Managed IT vs. Internal IT Hire

What each model actually costs.

Internal IT hire — loaded cost

A qualified healthcare IT professional (EHR experience + general IT competence) commands $75K-$130K salary in Northern NJ markets depending on experience. Loaded cost (salary + benefits + taxes + training + equipment) typically runs 1.3-1.5x salary, so $100K-$195K all-in for one FTE. Specialty expertise (EHR-specific, cybersecurity-specific) adds another 10-30%.

Managed IT — monthly fee structure

Healthcare-specific MSPs typically charge $150-400+ per user per month for comprehensive managed IT (endpoints, servers, network, helpdesk, security, and compliance support). For a 15-person practice, this translates to roughly $27K-$72K annually — less than one FTE in most cases. For a 50-person practice, $90K-$240K annually — approaching or exceeding FTE cost, but with substantially broader capability.

Coverage considerations

One FTE provides coverage during their working hours, when they're not on vacation, sick, or trying to do a different task. Real operational coverage for a single-FTE practice is roughly 40-45 hours per week with gaps. MSP coverage is typically 24/7/365 for monitoring and incident response with business-hours availability for routine support — materially broader coverage than one internal FTE can provide.

What each model brings to specialized work.

Internal IT strengths: deep knowledge of the specific practice, always physically available, direct alignment with practice operations, no external coordination overhead, and direct accountability to the practice.

Internal IT limitations: one person can't be specialist in all domains medical practices need — EHR administration, HIPAA compliance, cybersecurity, network architecture, server management, and end-user support. Single FTEs usually cover breadth at the expense of depth in any specific area. Vacation/sickness creates coverage gaps. Staff turnover creates significant practice risk.

MSP strengths: specialist team coverage — EHR specialists, HIPAA specialists, cybersecurity analysts, network engineers — rather than one generalist. 24/7 monitoring and incident response. Consistent coverage regardless of individual availability. Tools and infrastructure the MSP already owns (SIEM, RMM, ticketing) that individual practices can't justify.

MSP limitations: less deep knowledge of specific practice culture and priorities. Coordination overhead for routine tasks. Response time depends on SLA and MSP capacity. Risk of the MSP becoming a single point of failure if poorly selected.

Honest fit patterns.

Managed IT typically fits

• Small practices (under 25 users) where internal IT can't justify full FTE cost.
• Practices with meaningful cybersecurity and compliance requirements that exceed single-generalist capability.
• Multi-location or growing practices where scaling internal IT is operationally difficult.
• Practices wanting specialized EHR expertise combined with general IT support without hiring multiple specialists.
• Practices prioritizing operational consistency over complete in-house control.

Internal IT typically fits

• Larger practices (100+ users) where multiple internal IT staff is operationally appropriate.
• Practices with highly-specific operational requirements that warrant dedicated expertise.
• Organizations prioritizing complete in-house control for strategic reasons.
• Hospital-affiliated practices with access to health system IT resources.

Co-managed IT — hybrid approach

For larger practices wanting both internal presence and external expertise, co-managed IT combines internal IT staff with MSP partnership. Common model: internal IT handles day-to-day user support and practice-specific needs; MSP provides specialty expertise, 24/7 monitoring, security operations, and compliance support. See our full-managed vs co-managed comparison.