Justworks vs Rippling for a Multi-Hospital Vet Group

Picture that group again: two hospitals in the home state, a third opened last year across the state line, twenty-two W-2 staff total, and a rotating pool of eight relief veterinarians who cover shifts at whichever hospital needs them, paid per shift on a 1099 basis. The third hospital's staff, five DVMs and techs, created the group's first real multi-state payroll question the day it opened, independent of anything about the relief pool.

The relief vets are a separate question entirely: as long as they're genuinely choosing which shifts to take and working for other practices too, they sit outside the PEO relationship, but a relief vet who's effectively become the fourth full-time DVM at one location in practice, even if scheduled shift by shift, is worth a second look. That pattern is easy to miss because the paperwork still says relief coverage even after the reality has changed.

Each DVM needs an active veterinary license in the state where they're practicing, issued by that state's veterinary board, entirely separate from payroll. Opening a third hospital in a new state meant licensing every DVM working there in that state before they saw a single patient, a process your PEO has no role in. Keep license tracking as its own owned process, typically the practice manager's, regardless of which PEO platform runs payroll.

This gets more complicated with the relief pool, since a relief vet covering a shift at your new hospital also needs to be licensed in that state, even for a single overnight shift. Confirm licensure for every relief vet you dispatch to a given hospital, not just your full-time staff there.

Two or three hospitals, W-2 staff in one or two states, and a relief pool small enough to track by name is a profile where Justworks may fit, since it charges a per-employee fee and offers benefits and HR support, but confirm current plan details and new-state support before you commit.reates.

A group opening hospitals regularly, especially across more states, or one standardizing practice management software, imaging systems or scheduling tools across locations, tends to get more from Rippling's broader system: faster self-service state registration as you add hospitals, plus device and software provisioning for the equipment each new location needs configured. A group that's acquired a couple of independent practices recently and is folding their systems into one stack tends to feel this benefit fastest.

The relief pool is convenient precisely because it's flexible, which is also what makes it easy to dispatch someone to a hospital in a state they aren't licensed in, especially in a scheduling scramble to cover a last-minute callout. Build a quick license check into how you dispatch relief coverage across hospitals, not just when you first bring a relief vet into the pool, since a vet licensed for your home-state hospitals may not be licensed for the one you opened last year.

• List every hospital by state, and confirm licensing is current for every DVM practicing there
• Separate your relief vet pool from full-time staff, and flag anyone whose shift pattern looks more like a staff role
• Decide whether device and software provisioning across hospitals is worth Rippling's extra configuration
• Ask each vendor how quickly a new hospital's state registration is handled
• Confirm your relief-dispatch process checks license state before, not after, a shift is confirmed

Veterinary practices your size run payroll at roughly 36.4% of revenue¹, reflecting how labor-intensive clinical care is relative to revenue. A nonexecutive hire nationally takes a median 44 days to fill², and DVMs in particular are rarely faster than that, worth planning staffing around well before a new hospital opens.