People operations
Healthcare staffing for independent practices
Direct-hire is almost always better than agency staffing for an independent practice's core roles (MA, front desk, biller). Agencies make sense for temp coverage or hard-to-fill specialty roles. Retention is a bigger lever than initial pay — every departure costs 30%–75% of annual salary in productivity and hiring cost.
By Jordan Alderman, MBA, CMPE · Reviewed by Rania Hassan, JD, CHC · Last reviewed · Methodology
Disclosure: Independent editorial. No pay-for-placement, no affiliate rankings. Full editorial standards.
This guide covers staffing strategy for independent practices, including when to use agencies and when to hire direct.
Core staffing model (small primary care example)
- Practice manager / office manager: 1
- Front desk / patient access: 1–2
- Medical assistant: 1.5–2 per provider
- Nurse (RN/LPN): 0.5–1 per provider (higher in specialty)
- Billing coordinator (in-house model): 1 per 8k–12k claims/month
- Referral / prior auth coordinator: 0.5–1 (higher in specialty)
Pay bands (2026 US midpoints)
- Practice manager: $65k–$95k
- Front desk: $35k–$50k
- Medical assistant: $38k–$55k
- LPN: $52k–$68k
- RN: $70k–$95k
- Billing coordinator: $45k–$65k
When agencies make sense
- Temp coverage for maternity, medical leave, or gap
- Hard-to-fill specialty roles (nurse practitioner in rural markets)
- Traveling coverage for multi-site groups
- Try-before-hire (many agencies allow direct hire after 90 days)
Retention (the underrated lever)
Turnover is expensive: 30%–75% of annual salary per departure. The biggest retention levers are competitive pay (top-quartile local market), predictable schedule, meaningful benefits, and a functional manager. Skimping on any of these is false economy.