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    Luring patients back to medical practices is no longer one of the top concerns for practice administrators; instead, it’s bringing highly qualified staff onboard to serve them.

    As more healthcare organizations fully recover visit volumes to pre-pandemic levels and doctors are working more hours than ever, it is likely that more health systems and groups will look to add nursing staff and other positions in an increasingly competitive market that has seen difficulty in keeping pace with demand.

    Even before COVID-19, the U.S. Bureau of Labor Statistics estimated about 15% growth in healthcare occupations from 2019 to 2029, or roughly 2.4 million new jobs, with numerous clinical staff positions outpacing average estimated growth for all industries:

    The market for nonclinical staff also shifted in the past year, with more healthcare organizations competing for billers and coders who can work remotely.

    This has led to many medical practices taking a renewed look at benefits packages, as revealed in a June 8 MGMA Stat poll. But there’s another potential incentive that proves enticing for many would-be employees: Cash in the form of a sign-on bonus.

    A June 22 MGMA Stat poll found that 33% of medical practices have added or expanded bonuses to recruit staff this year, while 9% are considering it. The poll had 815 applicable responses.

    Among those who have added or expanded bonuses:

    • MAs, RNs, licensed practical nurses (LPNs) are the most frequently cited positions for new bonuses.
    • Existing staff are increasingly offered bonuses for successful referrals of new hires.
    • Many practice leaders phase in sign-on bonuses after a probationary period (e.g., 90 days or six months).

    Additionally, many practice leaders noted that starting wages have increased for many clinical support positions, and that pay grades for nurses have been revised upward on account of increasing competition in their markets.

    Did you know?

    MGMA DataDive Management and Staff Compensation includes bonus/incentive benchmarking data for a wide range of positions, from physician executives and senior managers down to clinical support and administrative staff. Discover key benchmarks and trends from the 2021 MGMA Management and Staff Compensation survey report paired with expert insights and MGMA Stat findings

    Labor demand and compensation data

    By most accounts, the COVID-19 pandemic stifled what was a considerable upward trend in compensation for nurses and medical assistants (MAs) in recent years:

    • The recently released 2021 MGMA DataDive Management and Staff Compensation (based on 2020 data) found minimal changes in median total compensation for licensed practical nurses (LPNs), registered nurses (RNs) and MAs versus 2019 levels.
    • However, the five-year trends (2016 to 2020) for those same positions found gains of 11.23% for LPNs, 13.66% for RNs and 12.07% for MAs, as well as a 26.14% growth for triage nurses.

    These compensation gains are likely the byproduct of looming MA and RN shortages:

    Practical steps

    There are obvious issues with using bonuses as a recruitment tool, starting with financial viability. However, if a local market has grown more competitive and put pressure on a practice to increase wages, a sign-on bonus can be one method to avoid a “compression effect” (e.g., ensuring that newly hired staff are not reaching the same compensation levels as your most experienced employees).

    Practice leaders also should consider adding additional paid time off for senior staff or determining a flat cost-of-living wage adjustment.

    Another approach would be to find nonclinical staff to assist with tasks such as rooming patients, according to Andrew Hajde, CMPE, assistant director of association content, MGMA. But a longer-term solution would involve going out to nursing schools and other training organizations to establish a feeder program that brings new staff into your organization regularly.

    MGMA’s Andrew Swanson, MPA, CMPE, vice president of industry insights, echoed that sentiment in a recent webinar on the Quantifying COVID-19 data report, saying that these market changes will force practice leaders “to think more strategically” about getting workers to perform tasks at the top of their licensure and building out pipeline/feeder systems in the community to bring in new talent.

    “If your nursing staff is bouncing around practices in town or between the hospital or hospital systems ... you’ve got to have a feeder system,” Swanson implored.

    Additionally, building more into the employee onboarding process is a crucial way to lay the groundwork for better retention as compensation and benefits become more competitive. Making those early days and weeks “memorable and extremely positive” to leave a lasting impact as a new employee integrates with your team might make the difference in keeping that individual when an offer for better pay comes along, Swanson said.

    “Really make a strong impression out of the gate — in the first day, in the first week, in the first month of somebody's employment — so that when somebody comes knocking on the door, or the workday gets really hard on Day 45 or on Day 68, they can reflect pretty quickly back on an experience they had that says, ‘This is worth it. It's worth it for me to stay here. I'm doing really good work,’” Swanson said.

    Do you have any best practices or success stories to share on this topic? Please let us know by emailing us at


    Our ability at MGMA to provide great resources, education and advocacy depends on a strong feedback loop with healthcare leaders. To be part of this effort, sign up for MGMA Stat and make your voice heard in our weekly polls. Sign up by texting “STAT” to 33550 or visit Polls will be sent to your phone via text message.

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