By the time 32 clinic administrators finished chatting in Madison, Wisconsin, in 1926, they had already done something radical. And they decided not to go back to running their practices alone.

That detail — preserved because the group hired a stenographer to record the meeting verbatim — still resonates a century later. As Dave Gans, a national authority on medical practice operations and MGMA’s unofficial historian, put it, those early administrators realized “we are not islands; we have common issues, we have common solutions, and we can learn from each other.”

That instinct — to share, compare, and professionalize the business side of medicine — is the connective tissue running through MGMA’s first 100 years. 

In a special centennial episode of the MGMA Insights Podcast, Daniel Williams, senior editor and host of the MGMA Insights Podcast, sat down with two leaders who embody that continuity and change: Gans, whose relationship with MGMA spans nearly five decades, and Akash Madiah, MGMA’s interim CEO, who is guiding the organization into its next century.

What emerged was not a nostalgia tour, but a set of concrete lessons for today’s practice leaders — many of whom are wrestling with challenges that look surprisingly familiar.

From Train Rides to Data Tables: Why MGMA Was Formed in the First Place

The origin story of MGMA is less about formal governance and more about practical necessity. In 1926, administrators traveled for days by train to meet centrally in Wisconsin. “When you traveled for a day or more to get together,” Gans noted, “what did they do? They talked. And they shared.”

The group quickly realized discussion alone was not enough. “They decided that we have needs that go beyond just discussion — we need to do a survey,” Gans said. 

That first survey examined practice costs, overhead, staffing levels, and collection percentages — metrics that remain central to practice management today.

What’s striking is not just that MGMA began as a data organization, but that it did so without staff. “For the first 30 to 40 years, it was completely member-oriented, run by members without a staff,” Gans said. 

Even after MGMA hired its first full-time executive, Ed Stevens, in the early 1960s to manage the journal and annual meeting, the organization’s operating model stayed anchored in member leadership. That structure still shapes how MGMA works — and why its resources tend to reflect operational reality rather than theory.

“You’re Still Doing the Same Job”: What Hasn’t Changed in 100 Years

Medicine has transformed since 1926. Practice administration, less so.

“The core concepts of being a practice executive have not changed,” Gans said flatly. “You’re still doing the same job.”

He recently revisited MGMA’s first-century evolution in an article titled A Century of Progress? — with a deliberate question mark. While technology has reshaped medical records, billing systems, and revenue cycle workflows, the administrator’s role remains balancing efficiency, cost, and clinical support.

“We have new ways of managing medical records,” Gans said. “We have new ways of managing revenues in the practice. We have new ways of trying to reduce our administrative costs — and we have new ways of increasing those costs.”

The tension between operational complexity and sustainability is not new. What’s new is the velocity at which tools, regulations, and expectations change — making shared benchmarks and peer insight even more critical.

The Physician–Administrator Compact That Defines Group Practice

To explain what truly distinguishes group practice, Gans reached back more than a century, quoting Harry Harwick, the Mayo Clinic’s first business manager and one of MGMA’s foundational figures.

“There seems to be a constant war on between the hospital superintendent and the professional staff,” Harwick warned, noting that the same risk could emerge in group practices if administration and clinicians drifted apart.
Gans emphasized the relevance of that observation today. “A group is no bigger than its professional staff,” he said, quoting Harwick, and its success depends on “a close, harmonious feeling between the administration and professional staff.”

This principle — physician–administrator collaboration — became one of MGMA’s enduring core values. In practice, that collaboration shows up in concrete ways: administrators securing prior authorizations, designing compensation models, and building workflows that allow clinicians to focus on care.

“In the best group practices, the best well-run, that antagonism doesn’t exist,” Gans said. “It’s a team.”

When Data Saves Jobs — And Careers

Gans said he never had a single “aha” moment when MGMA’s impact crystallized. Instead, it emerged repeatedly in member interactions.

“Members would come up to me at the annual meeting and say, ‘David, I really liked what you did,’” he recalled. Often, they were referring to an article, a benchmark survey, or a dataset they had used to justify staffing changes or redesign workflows.

Then came the part that stayed with him. “They said, ‘You made a difference,’” Gans said. “Or, ‘You saved my job.’ Or, ‘I got a promotion.’ You and MGMA made a difference.”

That same practical impact — MGMA data used to solve immediate, career‑shaping problems — also explains how Akash Madiah first encountered the organization long before he led it.

Before joining MGMA as CFO in October 2018, Madiah was running finances for a medical practice and relying on MGMA data to make high‑stakes operational decisions. “We were redoing all our comp plans for our doctors,” he said. “I used MGMA data.”

Only later did he realize the organization behind those datasets was located just down the road from where he lived and on the same street where he had gone to high school.

The Network Effect: Why Conferences Still Matter

Both leaders emphasized that MGMA’s value extends far beyond its datasets. “The most valuable thing you might get here is those hallway conversations,” Madiah told attendees at the MGMA Operations Conference in Charlotte.

He was explicit about the limits of formal programming. “You can listen to a speaker on stage,” he said, “but the thing you really remember is connecting it with that personal connection.”

Williams echoed that sentiment, noting that many members return year after year not for a single solution, but for reassurance. “Just to know that I’m not alone,” he said, describing conversations with attendees from Miami to Alaska who face similar operational pressures.

Those informal exchanges reflect MGMA’s original purpose — and remain a core strategic asset.

A New Logo, An Old Idea: Continuity Into the Next Century

MGMA’s centennial logo — unveiled earlier this year — features an infinity symbol woven into the number 100. For Madiah, the symbolism matters.

“It’s really signifying continuity,” he said. “Honoring the past, and we’re going to keep going. We’re going to keep advancing the business of health care.”

That continuity does not mean stasis. Madiah was clear that what worked in the past will not automatically work in the future. “What made MGMA great in the past is not going to make MGMA great in the future,” he said. “We have to continually be looking to the future.”

That includes being selective about technology adoption. “AI is just one example,” he said. “People are tired of initiatives that go nowhere and vendor promises.”

The litmus test, he argued, is whether MGMA makes members’ lives easier — not more complex.

What MGMA Wants to Be Known For in 2026 — And Beyond

Looking ahead, Madiah described a simple but demanding goal: relevance at the moment of need. “When people have a problem on the administrative side or the financial side or the ops side of healthcare,” he said, “the first thing they think of is MGMA.”

That requires relentless external focus — listening at conferences, analyzing session attendance, engaging with advocacy partners, and translating feedback into usable tools. It also requires humility. 

“We’re not always going to get it right,” Madiah acknowledged. “But half the problem is knowing what the problem is.”

As MGMA enters its second century, that may be its most enduring legacy — not just a repository of data or events, but a living network built on the same premise that brought 32 administrators to Madison in 1926: Shared problems are easier to solve together.