diff --git a/docker/openemr/7.0.3/Dockerfile b/docker/openemr/7.0.3/Dockerfile
index 1c39a8be..584eb604 100644
--- a/docker/openemr/7.0.3/Dockerfile
+++ b/docker/openemr/7.0.3/Dockerfile
@@ -3,11 +3,11 @@ FROM alpine:3.19
 #Install dependencies and fix issue in apache
 RUN apk --no-cache upgrade
 RUN apk add --no-cache \
-    apache2 apache2-ssl apache2-utils apache2-proxy git php83 php83-tokenizer php83-ctype php83-session php83-apache2 \
+    apache2 apache2-ssl apache2-utils apache2-proxy git php83 php83-fpm php83-tokenizer php83-ctype php83-session \
     php83-json php83-pdo php83-pdo_mysql php83-curl php83-ldap php83-openssl php83-iconv \
     php83-xml php83-xsl php83-gd php83-zip php83-soap php83-mbstring php83-zlib \
     php83-mysqli php83-sockets php83-xmlreader php83-redis php83-simplexml php83-xmlwriter php83-phar php83-fileinfo \
-    php83-sodium php83-calendar php83-intl php83-opcache php83-pecl-apcu php83-fpm \
+    php83-sodium php83-calendar php83-intl php83-opcache php83-pecl-apcu \
     perl mysql-client tar curl imagemagick nodejs npm \
     certbot openssl openssl-dev dcron \
     rsync shadow ncurses \
@@ -15,8 +15,15 @@ RUN apk add --no-cache \
 # Needed to ensure permissions work across shared volumes with openemr, nginx, and php-fpm dockers
 RUN usermod -u 1000 apache
 
-#BELOW LINE NEEDED TO SUPPORT PHP8 ON ALPINE 3.13+; SHOULD BE ABLE TO REMOVE THIS IN FUTURE ALPINE VERSIONS
+#STEPS TO ENSURE php and php-fpm/fcgi both work, which configure proper user/group for php-fpm and set the alpine Event MPM
+# (NOTE this needs to be modified with each new php version in 4 lines below)
 RUN cp /usr/bin/php83 /usr/bin/php
+RUN cp /usr/sbin/php-fpm83 /usr/sbin/php-fpm
+RUN sed -i "s/^user = [^ ]*/user = apache/" /etc/php83/php-fpm.d/www.conf
+RUN sed -i "s/^group = [^ ]*/group = apache/" /etc/php83/php-fpm.d/www.conf
+RUN sed -i "/^LoadModule mpm_prefork_module modules\/mod_mpm_prefork.so/ s/^/#/" /etc/apache2/httpd.conf
+RUN sed -i "/LoadModule mpm_event_module modules\/mod_mpm_event.so/ s/# *//" /etc/apache2/httpd.conf
+
 # Install composer for openemr package building
 RUN curl -sS https://getcomposer.org/installer | php -- --install-dir=/usr/bin --filename=composer
 
diff --git a/docker/openemr/7.0.3/openemr.conf b/docker/openemr/7.0.3/openemr.conf
index 46d646cf..789e03f9 100644
--- a/docker/openemr/7.0.3/openemr.conf
+++ b/docker/openemr/7.0.3/openemr.conf
@@ -25,6 +25,8 @@ CustomLog "|/usr/sbin/rotatelogs -n 5 ${APACHE_LOG_DIR}/access.log 86400" combin
 <Directory /var/www/localhost/htdocs/openemr>
     # Only allow these HTTP Methods
     AllowMethods GET POST PUT DELETE HEAD OPTIONS
+    # Default to index.html and index.php (added when transitioned to php-fpm/fcgi)
+    DirectoryIndex index.html index.php
     # No indexes anywhere
     Options -Indexes
     AllowOverride FileInfo
diff --git a/docker/openemr/7.0.3/openemr.sh b/docker/openemr/7.0.3/openemr.sh
index 911d393f..867be9b4 100644
--- a/docker/openemr/7.0.3/openemr.sh
+++ b/docker/openemr/7.0.3/openemr.sh
@@ -452,6 +452,8 @@ echo " > https://opencollective.com/openemr/donate"
 echo ""
 
 if [ "$OPERATOR" == "yes" ]; then
+    echo "Starting php-fpm!"
+    /usr/sbin/php-fpm
     echo "Starting apache!"
     /usr/sbin/httpd -D FOREGROUND
 else
diff --git a/docker/openemr/flex-3.19/Dockerfile b/docker/openemr/flex-3.19/Dockerfile
index b72e4c6f..c96df39d 100644
--- a/docker/openemr/flex-3.19/Dockerfile
+++ b/docker/openemr/flex-3.19/Dockerfile
@@ -3,11 +3,11 @@ FROM alpine:3.19
 #Install dependencies and fix issue in apache
 RUN apk --no-cache upgrade
 RUN apk add --no-cache \
-    apache2 apache2-ssl apache2-utils apache2-proxy git php83 php83-tokenizer php83-ctype php83-session php83-apache2 \
+    apache2 apache2-ssl apache2-utils apache2-proxy git php83 php83-fpm php83-tokenizer php83-ctype php83-session \
     php83-json php83-pdo php83-pdo_mysql php83-curl php83-ldap php83-openssl php83-iconv \
     php83-xml php83-xsl php83-gd php83-zip php83-soap php83-mbstring php83-zlib \
     php83-mysqli php83-sockets php83-xmlreader php83-redis perl php83-simplexml php83-xmlwriter php83-phar php83-fileinfo \
-    php83-sodium php83-calendar php83-intl php83-opcache php83-pecl-apcu php83-fpm \
+    php83-sodium php83-calendar php83-intl php83-opcache php83-pecl-apcu \
     mysql-client tar curl imagemagick nodejs npm \
     certbot openssl git openssl-dev dcron \
     rsync shadow jq ncurses \
@@ -18,8 +18,16 @@ RUN apk add --no-cache \
 RUN apk add --no-cache \
     unzip vim nano bash bash-doc bash-completion tree
 
-#BELOW LINE NEEDED TO SUPPORT PHP8 ON ALPINE 3.13+; SHOULD BE ABLE TO REMOVE THIS IN FUTURE ALPINE VERSIONS
+#STEPS TO ENSURE php and php-fpm/fcgi both work, which configure proper user/group for php-fpm and set the alpine Event MPM
+# (NOTE this needs to be modified with each new php version in 4 lines below)
 RUN cp /usr/bin/php83 /usr/bin/php
+RUN cp /usr/sbin/php-fpm83 /usr/sbin/php-fpm
+RUN sed -i "s/^user = [^ ]*/user = apache/" /etc/php83/php-fpm.d/www.conf
+RUN sed -i "s/^group = [^ ]*/group = apache/" /etc/php83/php-fpm.d/www.conf
+RUN sed -i "/^LoadModule mpm_prefork_module modules\/mod_mpm_prefork.so/ s/^/#/" /etc/apache2/httpd.conf
+RUN sed -i "/LoadModule mpm_event_module modules\/mod_mpm_event.so/ s/# *//" /etc/apache2/httpd.conf
+
+# Install composer for openemr package building
 RUN curl -sS https://getcomposer.org/installer | php -- --install-dir=/usr/bin --filename=composer
 
 # TODO: Note that flex series 3.14+ needs to keep build-base package in (ie. not apk del it after done) for now
diff --git a/docker/openemr/flex-3.19/openemr.conf b/docker/openemr/flex-3.19/openemr.conf
index 277eb7c6..557fae46 100644
--- a/docker/openemr/flex-3.19/openemr.conf
+++ b/docker/openemr/flex-3.19/openemr.conf
@@ -25,6 +25,8 @@ CustomLog "|/usr/sbin/rotatelogs -n 5 ${APACHE_LOG_DIR}/access.log 86400" combin
 <Directory /var/www/localhost/htdocs/openemr>
     # Only allow these HTTP Methods
     AllowMethods GET POST PUT DELETE HEAD OPTIONS
+    # Default to index.html and index.php (added when transitioned to php-fpm/fcgi)
+    DirectoryIndex index.html index.php
     # No indexes anywhere
     Options -Indexes
     AllowOverride FileInfo
diff --git a/docker/openemr/flex-3.19/openemr.sh b/docker/openemr/flex-3.19/openemr.sh
index cc2c80ad..cdbfc728 100644
--- a/docker/openemr/flex-3.19/openemr.sh
+++ b/docker/openemr/flex-3.19/openemr.sh
@@ -514,6 +514,8 @@ echo " > https://opencollective.com/openemr/donate"
 echo ""
 
 if [ "$OPERATOR" == "yes" ]; then
+    echo "Starting php-fpm!"
+    /usr/sbin/php-fpm
     echo "Starting apache!"
     /usr/sbin/httpd -D FOREGROUND
 else
diff --git a/docker/openemr/flex-edge/Dockerfile b/docker/openemr/flex-edge/Dockerfile
index f7b5744b..c1bb0f72 100644
--- a/docker/openemr/flex-edge/Dockerfile
+++ b/docker/openemr/flex-edge/Dockerfile
@@ -3,11 +3,11 @@ FROM alpine:edge
 #Install dependencies and fix issue in apache
 RUN apk --no-cache upgrade
 RUN apk add --no-cache \
-    apache2 apache2-ssl apache2-utils apache2-proxy git php83 php83-tokenizer php83-ctype php83-session php83-apache2 \
+    apache2 apache2-ssl apache2-utils apache2-proxy git php83 php83-fpm php83-tokenizer php83-ctype php83-session \
     php83-json php83-pdo php83-pdo_mysql php83-curl php83-ldap php83-openssl php83-iconv \
     php83-xml php83-xsl php83-gd php83-zip php83-soap php83-mbstring php83-zlib \
     php83-mysqli php83-sockets php83-xmlreader php83-redis perl php83-simplexml php83-xmlwriter php83-phar php83-fileinfo \
-    php83-sodium php83-calendar php83-intl php83-opcache php83-pecl-apcu php83-fpm \
+    php83-sodium php83-calendar php83-intl php83-opcache php83-pecl-apcu \
     mysql-client tar curl imagemagick nodejs npm \
     certbot openssl git openssl-dev dcron \
     rsync shadow jq ncurses \
@@ -18,8 +18,16 @@ RUN apk add --no-cache \
 RUN apk add --no-cache \
     unzip vim nano bash bash-doc bash-completion tree
 
-#BELOW LINE NEEDED TO SUPPORT PHP8 ON ALPINE 3.13+; SHOULD BE ABLE TO REMOVE THIS IN FUTURE ALPINE VERSIONS
+#STEPS TO ENSURE php and php-fpm/fcgi both work, which configure proper user/group for php-fpm and set the alpine Event MPM
+# (NOTE this needs to be modified with each new php version in 4 lines below)
 RUN cp /usr/bin/php83 /usr/bin/php
+RUN cp /usr/sbin/php-fpm83 /usr/sbin/php-fpm
+RUN sed -i "s/^user = [^ ]*/user = apache/" /etc/php83/php-fpm.d/www.conf
+RUN sed -i "s/^group = [^ ]*/group = apache/" /etc/php83/php-fpm.d/www.conf
+RUN sed -i "/^LoadModule mpm_prefork_module modules\/mod_mpm_prefork.so/ s/^/#/" /etc/apache2/httpd.conf
+RUN sed -i "/LoadModule mpm_event_module modules\/mod_mpm_event.so/ s/# *//" /etc/apache2/httpd.conf
+
+# Install composer for openemr package building
 RUN curl -sS https://getcomposer.org/installer | php -- --install-dir=/usr/bin --filename=composer
 
 # TODO: Note that flex series 3.14+ needs to keep build-base package in (ie. not apk del it after done) for now
diff --git a/docker/openemr/flex-edge/openemr.conf b/docker/openemr/flex-edge/openemr.conf
index 277eb7c6..557fae46 100644
--- a/docker/openemr/flex-edge/openemr.conf
+++ b/docker/openemr/flex-edge/openemr.conf
@@ -25,6 +25,8 @@ CustomLog "|/usr/sbin/rotatelogs -n 5 ${APACHE_LOG_DIR}/access.log 86400" combin
 <Directory /var/www/localhost/htdocs/openemr>
     # Only allow these HTTP Methods
     AllowMethods GET POST PUT DELETE HEAD OPTIONS
+    # Default to index.html and index.php (added when transitioned to php-fpm/fcgi)
+    DirectoryIndex index.html index.php
     # No indexes anywhere
     Options -Indexes
     AllowOverride FileInfo
diff --git a/docker/openemr/flex-edge/openemr.sh b/docker/openemr/flex-edge/openemr.sh
index cc2c80ad..cdbfc728 100644
--- a/docker/openemr/flex-edge/openemr.sh
+++ b/docker/openemr/flex-edge/openemr.sh
@@ -514,6 +514,8 @@ echo " > https://opencollective.com/openemr/donate"
 echo ""
 
 if [ "$OPERATOR" == "yes" ]; then
+    echo "Starting php-fpm!"
+    /usr/sbin/php-fpm
     echo "Starting apache!"
     /usr/sbin/httpd -D FOREGROUND
 else