diff --git a/.github/workflows/build.yml b/.github/workflows/build.yml
index 3b37d3a843..16317f7d0f 100644
--- a/.github/workflows/build.yml
+++ b/.github/workflows/build.yml
@@ -178,6 +178,19 @@ jobs:
           --health-retries 5
         ports:
           - 5432/tcp
+      postgres-seed:
+        image: postgres:${{ matrix.pg-version }}
+        env:
+          POSTGRES_DB: medplum_test
+          POSTGRES_USER: medplum
+          POSTGRES_PASSWORD: medplum
+        options: >-
+          --health-cmd pg_isready
+          --health-retries 5
+          --health-interval 10s
+          --health-timeout 5s
+        ports:
+          - 5433/tcp:5432/tcp
       redis:
         image: redis:${{ matrix.redis-version }}
         options: >-
@@ -225,6 +238,7 @@ jobs:
         env:
           POSTGRES_HOST: localhost
           POSTGRES_PORT: ${{ job.services.postgres.ports[5432] }}
+          POSTGRES_SEED_PORT: ${{ job.services.postgres.ports[5433] }}
           REDIS_PASSWORD_DISABLED_IN_TESTS: 1
       - name: Upload code coverage
         if: ${{ matrix.node-version == 20 && matrix.pg-version == 14 && matrix.redis-version == 7 }}
diff --git a/.gitignore b/.gitignore
index 3e6907b917..7423c47f81 100644
--- a/.gitignore
+++ b/.gitignore
@@ -45,6 +45,7 @@ packages/react/build-storybook.log
 
 # Jest code coverage
 coverage/
+packages/server/coverage-seed/
 
 # TypeScript incremental build
 tsconfig.tsbuildinfo
diff --git a/docker-compose.seed.yml b/docker-compose.seed.yml
new file mode 100644
index 0000000000..17ecc8af88
--- /dev/null
+++ b/docker-compose.seed.yml
@@ -0,0 +1,15 @@
+version: '3.7'
+services:
+  postgres-seed:
+    image: postgres:12
+    restart: always
+    environment:
+      - POSTGRES_USER=medplum
+      - POSTGRES_PASSWORD=medplum
+
+    volumes:
+      - ./postgres/postgres.conf:/usr/local/etc/postgres/postgres.conf
+      - ./postgres/:/docker-entrypoint-initdb.d/
+    command: postgres -c config_file=/usr/local/etc/postgres/postgres.conf
+    ports:
+      - '5433:5432'
diff --git a/docker-compose.yml b/docker-compose.yml
index 6b072b5578..7726992e47 100644
--- a/docker-compose.yml
+++ b/docker-compose.yml
@@ -17,6 +17,19 @@ services:
     command: postgres -c config_file=/usr/local/etc/postgres/postgres.conf
     ports:
       - '5432:5432'
+  postgres-seed:
+    image: postgres:12
+    restart: always
+    environment:
+      - POSTGRES_USER=medplum
+      - POSTGRES_PASSWORD=medplum
+
+    volumes:
+      - ./postgres/postgres.conf:/usr/local/etc/postgres/postgres.conf
+      - ./postgres/:/docker-entrypoint-initdb.d/
+    command: postgres -c config_file=/usr/local/etc/postgres/postgres.conf
+    ports:
+      - '5433:5432'
   redis:
     image: redis:7
     restart: always
diff --git a/package-lock.json b/package-lock.json
index b5e3cbf0ce..7ad4d653ab 100644
--- a/package-lock.json
+++ b/package-lock.json
@@ -23,6 +23,7 @@
         "@types/node": "20.12.7",
         "babel-jest": "29.7.0",
         "babel-preset-vite": "1.1.3",
+        "concurrently": "8.2.2",
         "cross-env": "7.0.3",
         "danger": "11.3.1",
         "esbuild": "0.20.2",
@@ -26164,6 +26165,92 @@
         "typedarray": "^0.0.6"
       }
     },
+    "node_modules/concurrently": {
+      "version": "8.2.2",
+      "resolved": "https://registry.npmjs.org/concurrently/-/concurrently-8.2.2.tgz",
+      "integrity": "sha512-1dP4gpXFhei8IOtlXRE/T/4H88ElHgTiUzh71YUmtjTEHMSRS2Z/fgOxHSxxusGHogsRfxNq1vyAwxSC+EVyDg==",
+      "dev": true,
+      "dependencies": {
+        "chalk": "^4.1.2",
+        "date-fns": "^2.30.0",
+        "lodash": "^4.17.21",
+        "rxjs": "^7.8.1",
+        "shell-quote": "^1.8.1",
+        "spawn-command": "0.0.2",
+        "supports-color": "^8.1.1",
+        "tree-kill": "^1.2.2",
+        "yargs": "^17.7.2"
+      },
+      "bin": {
+        "conc": "dist/bin/concurrently.js",
+        "concurrently": "dist/bin/concurrently.js"
+      },
+      "engines": {
+        "node": "^14.13.0 || >=16.0.0"
+      },
+      "funding": {
+        "url": "https://github.com/open-cli-tools/concurrently?sponsor=1"
+      }
+    },
+    "node_modules/concurrently/node_modules/ansi-styles": {
+      "version": "4.3.0",
+      "resolved": "https://registry.npmjs.org/ansi-styles/-/ansi-styles-4.3.0.tgz",
+      "integrity": "sha512-zbB9rCJAT1rbjiVDb2hqKFHNYLxgtk8NURxZ3IZwD3F6NtxbXZQCnnSi1Lkx+IDohdPlFp222wVALIheZJQSEg==",
+      "dev": true,
+      "dependencies": {
+        "color-convert": "^2.0.1"
+      },
+      "engines": {
+        "node": ">=8"
+      },
+      "funding": {
+        "url": "https://github.com/chalk/ansi-styles?sponsor=1"
+      }
+    },
+    "node_modules/concurrently/node_modules/chalk": {
+      "version": "4.1.2",
+      "resolved": "https://registry.npmjs.org/chalk/-/chalk-4.1.2.tgz",
+      "integrity": "sha512-oKnbhFyRIXpUuez8iBMmyEa4nbj4IOQyuhc/wy9kY7/WVPcwIO9VA668Pu8RkO7+0G76SLROeyw9CpQ061i4mA==",
+      "dev": true,
+      "dependencies": {
+        "ansi-styles": "^4.1.0",
+        "supports-color": "^7.1.0"
+      },
+      "engines": {
+        "node": ">=10"
+      },
+      "funding": {
+        "url": "https://github.com/chalk/chalk?sponsor=1"
+      }
+    },
+    "node_modules/concurrently/node_modules/chalk/node_modules/supports-color": {
+      "version": "7.2.0",
+      "resolved": "https://registry.npmjs.org/supports-color/-/supports-color-7.2.0.tgz",
+      "integrity": "sha512-qpCAvRl9stuOHveKsn7HncJRvv501qIacKzQlO/+Lwxc9+0q2wLyv4Dfvt80/DPn2pqOBsJdDiogXGR9+OvwRw==",
+      "dev": true,
+      "dependencies": {
+        "has-flag": "^4.0.0"
+      },
+      "engines": {
+        "node": ">=8"
+      }
+    },
+    "node_modules/concurrently/node_modules/date-fns": {
+      "version": "2.30.0",
+      "resolved": "https://registry.npmjs.org/date-fns/-/date-fns-2.30.0.tgz",
+      "integrity": "sha512-fnULvOpxnC5/Vg3NCiWelDsLiUc9bRwAPs/+LfTLNvetFCtCTN+yQz15C/fs4AwX1R9K5GLtLfn8QW+dWisaAw==",
+      "dev": true,
+      "dependencies": {
+        "@babel/runtime": "^7.21.0"
+      },
+      "engines": {
+        "node": ">=0.11"
+      },
+      "funding": {
+        "type": "opencollective",
+        "url": "https://opencollective.com/date-fns"
+      }
+    },
     "node_modules/config-chain": {
       "version": "1.1.13",
       "resolved": "https://registry.npmjs.org/config-chain/-/config-chain-1.1.13.tgz",
@@ -50331,6 +50418,15 @@
       "integrity": "sha512-PdhdWy89SiZogBLaw42zdeqtRJ//zFd2PgQavcICDUgJT5oW10QCRKbJ6bg4r0/UY2M6BWd5tkxuGFRvCkgfHQ==",
       "dev": true
     },
+    "node_modules/rxjs": {
+      "version": "7.8.1",
+      "resolved": "https://registry.npmjs.org/rxjs/-/rxjs-7.8.1.tgz",
+      "integrity": "sha512-AA3TVj+0A2iuIoQkWEK/tqFjBq2j+6PO6Y0zJcvzLAFhEFIO3HL0vls9hWLncZbAAbK0mar7oZ4V079I/qPMxg==",
+      "dev": true,
+      "dependencies": {
+        "tslib": "^2.1.0"
+      }
+    },
     "node_modules/sade": {
       "version": "1.8.1",
       "resolved": "https://registry.npmjs.org/sade/-/sade-1.8.1.tgz",
@@ -51752,6 +51848,12 @@
         "url": "https://github.com/sponsors/wooorm"
       }
     },
+    "node_modules/spawn-command": {
+      "version": "0.0.2",
+      "resolved": "https://registry.npmjs.org/spawn-command/-/spawn-command-0.0.2.tgz",
+      "integrity": "sha512-zC8zGoGkmc8J9ndvml8Xksr1Amk9qBujgbF0JAIWO7kXr43w0h/0GJNM/Vustixu+YE8N/MTrQ7N31FvHUACxQ==",
+      "dev": true
+    },
     "node_modules/spawn-please": {
       "version": "2.0.2",
       "resolved": "https://registry.npmjs.org/spawn-please/-/spawn-please-2.0.2.tgz",
diff --git a/package.json b/package.json
index f186c49fcd..fc1b07a932 100644
--- a/package.json
+++ b/package.json
@@ -44,6 +44,7 @@
     "@types/node": "20.12.7",
     "babel-jest": "29.7.0",
     "babel-preset-vite": "1.1.3",
+    "concurrently": "8.2.2",
     "cross-env": "7.0.3",
     "danger": "11.3.1",
     "esbuild": "0.20.2",
diff --git a/packages/server/jest.config.json b/packages/server/jest.config.json
deleted file mode 100644
index 8e2a0d7497..0000000000
--- a/packages/server/jest.config.json
+++ /dev/null
@@ -1,13 +0,0 @@
-{
-  "testEnvironment": "node",
-  "testTimeout": 600000,
-  "testSequencer": "<rootDir>/jest.sequencer.js",
-  "transform": {
-    "^.+\\.(js|jsx|ts|tsx)$": "babel-jest"
-  },
-  "moduleFileExtensions": ["ts", "js", "json", "node"],
-  "testMatch": ["**/src/**/*.test.ts"],
-  "coverageDirectory": "coverage",
-  "coverageReporters": ["json", "text"],
-  "collectCoverageFrom": ["**/src/**/*", "!**/src/__mocks__/**/*.ts", "!**/src/migrations/**/*.ts"]
-}
diff --git a/packages/server/jest.config.ts b/packages/server/jest.config.ts
new file mode 100644
index 0000000000..9c24d5533e
--- /dev/null
+++ b/packages/server/jest.config.ts
@@ -0,0 +1,15 @@
+import type { Config } from 'jest';
+
+export default {
+  testEnvironment: 'node',
+  testTimeout: 600000,
+  testSequencer: '<rootDir>/jest.sequencer.js',
+  transform: {
+    '^.+\\.(js|jsx|ts|tsx)$': 'babel-jest',
+  },
+  testMatch: ['<rootDir>/src/**/*.test.ts'],
+  moduleFileExtensions: ['ts', 'js', 'json', 'node'],
+  coverageDirectory: 'coverage',
+  coverageReporters: ['json', 'text'],
+  collectCoverageFrom: ['**/src/**/*', '!**/src/__mocks__/**/*.ts', '!**/src/migrations/**/*.ts'],
+} satisfies Config;
diff --git a/packages/server/jest.seed.config.ts b/packages/server/jest.seed.config.ts
new file mode 100644
index 0000000000..b428e8b3d5
--- /dev/null
+++ b/packages/server/jest.seed.config.ts
@@ -0,0 +1,8 @@
+import type { Config } from 'jest';
+import defaultConfig from './jest.config';
+
+export default {
+  ...defaultConfig,
+  testMatch: ['<rootDir>/seed-tests/**/*.test.ts'],
+  collectCoverageFrom: ['<rootDir>/seed-tests/**/*'],
+} satisfies Config;
diff --git a/packages/server/package.json b/packages/server/package.json
index cfdc3739d6..4abc16f616 100644
--- a/packages/server/package.json
+++ b/packages/server/package.json
@@ -18,7 +18,9 @@
     "clean": "rimraf dist",
     "dev": "ts-node-dev --poll --respawn --transpile-only --require ./src/otel/instrumentation.ts src/index.ts",
     "start": "node --require ./dist/otel/instrumentation.js dist/index.js",
-    "test": "jest"
+    "test:seed:serial": "jest seed-serial.test.ts --config jest.seed.config.ts --coverageDirectory \"<rootDir>/coverage-seed/serial\"",
+    "test:seed:parallel": "jest seed.test.ts --config jest.seed.config.ts --coverageDirectory \"<rootDir>/coverage-seed/parallel\"",
+    "test": "docker-compose -f ../../docker-compose.seed.yml up -d && npm run test:seed:parallel && jest"
   },
   "dependencies": {
     "@aws-sdk/client-cloudwatch-logs": "3.554.0",
diff --git a/packages/server/seed-tests/seed-serial.test.ts b/packages/server/seed-tests/seed-serial.test.ts
new file mode 100644
index 0000000000..1e8500b6c2
--- /dev/null
+++ b/packages/server/seed-tests/seed-serial.test.ts
@@ -0,0 +1,42 @@
+import { Project } from '@medplum/fhirtypes';
+import { initAppServices, shutdownApp } from '../src/app';
+import { loadTestConfig } from '../src/config';
+import { getDatabasePool } from '../src/database';
+import { SelectQuery } from '../src/fhir/sql';
+import { seedDatabase } from '../src/seed';
+import { withTestContext } from '../src/test.setup';
+
+describe('Seed', () => {
+  beforeAll(async () => {
+    console.log = jest.fn();
+
+    const config = await loadTestConfig();
+    config.database.port = process.env['POSTGRES_SEED_PORT']
+      ? Number.parseInt(process.env['POSTGRES_SEED_PORT'], 10)
+      : 5433;
+    return withTestContext(() => initAppServices(config));
+  });
+
+  afterAll(async () => {
+    await shutdownApp();
+  });
+
+  test('Seeder completes successfully -- serial version', async () => {
+    // First time, seeder should run
+    await seedDatabase({ parallel: false });
+
+    // Make sure the first project is a super admin
+    const rows = await new SelectQuery('Project')
+      .column('content')
+      .where('name', '=', 'Super Admin')
+      .execute(getDatabasePool());
+    expect(rows.length).toBe(1);
+
+    const project = JSON.parse(rows[0].content) as Project;
+    expect(project.superAdmin).toBe(true);
+    expect(project.strictMode).toBe(true);
+
+    // Second time, seeder should silently ignore
+    await seedDatabase({ parallel: false });
+  }, 240000);
+});
diff --git a/packages/server/src/seed.test.ts b/packages/server/seed-tests/seed.test.ts
similarity index 78%
rename from packages/server/src/seed.test.ts
rename to packages/server/seed-tests/seed.test.ts
index 1f5d77ace9..129bd383d2 100644
--- a/packages/server/src/seed.test.ts
+++ b/packages/server/seed-tests/seed.test.ts
@@ -1,10 +1,10 @@
 import { Project } from '@medplum/fhirtypes';
-import { initAppServices, shutdownApp } from './app';
-import { loadTestConfig } from './config';
-import { getDatabasePool } from './database';
-import { SelectQuery } from './fhir/sql';
-import { seedDatabase } from './seed';
-import { withTestContext } from './test.setup';
+import { initAppServices, shutdownApp } from '../src/app';
+import { loadTestConfig } from '../src/config';
+import { getDatabasePool } from '../src/database';
+import { SelectQuery } from '../src/fhir/sql';
+import { seedDatabase } from '../src/seed';
+import { withTestContext } from '../src/test.setup';
 
 describe('Seed', () => {
   beforeAll(async () => {
diff --git a/packages/server/src/config.ts b/packages/server/src/config.ts
index dac56e7df0..76d5a43556 100644
--- a/packages/server/src/config.ts
+++ b/packages/server/src/config.ts
@@ -175,7 +175,7 @@ export async function loadTestConfig(): Promise<MedplumServerConfig> {
   config.binaryStorage = 'file:' + mkdtempSync(join(tmpdir(), 'medplum-temp-storage'));
   config.allowedOrigins = undefined;
   config.database.host = process.env['POSTGRES_HOST'] ?? 'localhost';
-  config.database.port = process.env['POSTGRES_PORT'] ? parseInt(process.env['POSTGRES_PORT'], 10) : 5432;
+  config.database.port = process.env['POSTGRES_PORT'] ? Number.parseInt(process.env['POSTGRES_PORT'], 10) : 5432;
   config.database.dbname = 'medplum_test';
   config.redis.db = 7; // Select logical DB `7` so we don't collide with existing dev Redis cache.
   config.redis.password = process.env['REDIS_PASSWORD_DISABLED_IN_TESTS'] ? undefined : config.redis.password;
diff --git a/packages/server/tsconfig.json b/packages/server/tsconfig.json
index a5cb75c562..e53cd271e9 100644
--- a/packages/server/tsconfig.json
+++ b/packages/server/tsconfig.json
@@ -1,4 +1,4 @@
 {
   "extends": "../../tsconfig.json",
-  "include": ["src/**/*.ts"]
+  "include": ["src/**/*.ts", "seed-tests/seed-serial.test.ts", "seed-tests/seed.test.ts"]
 }
diff --git a/packages/server/turbo.json b/packages/server/turbo.json
new file mode 100644
index 0000000000..d00fb4125e
--- /dev/null
+++ b/packages/server/turbo.json
@@ -0,0 +1,16 @@
+{
+  "$schema": "https://turborepo.org/schema.json",
+  "extends": ["//"],
+  "pipeline": {
+    "test:seed:serial": {
+      "dependsOn": ["build"],
+      "outputs": ["coverage/**"],
+      "inputs": ["src/**/*.tsx", "src/**/*.ts"]
+    },
+    "test:seed:parallel": {
+      "dependsOn": ["build"],
+      "outputs": ["coverage/**"],
+      "inputs": ["src/**/*.tsx", "src/**/*.ts"]
+    }
+  }
+}
diff --git a/scripts/test.sh b/scripts/test.sh
index ae8f0a7084..c338b04f6e 100755
--- a/scripts/test.sh
+++ b/scripts/test.sh
@@ -7,19 +7,29 @@ set -e
 set -x
 
 # Set node options
-export NODE_OPTIONS='--max-old-space-size=5120'
+export NODE_OPTIONS='--max-old-space-size=8192'
 
 # Clear old code coverage data
 rm -rf coverage
+rm -rf coverage-seed
 mkdir -p coverage/packages
 mkdir -p coverage/combined
+mkdir -p coverage-seed/serial
+mkdir -p coverage-seed/parallel
 
-# Seed the database
+# Testing production path of seeding the database
 # This is a special "test" which runs all of the seed logic, such as setting up structure definitions
 # On a normal developer machine, this is run only rarely when setting up a new database
-# This test must be run first, and cannot be run concurrently with other tests
-time npx turbo run test --filter=./packages/server -- seed.test.ts --coverage
-cp "packages/server/coverage/coverage-final.json" "coverage/packages/coverage-server-seed.json"
+# We execute this in parallel with the main line of tests
+{
+  time npx turbo run test:seed:serial --filter=./packages/server -- --coverage
+  cp "packages/server/coverage-seed/serial/coverage-final.json" "coverage/packages/coverage-server-seed-serial.json"
+} &
+
+# Seed the database before testing
+# This is the parallel implementation so it's faster
+time npx turbo run test:seed:parallel --filter=./packages/server  -- --coverage
+cp "packages/server/coverage-seed/parallel/coverage-final.json" "coverage/packages/coverage-server-seed-parallel.json"
 
 # Test
 # Run them separately because code coverage is resource intensive
@@ -36,6 +46,7 @@ for dir in `ls examples`; do
   fi
 done
 
+wait
 
 # Combine test coverage
 PACKAGES=(