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    Chris Harrop
    Chris Harrop

    A tight labor market as the COVID-19 pandemic continues has most medical practices across the United States prepared to carve a much bigger piece of their budgetary pie for salaries and wages in 2022.

    A Dec. 14, 2021, MGMA Stat poll found that half of medical practices (50%) budgeted more than usual for workers’ cost-of-living increases for 2022, while 45% say they budgeted their usual annual increases and only 6% reported budgeting “less than usual” for next year.

    The poll had 496 applicable responses.

    Among medical practice leaders responding to the poll, the average cost-of-living increase reported was 5%, with the top responses reaching 15% to 25% for the most-sought-after clinical positions that were catching up with the market in certain regions.

    However, the financial strains of the COVID-19 pandemic and stagnant reimbursement were clear from many medical practice leaders who noted larger wage increases weren’t tenable at this time. “All staff wages increased, supply costs increased, service costs increased, yet physician reimbursement decreased,” one practice leader told MGMA.

    In other cases, practice leaders noted they finalized 2022 budgets before labor shortages became a major issue in their areas, leading them to consider additional measures in the coming months to ensure competitive pay for in-demand roles. Another practice leader told MGMA, there’s “no wiggle room” in the budget to accommodate large increases.

    Historically, many practices have planned for about 1% to 2.5% annual wage increases to keep pace with inflation; however, economic trends have pointed to growing inflation. The Social Security Administration (SSA) recently issued its largest increase for retirees in almost four decades, with a 5.9% cost-of-living adjustment (COLA) set for 2022, following a 1.3% COLA for 2021.

    But in many respects, COLA is just a byproduct of a historically difficult market for staffing in healthcare and beyond, ongoing throughout most of the COVID-19 pandemic. Practice leaders who responded to the most-recent MGMA Stat poll cited the following as their top recruitment/hiring challenges:

    • Medical assistants (MAs), receptionists/front-office workers and licensed practical nurses (LPNs) were the most commonly cited positions to be most difficult to recruit and hire.
    • Anesthesia providers are increasingly difficult to recruit, on account of larger organizations and private-equity-backed companies boosting sign-on bonuses larger than those seen in independent practices.
    • Various technician positions, including X-ray, respiratory and echocardiograph techs.

    Compensation trends

    As detailed in the MGMA data report Building a People-First Pandemic Recovery, the arrival of the COVID-19 pandemic did not drastically affect compensation levels for nurses and medical assistants (MAs) in 2020 — only triage nurses saw a sizable jump from 2019 compensation levels reported in MGMA DataDive Management and Staff Compensation. However, taking a five-year view from 2016 through 2020 shows that median compensation for these clinical provider roles saw 11.23% to 26.14% growth even before the effects of the labor shortage in 2021.

    Given that one-third of medical practices reduced staff compensation in the early months of the COVID-19 pandemic, it’s clear that the increased demand for these workers — along with improving visit volumes following vaccine rollout — has made the temporary stagnation of nurse and MA pay levels a thing of the past, with practices frequently noting their current compensation levels struggle to keep pace with incentives offered by large systems and hospitals.

    Did you know?

    The data report highlighted coastal areas generally as those ranked highest for total compensation for licensed practical nurses (LPNs), registered nurses (RNs) and MAs.

    The report also found significant variance in median compensation for those same clinical staff roles, based on 2021 MGMA DataDive Management and Staff Compensation data, from highest-paying area to lowest:

    • For LPNs, there’s a $23,015 gap between the highest-paying (Washington State) and lowest (Oklahoma).
    • For RNs, the gap between highest-paying (District of Columbia) and lowest (New Jersey) was $58,143.
    • The gap for MAs between Washington State and the lowest-paying area (Delaware) was $22,963.

    Staffing crisis prompts new approaches

    These findings are largely in line with past polling and MGMA member comments about the difficulty hiring for open positions, especially as the market for travel nurses has prompted significant turnover across the nation and wages in other industries (e.g., retail and food service) have become competitive with front-office and some clinical support positions in medical practices.

    As one MGMA-member practice administrator recently said, her independently owned dermatology practice was forced to increase hourly wages for almost all employees in 2021, all while facing a host of other difficulties retaining and recruiting other positions, including:

    • Continued difficulty hiring new medical assistants (MAs)
    • Rampant no-shows for interviews from job applicants
    • Newly hired employees who leave the job within a matter of days or weeks for other jobs
    • Longtime employees who have refused mask mandates or COVID-19 vaccination policies.

    To counteract some of these issues, many practice leaders seek out local salary surveys to understand what they need to do to keep pace with other employers in their market, whether that’s hospital-owned practices in the community or nearby retail stores and chain restaurants.

    In some instances, the answer for struggling practices has been to consider virtual assistants for a variety of front-, mid- and back-office functions (e.g., answering phones, scheduling appointments, authorizations).

    Outsourcing as an answer

    When the time came for more virtual care during the COVID-19 pandemic, the job of Fran Saperstein, chief operating officer, Center for Complex Neurology EDS & POTS, Phoenix, needed to account for staffing changes.

    Early in the pandemic, the practice had a front office worker quit as the scheduling of new patients dwindled and the office was going to be closed as the first wave of COVID-19 surged in Arizona. That left Saperstein, a care coordinator and one other team member to answer phones, handling medications and payments. Additionally, the practice’s first option for a telehealth platform became difficult to use after initial success during the pandemic, which pushed them to find another solution.

    Given these added administrative tasks, shifting away from in-office care meant needing a new infrastructure for virtual care delivery. The group already had a secure, third-party platform for patient communications that allowed patients to fill out registration forms and helped the group answer phones and manage text messaging from patients. When that platform added a telemedicine option to its software package, it made lots of sense.

    The next step was adding a virtual assistant: An outsourced worker with experience in insurance and patient scheduling. “She made my life so much easier that we brought on another [virtual assistant],” Saperstein said. The second virtual assistant had experience as a pharmacist and was able to assist with prior authorizations. Eventually, the group brought on a third assistant — specializing in transcription service — as a scribe for the doctor.

    These virtual assistants receive a flat hourly rate, and then the group provides the assistant access to the EHR and Microsoft Office 365 through a virtual private network (VPN) and the group’s VoIP-based phone system to ensure the work remains secure.

    “We’re looking at ways to continue to improve their function so that they can be even more helpful to us,” Saperstein said. “It has been pretty amazing in changing the way that our practice runs.”

    This simplification of administrative work and expansion of virtual care means patients get a better experience overall, which is important given the complexity and acuity of their health issues. “It’s so much easier for our patients. … They are happier to wait at home than they would be to wait in our office.”

    Learn more about virtual assistants, chatbots and outsourcing


    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.







    Chris Harrop

    Written By

    Chris Harrop

    A veteran journalist, Chris Harrop serves as managing editor of MGMA Connection magazine, MGMA Insights newsletter, MGMA Stat and several other publications across MGMA. Email him.

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