New Survey Shows Utilization, Revenue Decline for Medical Groups

Revenue Declined Further than Expenses in 2020

Alexandria, VA – AMGA’s newly released 2021 Medical Group Operations and Finance Survey reveals both median net revenue and expenses declined for medical groups in 2020, but the revenue decline outpaced the expense decline due to the decrease in volume caused by the COVID-19 pandemic.

“Although 2020 was in the height of the COVID-19 pandemic, many groups adapted during that year and made changes that will remain in place going forward,” said Rose Wagner, RN, M.H.S., FACMPE, AMGA Consulting chief operating officer. “Therefore, the pandemic resulted in many positive operational changes and learnings that medical groups can use to build upon. This survey is a critical tool to understand the financial and operational impact of the pandemic on medical groups.”

Revenue Trends

The survey showed median provider salary and benefits expense as a percent of net revenue rose from 72.1% to 84.9%, which is a result of provider compensation being protected during COVID-19 coupled with decreased productivity during the same time. Median clinic staff salary and benefits expense as a percent of net revenue decreased from 24.2% to 22.8%. The latter demonstrates the impact of layoffs, furloughs, and care model/process changes due to the COVID-19 pandemic. Additionally, median total operating expense as a percent of net revenue (excluding salary and benefits) rose from 21.7% to 29%.

"We have seen the median provider salary and benefits as a percent of net revenue trending upward in recent years, leaving a smaller percentage of the expense structure to cover staff salaries and benefits and operational expenses,” said Wagner. “This situation is not sustainable, and medical groups must focus on ensuring optimal efficiency in practice operations.”

Profit/Investment per Provider/Physician






Profit/Investment per Provider









Profit/Investment per Physician









“When looking at trends, organizations often look at investment per physician/provider as a benchmark of performance,” said Fred Horton, M.H.A., AMGA Consulting president. “However, since expenses included and allocation methodologies in the P&L differ from organization to organization, we recommend utilizing a comparative analysis at the expense line item level, and the survey enables such a comparison. This approach points efforts to areas where the medical group is able to control and ultimately impact change.”

Utilization Trends

The survey also showed median annual visits per provider declined in 2020. When medical groups employ both physicians and advanced practice providers (APPs), the “per provider” metric is typically utilized, with the metrics being divided by the total number of both physicians and APPs providers.

Median Annual Visits per Provider


All Medical Groups











Advanced Practice Provider Utilization

While system-affiliated medical groups utilized more APPs than independent medical groups, the ratios between the two were near identical. 

APP to Physician Ratio


All Medical Groups











 “APP to physician ratio did decline in 2020 in primary care and medical specialties, most likely due to layoffs and furloughs as a result of COVID-19,” Wagner said. “Prior to 2020, the APP to physician ratios had been increasing year over year.”

About the Survey

The 2021 edition of AMGA’s Medical Group Operations and Finance Survey is its most comprehensive survey yet, featuring data from 47 independent and affiliated medical groups, representing more than 23,000 providers across 6,712 clinic sites.

In addition to the above revenue and operational metrics, the full survey includes data on:

  • Access (scheduling, telehealth utilization, etc.)
  • Revenue cycles (account receivable, claims data, denials, etc.)
  • Staffing ratios for:
    1. Operational support departments
    2. Clinic staffing by role per physician, per provider and per 10,000 work RVU (wRVU)
    3. Advanced practice provider to physician ratio by specialty
  • Financial information – line item revenue and expense detail at the group and clinic level, available per physician, per provider and per 10,000 wRVU
  • And more

For press copies, please contact Matt Clarke.


About AMGA Consulting 

AMGA Consulting assists healthcare organizations in navigating the changing industry environment. AMGA Consulting builds clients’ organizational capabilities through effective governance, operational improvement, strategic alignment, talent management, provider compensation design, fair market value analysis, and total rewards solutions. To learn more, visit

About AMGA
AMGA is a trade association leading the transformation of health care in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate, and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of our members’ recognized excellence in the delivery of coordinated, high-quality, high-value care. Over 177,000 physicians practice in our member organizations, delivering care to more than one in three Americans.


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