Can you afford a medical assistant?

You can afford a medical assistant when the math covers their full cost, which is more than the hourly wage, and the time they free up turns into members or hours you'd otherwise lose.

Start with the full cost

The hourly wage is where everyone starts, and it's the number that fools you. An employee costs more than their pay. You'll have employer payroll taxes, any benefits you offer, workers' comp, training time, scrubs, a seat in your software, and payroll processing. How those payroll taxes work is your CPA's call. Your job is to put a dollar figure on each line before you post the job.

Here's a made-up example. Say you pay $20 an hour for 40 hours a week. That's $41,600 a year in wages ($20 times 2,080 hours). Say the extras above add $8,400 a year. Your fully loaded cost is $50,000 a year, or about $4,167 a month.

Now put that in members. If your membership is $75 a month, you need about 56 more members to cover the MA (4,167 divided by 75 is 55.6). That assumes each new member costs you little beyond your time. If labs and supplies eat part of each membership, the number goes up. That's the bar. Everything else in this post is about whether the MA helps you clear it.

What the MA has to free up

An MA pays for themselves in one of two ways. They let you see more members without longer days, or they take work off your plate so you get your evenings back. Both are fair reasons. Be honest about which one you're buying, because only the first one shows up in revenue.

Write down what you'd hand off. Rooming patients, vitals, refill requests, scheduling, inbox triage, inventory, lab draws. Next to each one, estimate the hours it takes you each week now. If the list adds up to six hours a week, ask what you'd do with those six hours.

If the answer is see more patients, you need people to fill those hours, either a waitlist or a steady flow of new members. If the answer is go home earlier, that's a quality of life choice, and it can be the right one. Make it on purpose, and budget for it as a cost you're choosing, not one you expect to pay for itself.

What I'd check before you post the job

• Your fully loaded monthly cost, written down line by line
• How many new members that cost equals at your current price
• Your panel trend over the last six months. Growing, flat, or shrinking?
• Whether people are waiting to join, or you've got open slots you can't fill yet
• How many months your cash could carry the MA if growth stalls
• The specific tasks you'll stop doing on day one

If you want a quick read on where your panel needs to be, our panel break-even calculator is a good place to start.

How to test it before you commit

You don't have to go from zero to full time. Here's what I'd do. Start part time on your busiest days and set a 90-day check. Before day one, write down three numbers: members on your panel, visits per week, and the hours you work.

At 90 days, look again. If the panel grew or visits went up without your hours going up, the MA is earning their keep. If nothing moved and you still feel buried, the tasks you handed off weren't the ones slowing you down. That's worth knowing before you add the full-time cost.

Check your cash before you start, too. Hiring ahead of growth means you'll carry the cost for a few months before new members catch up. Know how many months you can carry it. Our post on cash runway walks through that math. If the answer makes you nervous, wait, or start smaller.

When it's an easy yes

It's an easy yes when you've got a waitlist, your days are full, and your cash would cover the MA for six months even if no new members joined. It's a harder call when the panel is flat and the hire is mostly about relief. That can still be the right move. Know that you're paying for time, not growth, and plan your budget around it. It's your call either way.

Common questions

Should my MA be an employee or a contractor?
That depends on how the role works, and the rules are specific. Talk to your CPA or an employment attorney before you decide.

How long before an MA pays for themselves?
It depends on how fast the freed-up time turns into new members. Set a 90-day check on panel size, visits and your own hours. If none of them moved, rethink the role before you add hours.

Can you run payroll for my MA?
Yes, as an add-on. We run payroll in Gusto because it's efficient for us, and we don't have a referral arrangement with them.