Managed IT is not “someone to call when email breaks.” You are buying a named set of responsibilities: patching, monitoring, identity help, backups, and a response clock during the hours you see patients or clients. If those items are not in writing, you are buying a hope.
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What you are actually buying
- Endpoint and server monitoring with someone watching the alerts.
- Patching on a schedule, including the machines people are afraid to reboot.
- Identity administration: new hires, leavers, MFA exceptions that should not be exceptions.
- Backup oversight, or a clear statement that backup is yours.
- A response target during office hours, and a stated after-hours path if you pay for it.
Projects (new firewalls, migrations, cabling) are usually extra. If a quote looks cheap, look for projects, after-hours, and Microsoft licenses hiding in a later email.
Cost bands by size
For a typical professional office in 2026, all-in managed services often land roughly in these planning bands per user per month, excluding major projects and excluding Microsoft or practice-software licenses: about $150–$250 for a 1–10 person office that needs heavy hand-holding; about $125–$200 at 11–50 people when the stack is standard; sometimes lower per user at 51–100 if you have an internal coordinator. Rural coverage, imaging workstations, and after-hours SLAs push the number up.
A $70 “per seat” offer that excludes servers, firewalls, backups, and after-hours is not comparable to a $180 offer that includes them. Compare a sample monthly invoice for your real device count.
Red flags
- No list of devices and cloud tenants in scope.
- Unlimited support claimed with no response target.
- The technician who sells you also “handles HIPAA” as a certificate they print.
- A contract that auto-renews for years with no exit of your data and passwords.
- Unwillingness to name who covers lunches, vacations, and a Tuesday outage.
How we evaluated
We compare proposals on coverage, exclusions, response, and exit — not on logo familiarity. Crazy Smart Consulting is a related implementation option with disclosed ownership. It is not ranked here as an independent winner. For a gap list before you bid, run the scorecard.
FAQ
Should we hire an internal IT person instead? A practice under about 40 people rarely needs a full-time generalist and still needs after-hours coverage. Many offices do better with a managed provider plus one staff owner who can decide.
Is cheaper offshore monitoring fine? Monitoring can be remote. Decision rights and a person who has seen your operatory or file room still matter when imaging or a court deadline is involved.