The first labour tasks when opening a clinic — social insurance for nurses and reception staff, and the on-call permit for doctors

In short: When you open a clinic, the first labour tasks are enrolling staff in social insurance (health insurance and employees' pension), setting out working conditions and drawing up employment contracts, and — if you use 10 or more people — drawing up and filing work rules. If doctors or staff do night or holiday on-call duty, you also obtain an on-call permit from the Labor Standards Inspection Office, which places that time outside the working-hours rules. A medical corporation (a juridical person) is subject to compulsory social insurance if it employs anyone; a sole-proprietor clinic is compulsory once it regularly uses 5 or more people. This page sets out what to tackle first, how to judge social-insurance coverage, the meaning of the on-call permit, the timing of work rules and the 36 Agreement, and whom to ask for what.

Opening with "the director sees patients, labour matters come later" tends to create gaps and unpaid amounts in social insurance across the joining date. This page is for doctors and office managers opening a new clinic, and sets out the first labour tasks from the viewpoint of a shakai hoken roumushi's labour management.

What labour tasks come first when opening a clinic?

Apart from the clinic-opening notification (public health centre) and the designation as an insurance-covered medical institution, there are tasks that arise from employing people. In order, before and around opening:

Timing	What to do	Where to file
Before opening / before joining	Set out working conditions and draw up employment contracts (Labor Standards Act, Article 15)	Within the office (deliver to the person)
Joining date	Notification of acquisition of health-insurance and employees'-pension status (within 5 days)	Pension office (Kyokai Kenpo, etc.)
Joining date / within 10 days	Notification of acquisition of employment-insurance status	Hello Work
From when you start using workers	Establishment notification for labour insurance (workers' accident / employment) and estimated-premium return	Labor Standards Inspection Office / Hello Work
When you regularly use 10 or more	Draw up and file work rules (Labor Standards Act, Article 89)	The competent Chief of the Labor Standards Inspection Office
When staff do on-call duty	Permit for intermittent night/holiday on-call duty (Ordinance for Enforcement of the Labor Standards Act, Article 23)	The competent Chief of the Labor Standards Inspection Office

The health-insurance/pension acquisition notice is due within 5 days of joining, and the employment-insurance acquisition notice by around the 10th of the month after joining. The starting point is to fix "who, from when, into which insurance." For the general thinking on working hours and premium wages, see also The 36 Agreement and the overtime ceiling.

Do nurses and reception staff fall under compulsory social insurance, and how do you judge it?

Whether the office itself enrols in social insurance (health insurance and employees' pension) depends on the form of the office and the industry and headcount.

Form of office	Social insurance (health / pension)
A juridical person such as a medical corporation	Compulsory if it regularly uses employees (regardless of number)
Sole-proprietor clinic (a covered industry)	Compulsory if it regularly uses 5 or more; under 5 is voluntary

The medical business (treating illness, etc.) is a covered industry under the Health Insurance Act and the Employees' Pension Insurance Act (Health Insurance Act, Article 3, paragraph 3; Employees' Pension Insurance Act, Article 6). So even a sole-proprietor clinic is compulsory once it regularly employs 5 or more, and a medical corporation is compulsory regardless of number.

On top of that, whether a part-time nurse or receptionist individually becomes an insured person is judged by working hours and days. If the weekly scheduled hours and monthly scheduled days are three-quarters or more of an ordinary worker's, the person is insured; even below three-quarters, someone who meets certain conditions (20+ hours a week, monthly wage of 88,000 yen or more, etc.) is insured. This coverage of short-time workers has been expanding in stages. For where the line is drawn, see Social insurance for part-timers: the three-quarters guide and The expansion of social-insurance coverage.

Why is an on-call permit needed for doctors and staff, and to whom is it filed?

Night and holiday on-call duty (standby-type work at night or on holidays) is, in principle, treated as working time and feeds into overtime/late-night premium wages and the ceilings on working hours. However, for standby-type duty where there is normally almost no need to work, once the employer obtains a permit from the competent Chief of the Labor Standards Inspection Office (Form No. 10), the person may be used regardless of the working-hours rules (Labor Standards Act, Article 32) — under Labor Standards Act, Article 41, item 3, and Ordinance for Enforcement of the Labor Standards Act, Article 23. This is the on-call permit.

For doctors, since April 2024 (Reiwa 6) the overtime cap has applied to doctors engaged in medical practice, and time under an on-call permit is in principle not counted as working time, so whether the permit exists matters in practice in relation to the cap too. That said, even during permitted on-call duty, time spent on ordinary work of the same kind as regular duty is treated as working time and is subject to premium wages.

Item	Content
Basis	Labor Standards Act, Article 41, item 3; Ordinance for Enforcement of the Labor Standards Act, Article 23
Subject of the permit	Standby-type night/holiday on-call duty with normally almost no need to work
Where to apply	The competent Chief of the Labor Standards Inspection Office (Form No. 10)
Effect	Outside the working-hours rules (Labor Standards Act, Article 32); but time on ordinary work is working time

The decision on the permit is made by the Labor Standards Inspection Office. This office helps arrange the actual duty pattern in line with the permit standards and draft the application papers.

When are work rules and the 36 Agreement needed?

Depending on headcount and how you have people work, the following documents become necessary.

Document	When it is needed	Basis
Work rules	When you regularly use 10 or more workers (duty to draw up and file)	Labor Standards Act, Article 89
36 Agreement	When you have people work overtime or on holidays beyond statutory working hours	Labor Standards Act, Article 36

An employer that regularly uses 10 or more workers must draw up work rules and file them with the competent Chief of the Labor Standards Inspection Office (Labor Standards Act, Article 89). Even under 10, drawing them up to align working conditions and wage rules keeps the practice stable. For how many employees make work rules mandatory, see How many employees make work rules mandatory.

To have people work overtime or on holidays beyond statutory hours (in principle 8 hours a day / 40 hours a week), you must first conclude a 36 Agreement with the majority representative and file it (Labor Standards Act, Article 36). Because medical settings readily generate night and holiday work, it is safest to put work rules, the 36 Agreement, and premium-wage calculation in place as a set early in the opening phase.

How do you fit labour tasks into the opening schedule?

Labour tasks overlap in timing with the clinic-opening notification and preparing the premises. To avoid omissions, lay them out in this order.

Stage	What to do on labour
Planning premises and interior	From expected headcount and shifts, design social-insurance coverage and the working-hours framework
Hiring staff	Set out working conditions, draw up employment contracts, and prepare a first draft of the work rules
Just before opening	Prepare the labour-insurance establishment notice and the new social-insurance coverage notice
Joining date	Health/pension acquisition notices (within 5 days) and the employment-insurance acquisition notice
Promptly after opening	If 10 or more, file the work rules; if there is on-call duty, the on-call permit; conclude and file the 36 Agreement

Selecting and leasing the premises themselves is the realm of real estate, and the clinic-opening notification is a procedure for a gyoseishoshi or the director in person (public health centre); the parties in charge differ from labour. The next section sets this out.

Whom should you ask, and for what?

Opening a clinic is not completed by labour matters alone. The party in charge differs by task.

What to do	Whose work it is
Social- and labour-insurance coverage procedures; drawing up work rules and the 36 Agreement; working-hours and on-call-permit papers; payroll	A Shakai Hoken Roumushi (Certified Social Insurance and Labor Consultant) (this office)
Drafting administrative papers such as the clinic-opening notification	A Gyoseishoshi (Certified Administrative Procedures Legal Specialist) (or the director in person to the public health centre)
Decisions to grant/accept the on-call permit and the 36 Agreement	The competent Chief of the Labor Standards Inspection Office
Designation as an insurance-covered medical institution	The Regional Bureau of Health and Welfare
Selecting, leasing and fitting out the clinic premises	Real estate (a licensed real-estate broker)
Claims for unpaid wages and labour disputes	An attorney
Withholding, year-end adjustment, and corporate tax	A tax accountant

This office is limited to providing information and handling procedures for labour management. We can connect you to 四葉行政書士事務所 for administrative procedures such as the clinic-opening notification, and to 四葉不動産 for premises; on the premise that shakai hoken roumushi work, gyoseishoshi work, and the real-estate brokerage business are each carried out by an independent business entity and are contracted separately. We do not take on everything under a single contract.

What can 四葉社会保険労務士事務所 do for you?

四葉社会保険労務士事務所 in Kohinata, Bunkyo Ward, handles, for opening a clinic, social- and labour-insurance coverage procedures, setting out working conditions and drawing up employment contracts, drawing up and filing work rules and the 36 Agreement, arranging the on-call permit application, and payroll. The initial consultation is free. We quote according to the content and the number of employees; for how fees are thought about, see the fee schedule, and the questions we are asked most often are collected on the FAQ page.

Where a claim for unpaid wages or a dispute has already arisen, we will guide you to engage an attorney directly. This office does not accept referral fees.

Frequently asked questions

Q. Do we have to enrol in social insurance even with only two or three staff?
A. If you are a juridical person such as a medical corporation, health insurance and employees' pension are compulsory even with two or three employees. For a sole-proprietor clinic, it is compulsory once you regularly use 5 or more, and voluntary under 5. Because the industry and the way headcount is counted can require judgement, we recommend checking against the actual situation.

Q. If we obtain an on-call permit, do we never have to pay night-time premium wages?
A. No. The on-call permit places standby-type duty, where there is normally almost no need to work, outside the working-hours rules. Even during permitted on-call duty, time spent on ordinary work — such as handling an emergency patient — is treated as working time and is subject to premium wages.

Q. Are work rules absolutely required from the moment of opening?
A. The duty to draw up and file arises when you regularly use 10 or more workers (Labor Standards Act, Article 89). Even under 10, drawing them up to align working conditions and wage/service rules helps prevent later trouble.

Q. Can you also handle the premises search and the clinic-opening notification?
A. Labour management is the work of a shakai hoken roumushi; the papers for the clinic-opening notification are the work of a gyoseishoshi (or the director in person to the public health centre); the premises are the work of a licensed real-estate broker. On the premise that each is an independent business entity contracted separately, we can connect you to 四葉行政書士事務所 and 四葉不動産. We do not take these on together under a single contract.

Sources for this article

• Health Insurance Act (健康保険法, Act No. 70 of 1922), Article 3, paragraph 3 (covered industries; compulsory coverage of juridical-person offices; sole-proprietor offices compulsory in a covered industry with 5 or more regular employees)
• Employees' Pension Insurance Act (厚生年金保険法, Act No. 115 of 1954), Article 6 (covered offices)
• Labor Standards Act (労働基準法, Act No. 49 of 1947), Article 15 (statement of working conditions), Article 32 (working hours), Article 36 (agreement on overtime/holiday work), Article 37 (premium wages), Article 41, item 3 (exclusion for those in monitoring or intermittent work), Article 89 (duty to draw up and file work rules with 10 or more regular workers)
• Ordinance for Enforcement of the Labor Standards Act (労働基準法施行規則, Ordinance No. 23 of 1947), Article 23 (treatment where a permit is obtained from the competent Chief of the Labor Standards Inspection Office, by Form No. 10, for intermittent night/holiday on-call duty)
• The start date for applying the overtime cap to doctors engaged in medical practice is April 1, 2024 (Reiwa 6) (confirmed from the Ministry of Health, Labour and Welfare's materials on "physician work-style reform"; referenced September 2026)
• The health/pension acquisition notice is due within 5 days, and the employment-insurance deadlines were checked against the guidance of the Japan Pension Service and Hello Work (referenced September 2026)

This article does not go so far as to decide whom you should consult. Social- and labour-insurance coverage procedures, drawing up work rules and the 36 Agreement, on-call-permit papers, and payroll are the work of a shakai hoken roumushi. Administrative papers such as the clinic-opening notification are the work of a gyoseishoshi (or the director in person to the public health centre); premises selection and leasing are the work of a licensed real-estate broker; claims for unpaid wages and disputes are the work of an attorney; withholding, year-end adjustment, and corporate tax are the work of a tax accountant. Shakai hoken roumushi work, gyoseishoshi work, and the real-estate brokerage business are each carried out by an independent business entity and contracted separately. This office does not accept referral fees. The cost of consulting 四葉社会保険労務士事務所 is set out in the fee schedule, and the questions we are asked most often are collected on the FAQ page.

This article is general information. Judgments that fit your particular circumstances are made by a qualified professional after a meeting. Written by Joji Uramatsu (Shakai Hoken Roumushi (Certified Social Insurance and Labor Consultant), Gyoseishoshi (Certified Administrative Procedures Legal Specialist), Registered Real Estate Transaction Specialist).