Medical assistants (MAs) were in high demand in team-based primary care, prompting health systems to look towards career ladders based on expanded MA duties to boost MA recruitment and retention. For a study, researchers sought to understand better MA career goals and how they corresponded with existing development options. From August to December 2019, semi-structured focus groups were held in primary care clinics across three health systems in California and Utah. MA career objectives and their alignment with existing career ladders were discussed, recorded, and examined qualitatively. About three major themes emerged from 10 focus groups with 59 participants: mixed perceptions of expanded MA roles, with concerns about increased responsibility without corresponding pay increases; divergent career aspirations among MAs not addressed by existing career ladders; and career ladders implementation challenges, such as opaque advancement requirements and lack of consistency across practice settings. Although MAs had favorable views of career ladders, in theory, they advised several changes to their actual execution at three institutions, including enhancing clarity and consistency around promotion standards and aligning compensation with job responsibilities. The establishment of 2 separate clusters of MA professionals’ wants and ambitions shows room to improve career ladders and give personalized support to MAs to increase the healthcare workforce and talent pipeline.