Guide

Temps and per-diem: coverage without a payroll marriage

Summary

Yes. A solo or small practice can bring in temporary and per-diem staff — through a staffing agency, a direct per-diem arrangement, or a locum tenens clinician — without adding a permanent employee to payroll, as long as licensure is verified in the state where care is delivered, exclusion screening runs before the first shift, and the arrangement's malpractice and HIPAA responsibilities are spelled out in writing.

By Gale Editorial · Updated 2026-07-27. Every figure cited to a dated source. How we write.

Yes — and it's the most common first staffing move that isn't a full hire

A solo practice can use temporary and per-diem staff for front-desk coverage, clinical coverage during leave, or overflow capacity without taking on a permanent employee — it's often the first staffing decision a practice makes, before it ever runs its first full payroll.

The appeal is real: no benefits obligation, no long-term commitment, and coverage that scales up or down with demand. The tradeoff is that you're trading payroll simplicity for less control over who shows up and less institutional knowledge staying in the building — worth naming honestly before you lean on temp coverage as a permanent strategy rather than a bridge.

Three structures: staffing agency, direct per-diem, and locum tenens

A staffing agency supplies and employs the worker, handling payroll and often malpractice coverage, while your practice directs the day-to-day work — the closest thing to a hands-off arrangement. Direct per-diem means you contract with an individual clinician or admin worker yourself, as a 1099 relationship if the legal test for independent-contractor status is genuinely met. Locum tenens is the clinical-specific version of temporary coverage, typically for filling a licensed clinician's absence.

The locum arrangement carries its own credentialing and malpractice-tail questions that a front-desk temp assignment doesn't, since a locum clinician is billing under their own license for patients they may never see again. The administrative-staffing equivalent is worth naming too: VAs — domestic and offshore — cover front-desk and billing tasks the way per-diem clinicians cover clinical ones, though offshore arrangements raise a separate HIPAA question about where PHI physically travels.

Licensure travels with the person, not the assignment

A temporary or per-diem clinician must hold an active license in the state where the care is actually delivered — not where the agency is based, and not where the clinician happens to live — and verifying that license status is your responsibility before the first shift, not the agency's alone.

Every state board runs its own public verification lookup; Ohio's counselor, social worker, and marriage and family therapist board, for example, publishes license status directly on its site for exactly this kind of check 1Ref 1Ohio Counselor, Social Worker and Marriage and Family Therapist Board (2026).Ohio Counselor, Social Worker and Marriage and Family Therapist Board.Supports, as one concrete example, that state boards publish their own license-verification lookups — the reader's own state board, not this one, governs their assignment.. Your own state's board is the one that actually governs the assignment — treat any other state's board page as an example of the pattern, not a substitute for checking yours.

Exclusion screening applies to every temp, every time

Run the OIG's List of Excluded Individuals/Entities check on a temporary or per-diem worker exactly as you would a permanent hire, before they see a patient or touch a claim — the federal bar on program payment for an excluded person's services doesn't relax because the arrangement is short-term 2Ref 2HHS Office of Inspector General (2026).Exclusions Program.Supports that federal exclusion screening applies to temporary and per-diem workers the same as permanent hires..

If a staffing agency supplies the worker, ask in writing whether the agency already screens its roster and get the documentation, rather than assuming it happened. "The agency handles that" is not evidence of a completed check — a dated confirmation is.

FLSA and wage rules still apply if you pay them directly

If a staffing agency is the legal employer, federal wage-and-hour compliance is the agency's obligation, not yours. If you're paying a per-diem worker directly — whether as a W-2 or a genuine 1099 relationship — standard Fair Labor Standards Act rules apply to that payment the same as they would to any other employee 3Ref 3U.S. Department of Labor (2026).Fair Labor Standards Act.Supports that FLSA wage-and-hour rules apply when the practice, not an agency, is the direct payer of a per-diem worker..

Misclassifying a direct per-diem relationship as a contractor when the practice actually controls how, when, and where the work happens is a wage-and-hour and payroll-tax exposure that doesn't go away just because the person also works elsewhere. Registering for your state's hiring triggers — withholding and new-hire reporting — applies to a direct per-diem hire the same as it would to anyone else on payroll.

What a staffing agreement should cover

A written agreement with a staffing agency or a direct per-diem worker should cover four things at minimum: who carries malpractice coverage for the work performed, who is responsible for credential and license verification, a signed business associate agreement if the worker will access PHI, and how quickly system access gets revoked when the assignment ends.

The PHI-access question isn't optional just because the relationship is temporary — a temp worker touching your EHR or scheduling system falls inside the same risk analysis your Security Rule obligations already require you to maintain, and a short assignment is still a workforce access point that needs to be documented and closed out 4Ref 4Office of the National Coordinator / ASTP (2026).Security Risk Assessment Tool.Supports that a temporary worker's PHI access falls inside the same Security Rule risk-analysis obligation as any other workforce member..

When per-diem stops making sense and a real hire does

Per-diem and agency coverage tend to cost more per hour than an equivalent employee once you account for the agency markup or the premium a contractor charges for the flexibility — the crossover point is usually when the coverage becomes predictable rather than occasional.

Track it against your own numbers rather than a rule of thumb: compare what you're actually paying per shift against your practice's cost per visit and collections per hour to see whether the coverage is still net-positive, or whether it's quietly eating the margin the visits are generating. If the answer to "is this the first hire in disguise" starts trending toward yes, it usually is.

Common questions

Usually yes for agency-supplied staff — the agency is the legal employer, running its own payroll, withholding, and workers' comp, while your practice directs the day-to-day work. That division is exactly what makes agency staffing simpler than a direct hire, but confirm it in the contract rather than assuming it.

Yes, if the agency or its workers will access PHI, which is almost always the case for clinical or front-desk coverage. Treat the staffing agreement and the BAA as two separate documents signed before the first shift, not one combined form.

No. License verification in the state where the care is actually delivered comes before the first patient contact, not after — telehealth locum arrangements in particular can trip this up when a clinician is licensed in one state and covering patients physically located in another.

It depends on who employs them. If a staffing agency is the legal employer, the agency carries the FLSA obligation. If you're paying a per-diem worker directly, standard federal wage-and-hour rules apply to that relationship the same as any other employee or contractor arrangement.

Roughly, once per-diem hours become predictable and near full-time for one person, the agency markup or 1099 premium usually exceeds what a direct hire would cost in wages plus benefits and payroll overhead. Track actual per-diem spend against a hypothetical hire's fully loaded cost before the coverage becomes a habit rather than a stopgap.

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References

1.Ohio Counselor, Social Worker and Marriage and Family Therapist Board (2026). Ohio Counselor, Social Worker and Marriage and Family Therapist Board. State of Ohio. link ✓Supports, as one concrete example, that state boards publish their own license-verification lookups — the reader's own state board, not this one, governs their assignment.
2.HHS Office of Inspector General (2026). Exclusions Program. HHS Office of Inspector General (OIG). link ✓Supports that federal exclusion screening applies to temporary and per-diem workers the same as permanent hires.
3.U.S. Department of Labor (2026). Fair Labor Standards Act. U.S. Department of Labor (Wage and Hour Division). linkSupports that FLSA wage-and-hour rules apply when the practice, not an agency, is the direct payer of a per-diem worker.
4.Office of the National Coordinator / ASTP (2026). Security Risk Assessment Tool. HealthIT.gov. link ✓Supports that a temporary worker's PHI access falls inside the same Security Rule risk-analysis obligation as any other workforce member.

https://www.gale.care/for-providers/hsf-temp-perdiem-coverage · 4 sources. Competitor details are cited to dated public sources and maintained as they change; figures are estimates, not commitments. Synthetic demonstration.

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