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Healthcare Practices: Managing Part-Time Worker Payroll (2026)
Part-time payroll in healthcare practices carries the same withholding and overtime rules as full-time, and part-time hours count toward the ACA employer mandate at 120 hours a month per full-time equivalent. BEG: $45 per employee per month inside the payroll software you already use, live in 3 to 5 days.
Rules that matter for part-time healthcare practice staff
Hospitals and residential care establishments may compute overtime over a fixed 14 consecutive day work period instead of the 40 hour workweek, paying time and one half for hours over 8 in a day and over 80 in the period. The employer must have a prior agreement or understanding with the affected employees before the work is performed, and cannot use both systems for the same employee.
When an employee works two jobs at different rates in one workweek, such as a nurse aide who also covers reception, overtime may be computed on the weighted average of the rates, or at time and one half the rate for the work performed during the overtime hours if agreed in advance.
An employer that averaged at least 50 full-time employees, counting full-time equivalents, in the prior calendar year is an applicable large employer and must offer affordable minimum essential coverage to full-time employees and their dependents or face an employer shared responsibility payment. A full-time employee is one with at least 30 hours of service a week or 130 hours a month; the base payments are $2,000 and $3,000 per employee per year, indexed, and were $2,970 and $4,460 for 2024.
The arithmetic
Overtime is owed after 40 hours in the workweek regardless of part-time status, and a part-time employee who picks up shifts across two roles has their regular rate blended across both. For the ACA, monthly hours of all non-full-time employees are pooled and divided by 120 to produce full-time equivalents; 60 part-time employees at 60 hours a month are 30 FTEs. For FMLA, a part-time employee counts as one employee toward the 50 threshold and is eligible personally only after 1,250 hours in the prior 12 months. At the BLS May 2025 national median for registered nurses, $97,550 a year or about $47 an hour, a 20-hour week is $938 before tax.
The rules behind this page, with sources
General information, not legal advice. Every rule below was read on the agency page linked next to it.
- Hospitals and residential care establishments may compute overtime over a fixed 14 consecutive day work period instead of the 40 hour workweek, paying time and one half for hours over 8 in a day and over 80 in the period. The employer must have a prior agreement or understanding with the affected employees before the work is performed, and cannot use both systems for the same employee. [DOL Fact Sheet #54]
- When an employee works two jobs at different rates in one workweek, such as a nurse aide who also covers reception, overtime may be computed on the weighted average of the rates, or at time and one half the rate for the work performed during the overtime hours if agreed in advance. [DOL Fact Sheet #54]
- An employer that averaged at least 50 full-time employees, counting full-time equivalents, in the prior calendar year is an applicable large employer and must offer affordable minimum essential coverage to full-time employees and their dependents or face an employer shared responsibility payment. A full-time employee is one with at least 30 hours of service a week or 130 hours a month; the base payments are $2,000 and $3,000 per employee per year, indexed, and were $2,970 and $4,460 for 2024. [IRS Employer Shared Responsibility Provisions]
Read the full guide to ACA reporting and the employer mandate, and the rest of the healthcare practice payroll library.
Managed Payroll, Handled.
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Frequently Asked Questions
Do part-time physicians at a healthcare practice count toward the ACA 50-employee test?
Yes, as full-time equivalents: their monthly hours are pooled and divided by 120. That is why the count is run from payroll hours every year rather than from headcount.
Is overtime owed to a part-time healthcare practice employee?
Yes, after 40 hours in a workweek, at time and one half on the regular rate. Part-time status changes benefits eligibility, not the overtime rule. Hospitals and residential care establishments may compute overtime over a fixed 14 consecutive day work period instead of the 40 hour workweek, paying time and one half for hours over 8 in a day and over 80 in the period.
What does managed payroll cost for a healthcare practice?
$45 per employee per month, all-inclusive, inside the payroll software you already use, with no monthly minimum. Shift differentials, on-call pay and credentialing-based pay tiers are configured at setup, not billed as add-ons.
Related Resources
Anthony leads payroll solutions at Business Executive Group, a national managed payroll firm serving businesses across industries including Healthcare Practices. BEG manages payroll at $45 PEPM, all-inclusive, with deep expertise in compliance, multi-state filing, and industry-specific payroll requirements. Get instant pricing at beghr.com.
Authoritative source: U.S. Department of Labor: Wage and Hour Division
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