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Staffing the Membership Practice: Who to Hire First, and How Many | CMT Research Brief No. 40

Educational content only. Not medical, legal, tax, financial or accounting advice. Read the disclaimer.

Concierge Medicine Today

CMT Research Brief No. 40 · Practice Operations · October 2026

Research Brief No. 40Practice OperationsPrimary evidence: Population Data

Staffing the Membership Practice: Who to Hire First, and How Many

A concierge physician with a few hundred members does not need the staff of a 2,300-patient practice, but the promises a membership makes, such as a same-day answer or a real person on the phone, land on staff before they land on the physician. This brief sets out the roles, what they cost, what each may legally do, and a reasonable order for hiring them.

By Concierge Medicine Today, Editorial ResearchPublished October 2026Version 1.0External review: pendingReading time: 13 minutes

New in October 2026. Wage figures are BLS May 2025 data, the latest published.

Start here: the questions this brief answers

Tap a question for the short answer, then jump to the evidence.

The 30-second answer

There is no published, methodology-disclosed staffing benchmark for concierge practices. The best primary care data come from traditional practices: 4.50 FTE staff per FTE physician across 496 practices in a CMS initiative, fewer in larger groups. A membership practice carries a much smaller panel, so it usually needs fewer people per physician. Each of those people, though, carries more of the service promise. Most practices start with one strong clinical hire and one person who owns the patient’s first contact, then add the rest as members and physicians grow. Medical assistant scope varies by state, which can decide whether your clinical lead is an MA or a nurse.

From the Editor-in-Chief

“Remove every unnecessary obstacle FOR the patient and build systems that make servanthood in healthcare repeatable.”

Michael Tetreault Editor-in-Chief, Concierge Medicine Today

How many staff does a concierge physician need?

Nobody has published a reliable concierge benchmark. Traditional primary care practices in one large CMS study averaged 4.50 FTE staff per FTE physician; a membership practice with a far smaller panel usually runs leaner, but not in proportion to the panel.

Go to the full answer ↓

Who should I hire first?

In CMT’s editorial reading, a versatile clinical lead and a person who owns first contact with members. The other roles follow as the practice grows.

Go to the full answer ↓

What do these roles cost?

BLS national medians for May 2025 run from $38,010 for receptionists and $45,690 for medical assistants to $97,550 for registered nurses and $123,860 for medical and health services managers. Local pay varies widely.

Go to the full answer ↓

Can a medical assistant handle after-hours calls?

It depends on the state and the call. California, for example, bars medical assistants from independent telephone triage, which matters if your membership promises direct phone access.

Go to the full answer ↓

Should my first clinical hire be an NP or PA?

That is a different decision, covered in CMT Research Briefs No. 18 and No. 20. This brief focuses on the support team around the physician.

Go to the full answer ↓

Written for:Physicians planning a conversionConcierge practice ownersPractice managersNew concierge staffAdvisors and consultants

Part 1 · The starting numbers

Why membership staffing does not follow the usual ratios

Ask a consultant how many staff a primary care physician needs and you will hear a ratio. The ratios come from practices built around volume. Membership practices are built around something else, and the numbers only take you part of the way.

The cleanest public data come from a CMS-funded study of practices selected for the Comprehensive Primary Care Initiative. Across 496 practices, the authors counted 4.50 full-time-equivalent staff for every full-time physician, with small practices running heavier than large ones.¹ The sample was not designed to represent the nation, and the practices were more technologically advanced than most. MGMA cost data tell a related story for multispecialty groups: a median near 5.0 support staff per physician, and practices staffed at 2.1 to 3.0 per physician produced the least.² Practice Insight

4.50

mean FTE staff per FTE physician across 496 traditional primary care practices in the CMS Comprehensive Primary Care Initiative (2014 data)

Population Data ¹

5.32 vs. 3.35

staff per physician in the smallest practices (2 or fewer physicians) vs. the largest in the same study

Population Data ¹

983

patients one physician could reasonably care for with no task delegation, in a published model; about 1,947 with heavy delegation to the team

Practice Insight ³

898 vs. 2,303

mean patient panel of retainer (concierge) physicians vs. traditional physicians in a 2005 national survey

Population Data ⁴

The panel numbers matter more for a concierge physician. In 2005, the only national survey of retainer physicians CMT located reported panels averaging 898 patients, against 2,303 for comparison physicians.⁴ That survey is two decades old, and panels vary widely today. A modeling paper in Annals of Family Medicine offers a different angle: a physician doing all the work personally could carry about 983 patients, and the number roughly doubles when the team takes on most preventive work and about half of chronic care.³

CMT reading

Put those two papers side by side and the membership logic is plain. A concierge physician with a smaller panel does much of the work a high-volume practice delegates, which is one reason members join. So the main job of staff in a membership practice is to keep the access promise when the physician is at the hospital or asleep. That usually means fewer people per physician than a traditional practice, but the reduction is smaller than the panel cut would suggest, because each staff member carries more of the relationship. This is CMT’s editorial reasoning, not a measured benchmark.

CMT data slot · concierge staffing per physician

No published source reports staff per physician for concierge practices. A CMT survey of concierge practice owners would fill this gap. Useful fields: physicians and NPs/PAs on staff; total members; FTE count by role (MA, LPN, RN, front desk or patient experience, care coordinator, biller, manager); which functions are outsourced; and whether the practice bills insurance. Report concierge and DPC respondents separately, with sample size, dates and recruitment method.

Editor: replace this box with CMT survey results (with sample size, dates and recruitment method) before publishing, or delete it.

Part 2 · The roles

Six roles, and what each does in a membership practice

The job titles are the same ones any primary care office uses. What changes is the weight of each job. In a membership practice, the person answering the phone is part of what the member pays for.

Wage figures below are BLS national medians for May 2025.^5,6,7,8,9 Local pay can sit well above or below them, and medians do not include benefits or payroll taxes.

Role	What it covers in a membership practice	BLS median pay, May 2025	Credential and scope	Evidence type
Medical assistant (MA)	Rooms members, takes vitals, draws blood where permitted, handles refill and lab-result logistics, keeps the schedule moving	$45,690 national; $45,520 in physician offices	Usually unlicensed; scope set by state law and the supervising physician	Population Data Policy and Law
Licensed practical or vocational nurse (LPN/LVN)	Clinical work above MA scope in many states, medication tasks, follow-up calls under nursing rules	$64,400 national; $59,520 in physician offices	State nursing license; scope narrower than an RN	Population Data
Registered nurse (RN)	Clinical triage, care management, post-hospital follow-up, patient education, often the after-hours clinical voice	$97,550 national; $91,230 in ambulatory care	State nursing license; broadest support-staff clinical scope	Population Data
Front desk or patient experience lead	The first voice members hear: scheduling, phones, messages, welcome and renewal conversations	$38,010 national for receptionists; $19.00 an hour in health care	No license; judgment and discretion matter more than credentials	Population Data
Care coordinator	Referrals, records, specialist and hospital communication, keeping track of what happens after the visit	No single BLS category; often an RN, LPN or experienced MA	Depends on who fills it; clinical coordination may need a license	Practice Insight
Practice manager	Payroll, vendors, compliance calendar, hiring, membership billing and, in blended practices, insurance billing oversight	$123,860 national; $105,770 in physician offices	No license; many small practices share or outsource this role	Population Data

Two roles are missing on purpose. Nurse practitioners and physician assistants change the practice’s clinical capacity and its membership design, which makes them a separate decision; CMT Research Briefs No. 18 and No. 20 cover that decision in depth. Billing staff are folded into the manager row because most small concierge practices either outsource insurance billing or, if they no longer bill insurance, need only membership billing and bookkeeping.

The CMS study gives a sense of what is common in traditional practices. Nearly all reported administrative staff (98%) and most reported medical assistants (89%). Fewer had LPNs (47%) or RNs (36%), and only 24% reported a care manager or coordinator.¹ Population Data Concierge practices may look different. Nobody has published the data to say.

Part 3 · The labor market

What the roles cost, and which are hardest to fill

The gap between an MA and an RN is more than $50,000 a year at the national median. For a one-physician practice, that single choice can move the staffing budget more than any other.

National median pay by role, May 2025

Annual median wage, all industries. Benefits and payroll taxes not included.

Analysis and chart: Concierge Medicine TodaySource: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, May 2025 wage data.^8,5,6,7,9 Medians in physician offices are lower for LPNs ($59,520) and managers ($105,770). Population Data.

Supply is tight where small practices feel it most. In a May 2025 MGMA Stat poll with 420 applicable responses, 47% of practice leaders said medical assistants were their hardest role to recruit, well ahead of nurses at 15%.¹⁰ Practice Insight A separate MGMA poll the same month found turnover had settled for most practices, but medical assistants and front-office staff were still the roles with the most churn.¹¹ Practice Insight

BLS projects medical assistant jobs to grow 13% from 2025 to 2035, much faster than average, and receptionist jobs to shrink 2%.^5,8 Population Data Over half of medical assistants (56%) already work in physician offices, so a concierge practice is competing with the offices down the hall.⁵

First-principles question

When a staff member leaves, recruiting time is the obvious cost. A membership practice pays another one: members know the person who answers the phone by name, and a departure is something they notice. Factor that into the pay decision, not just the median.

Part 4 · Scope of practice

What your staff may do depends on your state

BLS puts it simply: the tasks medical assistants are allowed to do vary by state.⁵ For a concierge practice that promises direct access, this is not a technicality. It decides who can answer a clinical call.

Two states show how far apart the rules can be. California treats the MA as an unlicensed role bound tightly to an on-site supervisor. Washington requires a state credential before someone can practice under an MA title.

California: supervisor on the premises

The Medical Board of California describes medical assistants as unlicensed staff who perform non-invasive technical support. The supervising physician (or another listed licensee) must be on the premises. After required training, MAs may give injections and draw blood. They may not start IVs, insert urinary catheters, administer chemotherapy or independently perform telephone triage.¹² Policy and Law

Washington: a credential is required

Washington law says no one may practice as a medical assistant-certified, medical assistant-registered or in the other listed MA categories without certification or registration from the state.¹³ Policy and Law

A hire who worked as an MA elsewhere may need a Washington credential before day one.

The same MA, given a bigger job

In a 12-month randomized trial at two San Francisco safety-net clinics, patients coached by medical assistants were more likely to reach at least one of their uncontrolled clinical goals: 46.4% vs. 34.3% with usual care.¹⁴ Clinical Trial Evidence

The setting differs from concierge practice, but it shows what a trained MA can add beyond rooming.

Stable pairs, less exhaustion

A survey of 16 San Francisco primary care clinics found that clinicians who worked consistently with the same medical assistants, and who reported a stronger team culture, had less exhaustion.¹⁵ Practice Insight

Site visits to 23 high-functioning practices found the same shift toward more clinical support per physician; at one, each physician worked with two MAs or an MA and an RN.¹⁶

If the membership promises a quick answer to a clinical question, find out before you hire who in your state is allowed to give it.

For many concierge practices this turns into a practical rule. If members will call or text with symptoms, and the physician is not always the one answering, a licensed nurse often has to be part of the plan. That is CMT’s reading of the scope rules above, not legal advice; confirm with your state medical and nursing boards or counsel.

Part 5 · Build

A reasonable hiring order, and a planner to talk it through

There is no tested hiring sequence for concierge practices. What follows is CMT’s editorial reading of the evidence above, offered as a starting order that many practices will change.

A clinical lead

One person who can room members, draw labs where permitted and handle clinical messages under your direction. An experienced MA fits many practices; an LPN or RN fits better if the role includes triage or after-hours clinical calls. Hire for judgment and warmth before speed.

Someone who owns first contact

Scheduling, phones, portal messages, welcome calls and renewals. In the first months this may be the clinical lead or a part-time hire, but once members call daily it needs an owner. Members judge the practice here before they meet the physician.

Care coordination

Referrals, outside records and hospital follow-up add up quickly when members expect you to stay involved. Many practices give this to an RN; others train a senior MA. CMT Research Brief No. 48 covers the hospital piece.

Billing and books, often outsourced

A blended concierge practice that still bills insurance and Medicare needs reliable claims work, usually from an outside service at first. A practice that bills only memberships needs bookkeeping and membership billing, which also outsource well.

A practice manager

Usually the hire that comes with a second physician or an NP or PA, when payroll and compliance work stop fitting into the physician’s evenings. Before then, the work is often split between the physician and an outside accountant or consultant.

Answer a few questions about your practice to see which roles to put on the table and the questions to take to your advisors. The planner lists roles to discuss. It does not set staffing levels and is not a benchmark.

Interactive tool

Staffing planner

Physicians in the practice Members per physician (planned or current)

We bill insurance or Medicare for covered visits We promise members after-hours phone or text access We draw blood or run labs in the office We follow members closely through referrals and hospital stays We run multi-part assessments (executive or longevity style) We employ, or plan to employ, an NP or PA

When you are ready to recruit, the CMT Job Board lists concierge openings and practices for sale, and organizations can post their own listings there.¹⁷ Its current listings are mostly physician roles, so for support staff most practices will also recruit locally.

Learn

Know the rules

Read your state’s scope rules for medical assistants and nurses before writing a job description. Two states, two very different answers.

Build

Hire for the promise

Write down what your membership promises members, then name the person who keeps each promise when you are unavailable. Gaps in that list are your next hire.

Lead

Keep the team together

Stable pairings and a real team culture are linked to less exhaustion. In a practice members choose for continuity, staff continuity counts too.

Methods, limitations and evidence types

How this brief was built

CMT searched for published staffing data on concierge practices and found no study or survey with a disclosed method that reports staff per physician for concierge practices alone. The brief therefore leans on research from traditional primary care. Its core is a CMS-funded study of 496 practices, supported by MGMA cost data and by team-based care studies in Annals of Family Medicine and the Journal of the American Board of Family Medicine. It adds national wage data from the Bureau of Labor Statistics Occupational Outlook Handbook (May 2025 figures, the latest published) and MGMA Stat polls on hiring, and checks medical assistant scope against official material from two states. Every source was opened in October 2026.

Comparisons between traditional and membership staffing are CMT’s editorial reasoning and are labeled that way. The one concierge-specific figure (panel size) comes from a 2005 national survey and is old. No direct primary care data are used, because CMT treats DPC as a separate model with its own staffing questions. The staffing planner in Part 5 lists roles to discuss. It is not a benchmark and does not recommend staffing levels.

How to read the evidence types

Every key finding is labeled by evidence type. Labels describe the type of evidence, not its value. Each type answers different questions. Funding is disclosed on every source.

Clinical Trial Evidence
Randomized trials and systematic reviews.Best for cause and effect.

Population Data
Large observational studies and government data.Best for trends at scale.

Practice Insight
Surveys, smaller studies and expert consensus.Best for real-world experience.

Industry Research
Company-sponsored or company-reported data that is not peer-reviewed.Best for early signals and operating data.

Policy and Law
Statutes, regulation and official guidance.Best for what is required.

What we don't know

How many staff concierge practices actually employ per physician, by panel size. No public dataset reports it.
Whether concierge staff stay longer or leave sooner than staff in traditional practices.
How AI scribes and messaging tools are changing the number of support staff a membership practice needs.
How member satisfaction relates to staffing levels in concierge practices; no study CMT found tests it.

How to cite this brief

Concierge Medicine Today. “Staffing the Membership Practice: Who to Hire First, and How Many.” CMT Research Brief No. 40. October 2026. https://conciergemedicinetoday.net/staffing-the-membership-practice

External review: this brief has not yet been reviewed by an outside expert. When review is complete, the reviewer is credited by name above with any conflicts of interest, and the version number is updated. Reviewers check accuracy and fairness; CMT is responsible for the final content.

Corrections policy: when an error is identified, CMT corrects it in the open and updates the version number above. Send corrections to the editor through conciergemedicinetoday.net.

Keep reading

Related CMT Research Briefs

Sources

References

Peikes DN, Reid RJ, Day TJ, Cornwell DDF, Dale SB, Baron RJ, Brown RS, Shapiro RJ. Staffing patterns of primary care practices in the Comprehensive Primary Care Initiative. Annals of Family Medicine. 2014;12(2):142-149. doi:10.1370/afm.1626. www.annfammed.orgFunding: federal (Centers for Medicare and Medicaid Services, contract HHSM-500-2010-00026I/HHSM-500-T0006)
Gans DN. Data Mine: the secret of staffing success (2018 MGMA DataDive Cost and Revenue data, 141 multispecialty groups). Medical Group Management Association. June 10, 2019. www.mgma.comFunding: not stated (conducted and published by MGMA)
Altschuler J, Margolius D, Bodenheimer T, Grumbach K. Estimating a reasonable patient panel size for primary care physicians with team-based task delegation. Annals of Family Medicine. 2012;10(5):396-400. doi:10.1370/afm.1400. www.annfammed.orgFunding: not stated
Alexander GC, Kurlander J, Wynia MK. Physicians in retainer ("concierge") practice: a national survey of physician, patient, and practice characteristics. Journal of General Internal Medicine. 2005;20(12):1079-1083. pure.johnshopkins.eduFunding: mixed: professional society (AMA Institute for Ethics), foundation (Robert Wood Johnson Clinical Scholars Program) and academic (MacLean Center for Clinical Medical Ethics)
U.S. Bureau of Labor Statistics. Occupational Outlook Handbook: Medical Assistants (pay, work environment and outlook tabs; May 2025 wage data; 2025 to 2035 projections). Accessed October 2026. www.bls.govFunding: federal (U.S. Bureau of Labor Statistics publication)
U.S. Bureau of Labor Statistics. Occupational Outlook Handbook: Licensed Practical and Licensed Vocational Nurses (May 2025 wage data; 2025 to 2035 projections). Accessed October 2026. www.bls.govFunding: federal (U.S. Bureau of Labor Statistics publication)
U.S. Bureau of Labor Statistics. Occupational Outlook Handbook: Registered Nurses (May 2025 wage data; 2025 to 2035 projections). Accessed October 2026. www.bls.govFunding: federal (U.S. Bureau of Labor Statistics publication)
U.S. Bureau of Labor Statistics. Occupational Outlook Handbook: Receptionists (May 2025 wage data; 2025 to 2035 projections). Accessed October 2026. www.bls.govFunding: federal (U.S. Bureau of Labor Statistics publication)
U.S. Bureau of Labor Statistics. Occupational Outlook Handbook: Medical and Health Services Managers (May 2025 wage data; 2025 to 2035 projections). Accessed October 2026. www.bls.govFunding: federal (U.S. Bureau of Labor Statistics publication)
Harrop C. Why medical assistants are still tougher to hire today than nurses, coders and other medical practice staff. MGMA Stat poll, May 6, 2025 (420 applicable responses). Medical Group Management Association. May 7, 2025. www.mgma.comFunding: not stated (conducted and published by MGMA)
Harrop C. Can staff turnover continue to be tamed in medical practices into 2026? MGMA Stat poll (357 applicable responses). Medical Group Management Association. May 14, 2025. www.mgma.comFunding: not stated (conducted and published by MGMA)
Medical Board of California. Medical Assistants (practice information; Business and Professions Code sections 2069 to 2071; Title 16, California Code of Regulations, sections 1366 to 1366.4). Accessed October 2026. www.mbc.ca.govFunding: not stated (official guidance of the Medical Board of California, a state agency)
Washington State Legislature. RCW 18.360.020, Certification or registration required (medical assistants). Accessed October 2026. app.leg.wa.govFunding: not stated (state statute)
Willard-Grace R, Chen EH, Hessler D, DeVore D, Prado C, Bodenheimer T, Thom DH. Health coaching by medical assistants to improve control of diabetes, hypertension, and hyperlipidemia in low-income patients: a randomized controlled trial. Annals of Family Medicine. 2015;13(2):130-138. doi:10.1370/afm.1768. www.annfammed.orgFunding: foundation (Gordon and Betty Moore Foundation, Betty Irene Moore Nursing Initiative)
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Disclaimer

Educational and informational only. This CMT Research Brief does not constitute medical, legal, tax, financial, accounting or other professional advice, and it does not create a professional relationship of any kind. Statements about laws, regulations, tax rules and payer policies are general, may not reflect the rules in your state, and can change after publication. Consult a qualified attorney, accountant, tax adviser, compliance professional or licensed clinician before acting on anything here.

Independence. Concierge Medicine Today is an independent publication. It does not accept payment for favorable coverage, and it does not favor one practice model over another. Company names and products are mentioned for context only and are not endorsements. Funding is disclosed for every source in the reference list.

Accuracy. CMT verifies figures against their original or best available sources at the time of publication. Where a figure is an estimate, an inference or a company-reported number, the brief says so. This content is not without possible error or omission.