Running relief staffing without an agency comes down to four things a practice group has to own itself: sourcing qualified relief vets and techs, tracking their credentials and shift compliance, paying them correctly as 1099 or W2 workers, and processing that payment without someone in the office reconciling invoices by hand.
Most groups that try this start with a spreadsheet and a group text, and the spreadsheet is usually the first thing to break. That breakdown is worth understanding before a practice decides to go it alone, because the agency fee it's trying to avoid isn't the only cost in the equation.
Why Practices Are Trying to Cut Agencies Out in the First Place
Traditional staffing agencies typically add 20% to 40% on top of a relief vet's base rate to cover their own overhead, liability, and profit, an industry-wide markup that shows up regardless of which agency a practice uses. An $800 relief shift can land closer to $1,000 to $1,200 once that markup is added, and a group running relief across several locations feels that multiplier every week, not just on the occasional emergency fill.
The instinct that follows is reasonable: cut out the middle layer, build a relationship directly with a pool of relief vets and techs, and keep the margin. Some groups have already done exactly this with their own locum reduction strategy.
The part that's easy to underestimate is everything the agency was quietly doing besides sourcing the person: verifying licenses, tracking who's cleared to work where, handling 1099 versus W2 classification correctly by state, and making sure payment actually goes out on time.
What Running Relief In-House Actually Requires
Replacing an agency means replacing four functions, not one. Skipping any of them doesn't remove the cost, it just moves it onto whoever's desk the spreadsheet lives on.
Where the Spreadsheet Model Breaks Down at Scale
A single practice can often run relief on a spreadsheet and a shared calendar because the volume is low enough that one person can hold it all in their head. That stops working once a group crosses two or three locations.
The same relief vet might be eligible to work at one site and not another, depending on state licensing. The pay rate quietly drifts between locations because nobody's comparing notes. Credential expiration dates live in someone's memory instead of a system that flags them.
This is the point where groups either hire a dedicated coordinator, which adds a real salary line to offset the agency fee they just cut, or bring in software built specifically to run relief staffing as a program rather than a series of one-off favors. Either way, the underlying math is the same: going in-house only pays off once the four functions above are actually being run somewhere, not just theoretically owned by whoever has time that week.
Groups that make the switch from agency to in-house relief aren't just avoiding a fee, they're taking on a coordination job the agency used to do quietly in the background. Whether that trade is worth it usually comes down to whether the group has, or builds, a real system for the four functions above instead of trying to run them out of someone's inbox.