Poor Onboarding Is Actually Costing Your Practice
Most specialist and allied health practices know that losing a new staff member early is expensive. What most do not know is exactly how expensive.
The visible cost is easy to see. The salary paid during the period. The time spent on interviews. Perhaps an agency fee.
The invisible cost is where the real damage sits. And when you add it up honestly, the total is almost always a shock.
AHRI’s 2026 Managing the 5Rs report estimates the average cost of replacing an employee at $28,500. For specialist and allied health practice roles, where billing accuracy, patient communication and clinical support require specific knowledge and confidence, that figure is not an outlier. It is a starting point.
The cost of poor onboarding is not just the salary paid during the training period. It is everything that flows from a new person not being set up to succeed.
The Onboarding Cost Formula for Medical Practices
Every practice that relies on informal onboarding is absorbing costs across the same six categories. Most practices absorb them silently, spread across the team, without ever identifying the onboarding process as the source.
Here is the formula:
| Cost Area | What to Calculate |
| 1. Recruitment and interview time | Hours spent writing the ad, reviewing applications, interviewing and checking references. Multiply by the hourly rate of the person doing this work. |
| 2. Senior staff sit-beside training | Hours spent sitting with, explaining to and checking the work of the new starter. Multiply by the senior staff member’s hourly rate, include the cost of their own tasks being delayed. |
| 3. New starter reduced productivity | The gap between what the new starter is being paid and what they can confidently deliver during weeks one to eight. Estimate productive output of a fully capable person and calculate the shortfall. |
| 4. Rework and errors | Time spent identifying and correcting billing errors, booking errors and administrative mistakes made during the learning period. |
| 5. Team disruption | The cost of other staff being interrupted to answer repeated questions or absorb tasks that are not flowing correctly. |
| 6. Repeat cycle if they leave early | If the new person leaves at 30 or 60 days, a significant portion of these costs begins again with the next hire. |
Worked Example: What This Looks Like in a Specialist Practice
The following uses benchmarked figures for a medical receptionist role at $68,000 salary, recruited through an agency.
| Cost Item | Estimate |
| Recruitment, advertising and interview time | $3,500 |
| Senior staff sit-beside training (2 hrs/day x 15 days x $52/hr) | $1,560 |
| New starter reduced productivity, weeks 1 to 8 | $6,500 |
| Rework, errors and team disruption | $4,000 |
| Total if they stay | Approximately $15,560 |
| If they leave at 60 days — add recruitment cost again | $19,000 to $25,000+ |
These are estimates, not a fixed calculation. The actual cost for your practice will depend on the role, the salary, whether an agency was involved, and how much documented training material already exists.
What the formula makes visible is the structure of the cost. AHRI benchmarks the full replacement figure for most practice roles at $15,000 to $30,000 or more once every category is counted.
A failed hire in a small to medium specialist practice is not just a disruption. It is a $15,000 to $30,000+ event that most practices never formally account for
The 60-Day Risk Window
Most informal onboarding failures become visible within the first 60 days. The new staff member arrives capable and motivated. But the environment does not give them what they need to build confidence quickly.
By week four they are still asking questions they feel they should no longer need to ask. By week eight, errors are compounding. By week twelve, they have quietly started looking elsewhere.
The practice concludes it was the wrong hire.
In most cases, it was the right hire placed inside an onboarding process that gave them no genuine chance to succeed. The practice will now run the same cycle again, with the same informal model, and wonder why it keeps producing the same result.
The 60-day window is not just a retention risk. It is the period in which the investment of recruitment is either protected or lost entirely.
What Changes When Onboarding Is Structured
Structured onboarding does not require a dedicated HR function or a formal learning management system. It requires four things:
- A defined framework for the first 30 and 60 days — what the new person learns, when, and in what sequence.
- Documented workflows they can follow from day one rather than relying on observation and memory.
- A structured check-in at the end of week one — a brief conversation covering clarity, confidence and workload. This catches concerns before they settle into patterns.
- A 30-day and 60-day review — formal enough to be useful, simple enough to actually happen.
When these four elements are in place, new starters reach genuine capability faster. Senior staff spend less time repeating themselves. Errors in the first two months reduce. And the 60-day resignation risk drops significantly.
There is also a broader benefit. When a practice documents its workflows for onboarding purposes, those documents serve the whole team. The knowledge that previously lived in one person’s head becomes accessible to everyone. The practice becomes less dependent on any single individual showing up to hold things together.
When you document your workflows for onboarding, you are not just creating a training resource. You are reducing the single biggest operational risk in your practice
Before Your Next Hire
If your practice is losing new starters in the first 90 days, the onboarding process is almost certainly part of the answer.
The starting point does not have to be a full documentation project. Begin with the five to ten tasks that every person in a given role performs in their first week. Write them down. Make them available. Build from there.
That small investment will return more than almost anything else you could do before your next hire arrives.
Working With Denise Pacey
If the costs described in this blog feel familiar, or if you are heading into the second half of the financial year knowing that onboarding in your practice needs to change, this is exactly the work Pace MediSystems is designed to support.
Denise works with specialist and allied health practices across Australia to systemise operations, redesign workflows and build the structural foundations that allow practices to grow without depending on specific people showing up every day to hold things together.
About Denise Pacey
Denise Pacey is the founder of Pace MediSystems and a Certified SYSTEMologist with over two decades of experience in specialist medical practice management. She works with medical practices across Australia in three areas: practice systemisation, Xestro implementation and coaching and mentoring.
Pace MediSystems. Systemise for Success.