Staff turnover is costing you; invest in it
It isn’t inflation, rent, or even payer claw-backs. Your steepest internal cost is people walking out the door.
MGMA’s 2024 operations dataset pegs front-office turnover at 40% and clinical-support turnover at 33% for single-specialty practices. Every departure pulls cash straight off the income statement:
Medical Assistant
Average Turnover cost: $14K
Nurse
Average Turnover Cost: $61K
NP or PA
Average Turnover Cost: $150K
Physician
Average Turnover Cost: $1.2M
Those dollars go to recruiting fees, overtime for remaining staff, ramp-up training, credentialing and enrollment timelines, and appointment slots you can’t fill while short staffed.
Here’s an example to put those numbers in context:
Current headcount: 5 MAs, 4 NPs, 2 physicians
Turnover: 1 MA + 1 NP
Hard cost: $14K + $150K = $164K
Lost visits while back-filling (est. 9 slots/day × 30 days): 270 visits × $85 net per visit = $23K
All-in annual turnover cost: $187K
Enough to cover a full-time NP.
The kicker: those dollars are post-tax and post-overhead. You have to gross roughly $267K in collections just to break-even.
Capital allocation, HR edition
It’s really easy to want to fund assets, ultrasounds, CTs, etc. because the ROI is tangible. And you know, shiny. Yet a $1,500 retention bonus that prevents a $14K MA exit produces a 9.3 × cash-on-cash return in year 1. Nothing in the bond market even blinks at that yield.
And, instead of depreciating over 5–7 years, investing in people pays immediate, compounding dividends:
$1,500 retention bonus
Prevents flight risk for 12 months
ROI: 830% in 12 months
$3/hr raise ($5,800/yr)
2 year churn reduction
ROI: 240% by year 2
Playbook:
1/ Calculate turnover costs: last 12 months’ separations × role-specific cost. Put the number on the finance dashboard. What gets measured gets improved.
2/ Identify your flight-risk cohort: anyone under 24 months’ tenure. The 2 year mark is the safer zone.
3/ Two potential retention levers:
Career-ladder stipend: $600–$1,000 for certification prep. Claw-back if they leave inside a year.
Bonus and salary progression transparency: Institute policy for bonus and for raises that everyone knows and has visibility into.
4/ Workplace feedback and survey: If you’re big enough, deploy surveys to staff. Keep it anonymous and don’t get your feelings hurt. If small, hold all-hands meetings for open and honest feedback.
Wrapping up
Recruiters will tell you turnover is “just the market.” Grumpy people will tell you that, “no one wants to work anymore.”
But in reality, the best way to avoid these costs is to invest in them. On top of the amazing environment you have created, pay people well. Invest in them.
It’s a capital allocation choice: pay six figures after people quit, or spend a fraction up front to keep them. In a 4 % interest-rate world, no other investment turns $1 into $9 faster. Treat retention like a line of business. Because your margin, and your sanity, depend on it.
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