-answered polls in MGMA Stat history are mostly personal. The record holder — a July 2018 question on patient portals — drew 1,785 responses. Right behind it, at 1,746, is “Do you feel burnt out at your job?” from June 2018; 45% said yes and another 28% said somewhat. A question about hours spent in meetings ranks fourth. In a September 2017 poll that drew 1,643 responses, 60% said they rarely or never manage a daily lunch break. And for the record, 76% of practices gave staff a holiday bonus or gift in 2016, and 76% did in 2019. 

Those polls are a reminder that the people on the other end of the text are doing demanding work, and that they answer anyway. 

The next 10 years 

MGMA's founders would recognize the impulse behind MGMA Stat. As Dave Gans and I recounted in August, Col. Joseph W. “Bud” Jackson opened the 1926 meeting in Madison, Wisconsin, that created this association by greeting 32 clinic administrators who would, before the week was out, agree to survey one another on costs, staffing, overhead and collections and share what they found. Jackson also worked through a deck of playing cards that day, each one naming something a manager had to know, which amounted to the profession's first body of knowledge. A hundred years later, that comparing of notes happens by text every Tuesday, and the Body of Knowledge for Medical Practice Management is approaching its fifth edition. As that major refresh comes together, a decade of MGMA Stat answers is part of the evidence for what the job now demands. 

This week's question asked what will add the most complexity to practices through 2036. The next decade of this record will be written the same way the first one was: practice leaders willing to take a few seconds out of a crowded day and tell us how the work is going. 

To everyone who has ever thumbed a reply to one of these texts: thank you. Every Tuesday, a few hundred answers add another small entry to the history of medical practice management, and it has been the privilege of my career at MGMA to help write it down. The next question goes out Tuesday. 

To join the MGMA Stat panel, text "STAT" to 33550 or visit www.mgma.com/mgma-stat.