For years, medical group leaders have treated support staffing as a balancing act: enough people to room patients, answer phones, collect balances, manage referrals and work authorizations while keeping providers moving — but not so many that labor costs outrun revenue. That balance is getting harder to hold.
Our July 7, 2026, MGMA Stat poll asked medical practice leaders: "How has your ratio of support staff to FTE physicians changed in 2026?" Among 216 applicable respondents, 63% said the ratio stayed the same, 18% said it increased, and 19% said it decreased. With increases and decreases nearly offsetting around a large steady middle, most practices are holding their support-staffing ratios in place this year.
What you told us
Asked whether current support staffing is adequate for patient demand, most leaders whose ratios rose or held steady said “yes” — but roughly one in four said no, and several answered only with qualifiers: “a little short,” “not always,” or “tight but adequate.” Hiring freezes were noted though not frequently. A few who had added staff still called it insufficient and pointed to workflow rather than headcount, including one whose new EHR “added a tremendous amount of work” and another who said the group had “thrown more FTEs at workflows versus leveraging the EHR.”
For the 19% whose ratios fell, the sharpest impacts were lost productivity, reduced patient access and heavier provider burden — most often traced to difficulty hiring qualified staff and to budget and reimbursement pressure. Some decreases were deliberate: respondents named AI-enabled consolidation of staff and “right-sizing to benchmarks,” though with the caution from one practice leader who noted this “caused pain points.” In both directions, the ratio sometimes moved on provider counts rather than staffing plans — increases tied to physician resignations, decreases to added providers and “less productivity per provider.”
The dynamics we’re seeing
Support staffing is one of the clearest places where medical group economics, patient demand and workforce limits meet. A higher support-staff-to-physician ratio can signal investment in access, rooming capacity and revenue cycle performance — or it can mean a group needs more people to do the same work because workflows have grown more complex. A lower ratio can reflect efficiency, technology gains or better role design — or it can leave too few people carrying too much.
Two moving parts complicate it, though. Practices are shifting work onto advanced practice providers (APPs) — 48% of groups raised their APP-to-physician ratio in 2025, even as physician encounters fell — so the “per physician” denominator doesn’t compare well when we discuss who is being supported by support staff. And when a physician retires or departs without a backfill, the ratio can climb on its own, signaling lost capacity rather than added support. What the ratio means depends on which of these is moving it.
The squeeze is measurable this year: Operating costs climbing in 84% of groups, with labor the most-cited driver, while revenue growth narrowed — 47% of groups reported higher year-to-date revenue against 36% reporting a decline, down from a 26-point gap a year ago to 11. Support staffing is where that pressure gets decided at the role level.
The labor market
National labor data show why the ratio is hard to manage from the hiring side. Healthcare added 35,000 jobs in May 2026, including 26,000 in ambulatory health care services, according to the Bureau of Labor Statistics. Strong sector hiring does not mean a given practice can fill every role it needs, when it needs it.
Medical assistants (MAs) are the clearest example. BLS projects MA employment to grow 12% from 2024 to 2034 — much faster than the average for all occupations — with about 112,300 openings each year. Most MAs work in physician offices, where their duties span clinical and administrative work: rooming, vitals, patient histories, documentation support, injections or medications as allowed by state law, appointment support and supply management. That range makes the MA role valuable and hard to replace quickly when a vacancy lingers.
Nursing and revenue cycle roles add a second layer. Registered nurses (RNs) are projected to grow more slowly than MAs — 5% from 2024 to 2034 — but the labor pool is far larger and replacement demand is high, at about 189,100 openings a year. Ambulatory settings employ a substantial share of RNs, so physician practices compete not only with one another but with hospitals, outpatient centers, home health, payers and hybrid or remote employers.
Pay pressure has not eased enough to solve the problem. BLS Employment Cost Index data show total compensation for private-industry workers rose 3.4% for the 12 months ending March 2026, and compensation in health care and social assistance — a sector-wide measure that includes hospitals and nursing facilities alongside ambulatory practices — has been running ahead of that pace. For many groups, that means staff compensation budgets stay under pressure even as reimbursement growth is limited, payer rules grow more complex and patient expectations keep rising.
Practice-level benchmarks show that pressure landing unevenly by role. MGMA's 2026 DataDive Management and Staff Compensation data set found median total compensation for MAs rose 4.3% in 2025 and is up 20.6% over five years, while medical receptionists — among the hardest support seats to keep filled — climbed 4.8% in 2025 and 22.0% over five years. Nursing pay moved the other way in the one-year window: RN median compensation fell 8.9% and triage nurse pay fell 10.6%, though both remain well above their five- and 10-year levels.
The split tracks two different labor markets. Practices benchmark nurses and technical staff against a hospital market that cooled as travel rates normalized, while front-desk and MA-adjacent roles compete with retail, hospitality and call centers — which is where 2025 pay kept climbing. Tenure is buying little separation, either: the 2025 median for nursing roles with 21 or more years of experience was just $298 above the median for those with five or fewer.
The operational risk is treating support staffing only as a cost center, which misses what adequate staffing protects. When the support team is too thin, physicians and advanced practice providers (APPs) absorb work that should be handled before, during or after the visit — which shows up as slower rooming, fewer completed visits, longer message turnaround, higher call abandonment, delayed authorizations, weaker point-of-service collections, older A/R or more provider time spent on inbox and documentation. Adding headcount alone is not a strategy, though; groups need to know where staff capacity produces measurable value.
First, build a role-by-role staffing map. Compare support staffing by site, specialty and physician FTE, but also by demand: visits, phone volume, portal messages, prior authorizations, referrals, procedures, imaging volume and payer mix. One MA per physician may be adequate in one specialty and inadequate in another. A single front-desk ratio may hide the fact that one site is drowning in calls while another is struggling with check-in, eligibility or collections.
Second, separate vacancy problems from workflow problems. If clinicians are waiting for patients to be roomed, that is a clinical support issue. If schedules are full but patients cannot get through by phone, that is an access-design issue. If staff are available but denials and authorizations are rising, the problem may be specialization, training or payer complexity rather than raw headcount. Payer-mix shifts and mid-year coverage losses are pushing eligibility, financial-counseling and denial volume up even where headcount looks adequate. Each needs a different fix.
Third, use AI and automation to redesign work before reducing staff. Ambient documentation, patient self-service, digital intake, automated reminders, eligibility checks, work queues and prior authorization tools can remove pieces of work from staff and providers. Most groups have barely begun: in our June polling, 68% of groups had no yet redesigned a role or adjusted staffing with AI, and the leading front-office targets — scheduling, calls, eligibility and prior authorization — are exactly the work that drives support-staffing need. But the best early use case is usually redeployment, not cuts. If technology saves 10 minutes per visit, decide where that time goes: more same-day access, faster chart closure, better outreach, fewer after-hours messages or more complete revenue cycle follow-up.
Fourth, build internal pipelines for hard-to-fill roles. For MAs and other clinical support staff, that can include externship partnerships, MA I/II/III ladders, certification reimbursement, cross-training and clear pay progression. For revenue cycle staff, it can mean moving from general billing roles to denial, coding, prior authorization or managed care specialist tracks. Smaller and independent practices with fewer formal rungs can still use cross-training and certification support to the same end: career paths do not remove wage pressure, but they give employees a reason to stay and give managers a better way to match pay to skill.
Finally, watch the warning metrics. The support staffing ratio should be read alongside third-next-available appointment, rooming cycle time, provider idle time, inbox volume, overtime, turnover, call abandonment, authorization delays, denial rates, days in A/R and patient complaints. If the ratio looks stable but these measures are worsening, the group is understaffed in practice even if the spreadsheet looks balanced.
Closing thoughts
On the surface, 2026 looks like stasis: most ratios flat, increases and decreases nearly canceling. The comments from practice leaders point to something more strainer: adequate-but-barely staffing levels, hiring freezes, ratios shifting on physician turnover rather than a plan, and a minority already losing productivity and access where the ratio slipped. Stability in the number is not the same as stability in the operation.
The ratio is a starting point for that diagnosis rather than the conclusion. The operational questions underneath it — which work truly requires a person, which work can be redesigned, and where support staffing protects access, revenue and provider productivity — matter more than the direction the number moved. Groups that work through them will read a rising, falling or flat ratio far more accurately than the headline figure allows.
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