Recently, several fascinating articles have been circulating discussing an intriguing possibility. Your physician may become a gig worker: “About 50,000 doctors, or 7% of the U.S. physician workforce not including foreign medical-school graduates, now practice medicine via temporary assignments, according to medical-staffing company CHG Healthcare. That is a nearly 90% increase from 2015….Like
This is such an intriguing concept. The article definitely resonates with me professionally, especially as we struggle to recruit for our tele service line and struggle to grow due to lack of manpower. Gigs improve access to care and reduce burnout but affects patient care continuum. As a patient, I value seeing same physician in an outpatient and inpatient setting (more impractical inpatient). As a physician, I value building patient doctor relationships that last long term. At this time, I feel that the gig economy for physicians may be more of a personal choice for various different pros and cons that you have mentioned.
Imagine you have a brain tumor. Or need heart surgery. A once in a lifetime, high stakes event. What is your measure of quality? In healthcare, quality can be so opaque that even over doctors have a hard time telling. In which case a long standing reputation for quality built upon a track record serves an adequate surrogate. Gig takes that away. Higher quality doctors have essentially a limitless supply of patients and so operational efficiency dictates that they don’t travel at all as the supply comes to them, on their own crafted terms to limit any variability in the system, demand and get any changes to enhance their effectiveness, no wasted time and control of the environment to the benefit of the doctor and patient. Anyone who walks away from such efficiencies could be a signal of low supply due to poor reputation and signal lower quality or experience. Is that what you would want as a patient?
Gig is an amazing concept in healthcare because i feel it can dramatically increase supply-side economics as it is a knowledge industry. As in, I can only have so many cars on the road which can utilize ride-share but with healthcare, all the world's top healthcare professionals can potentially contribute to solving a 'local' problem (pending the regulatory and industry constraints).
While there are issues around patient-doctor relationship and the care network, cost is such a big factor that many of the improvements remain on paper only. Gig-healthcare could become the sword which cuts the gordian knot to western healthcare problems.
thanks for the note professor.
It's also an opportunity for doctor burnout reduction / management products like
Is the main driver of higher pay that the gig doctors are filling the highest demand specialties for the location? This might also imply that the fee-for-service utilization of such gig doctors is higher since they lack the administrative responsibilities. It would be great if this caused non-gig doctors to push back against activities that don't require their high level of medical expertise.
Might this create a new optimized hybrid non-traveling role without administrative duties that allows for both continuity of care/relationships AND physician autonomy of schedule?
The biggest obstacle that I see is that the most common path to earning the most for any specialty (including dental) is to own and run a private practice so the doctor is not an employee. And in that case, the doctor has full accountability not only for the patient care, but also for running the business.