Your Doctor May Soon be a Gig Worker

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 traveling nurses, many of these doctors are tapping into booming demand for their services, especially at labor-starved community hospitals around the U.S. Primary-care doctors are the most sought after, according to CHG Healthcare data. So are specialists such as cardiologists, pulmonologists, surgeons and oncologists.”

As most of you already know, I am an ardent observer and advocate of the gig economy, so I find the concept quite interesting. Especially since I believe that eventually, all of us (with the possible exception of managers) will become gig workers one way or another, as this will allow us to focus on what we actually enjoy doing (I know… I have a very privileged view of the world). However, a transition like that would require us to alter our understanding of “gig work” and shed the negative connotations often associated with it. In addition, we would need to better understand whether this type of labor arrangement is preferable. 

The gig economy debate is usually centered around the type of gig work currently available: driving and food delivery. Arguments against gig work usually involve the platforms’ power and their ability to “exploit” workers. However, it may be difficult to apply this line of thought to physicians in a similar gig structure. More importantly, the possible implications (both positive and negative) of such a change haven’t been thoroughly researched yet, mainly due to limited available data. So let’s delve deeper and try to understand what primarily motivates physicians to switch and explore the positive and negative implications for patients and society. 

Why are Physicians Switching?

The first reason is actually counter-intuitive: 

“Doctors once turned to part-time work mostly as a transition into retirement. Overloaded and burned out, many in their working prime are now building entire careers as temporary physicians-for-hire…Since the onset of the pandemic, medical professionals have been under significant pressure due to increasing workloads, resulting in overcrowded patient lists and a surge in fatigue among nurses and doctors.”

The American Medical Association reveals a dramatic increase in burnout rates among doctors in recent years, with a 25% spike in physicians exhibiting at least one burnout symptom. Increased stress levels, paired with a downward trend in pay, is leading many healthcare professionals to question their career choices. Recently published research in the Journal of General Internal Medicine presents shocking figures: nearly one in four American physicians plan to depart from their profession in the upcoming two years.

The reason this is counter-intuitive is that we tend to associate gig work with burnout: 

“Gig work is a type of contingent work which has increased markedly in recent times, and is characterized by uncertainty, unpredictability, and instability of both schedules and income earned. Gig workers are also likely to work for multiple platforms and/or employers. These work characteristics mean that performing gig work is associated with higher rates of stress than the general population (Madden et al. Pers Rev 2017). …No differences in stress were seen between gig workers with one employer and those with multiple employers. Findings suggest that some coping strategies may lower stress in gig workers, though long-term outcomes should be considered in future research.”

But maybe this tells us everything we need to know about physician burnout:

“Physician burnout is an epidemic in the U.S. health care system, with nearly 63% of physicians reporting signs of burnout such as emotional exhaustion and depersonalization at least once per week. While many factors contribute to burnout, the burnout epidemic is often associated with system inefficiencies, administrative burdens and increased regulation and technology requirements.”

But there are, of course, other reasons too. 

Better Pay: 

“Doctors and staffing agencies say working temporary hospital gigs typically can pay 30% to 50% more than what a full-time hospital staff doctor would earn—and sometimes more, depending on the specialty and location. An obstetrician-gynecologist can earn $140 an hour, while an emergency-medicine doctor can make as much as $300 an hour, according to Locumstory.com, a resource site for temp-working physicians. That said, they are often on the hook for financing their retirement and other benefits.”

Flexibility and Reduced Administrative Duties: 

Locum tenens (the formal term for temporary physician) work allows physicians to choose when and where they want to work. Locum tenens physicians are typically focused on patient care, with fewer administrative responsibilities than their full-time counterparts. This can lead to greater job satisfaction for some:

“Rocha-Cabrero finished his residency in Miami in 2021, where he says he often juggled more than 20 critically ill patients during night shifts. Next came a neurophysiology fellowship at the University of California-Irvine, where he worked 60 to 80 hours a week, much of it on paperwork. His supervisors’ schedules were just as grueling. ‘I didn’t want to be a part of that cycle,’ he says.”

Experience: 

Physicians who work in different locations and settings are exposed to a wide range of patient populations, medical conditions, and healthcare systems. This can enhance their skills and make them more adaptable.

Overall, this may not be an ideal job arrangement for everyone, but it’s clearly quite appealing. 

Is the Gig Model Good for Patients?

The gig economy model can be more effective in matching supply and demand thus allowing healthcare facilities to remedy staffing deficits during periods of high demand or when regular staff is on leave. This ensures that patient care is not disrupted.

This is even more important in rural areas where hospitals don’t have the ability to employ certain specialties year-round: 

“Still, gig-working physicians are often what allows community hospitals, particularly in rural areas, to provide basic services and continual care, hospital administrators argue. ‘You want to keep the doors open,’ says Christy Bray Ricks, vice president of provider talent for Ardent Health Services, which owns and operates hospitals across the country.”

And,

“...some doctors who’ve switched to temporary work say patients often fare better with a doctor who can focus entirely on providing care. Rocha-Cabrero says that is now his main focus, rather than the meetings and administrative work that come with a full-time hospital job. ‘Instead of paperwork and checklists, I can focus on things that matter,’ he says.”

But this brings me to the negative impact the gig model has for both physicians and patients. 

The Downside for Physicians 

Lack of Stability: Locum tenens positions are temporary by nature, which can lead to a lack of job security and stability. As discussed above, this is one of the most common stressors for any gig work. 

Frequent Travel: While some professionals may enjoy traveling for locum tenens work, frequent travel can be tiring and disruptive to personal life and family routines.

Lack of Continuity: Locum tenens physicians may not have the opportunity to establish long-term relationships with patients, which can be one of the most rewarding aspects of practicing medicine. 

Variable Work Conditions: Each new assignment can come with its own set of challenges, including different electronic health record (EHR) systems, office procedures, and workplace cultures. Adapting to these changes can be stressful.

“Temp doctors have to fulfill credentialing and licensing requirements for each new state or facility they practice in. They typically get malpractice coverage through the temp agencies they work with, but the risk of being sued can vary greatly from state to state.”

Benefits and Retirement: Locum tenens positions typically don’t offer the same benefits (i.e., health insurance, paid leave, retirement plans) as permanent positions do. Physicians who choose these positions must often arrange these aspects independently.

Risks for Patients’ Care

While most physicians may be well educated and capable enough to assess the benefits and shortcomings in order to make an informed decision, this might not be the case for the patients being seen by these physicians. The patients’ downside:

Lack of Continuity of Care: Patients may find it unsettling to see different physicians, particularly if they have ongoing health issues that require consistent monitoring. This can also lead to fragmented care as it can be challenging for patients to build trust with a physician they see only once or a few times. This impacts the patient-physician relationship and can potentially affect the quality of care. And there is clear evidence that continuity of care is important:

“This first systematic review reveals that increased continuity of care by doctors is associated with lower mortality rates. Although all the evidence is observational, patients across cultural boundaries appear to benefit from continuity of care with both generalist and specialist doctors. Many of these articles called for continuity to be given a higher priority in healthcare planning. Despite substantial, successive, technical advances in medicine, interpersonal factors remain important.”

Communication: There may be communication issues if the locum tenens physician is not fully aware of the patient’s medical history or if there are gaps in the handover process from their regular physician.

Availability: Depending on demand and supply of locum tenens physicians in a particular area or specialty, there may be times when a locum tenens physician is not available when needed.

Quality of Care: While locum tenens physicians are fully licensed and hold the necessary credentials, the quality of care can vary, just as with regular physicians. However, patients may have concerns about receiving care from a physician who is not permanently attached to the facility.

Patient-Physician relationship: The gig economy often results in worker alienation and adversarial relationships between gig workers and their “customers.” Physicians might not be exempt, and this shift could potentially alter the way they practice, the way they communicate, and how they preserve their professional boundaries. For example, there is ample research on the role of empathy: 

“It is remarkable that empirical studies on physician empathy are still relatively scarce. According to the results of the studies included in this systematic review, empathy is an important factor in patient satisfaction and adherence, in decreasing patients’ anxiety and distress, in better diagnostic and clinical outcomes, and in strengthening patient enablement. Thus, physician empathy seems to improve physical and psychosocial health outcomes.”

If we add this to the usual form of compensation for gig workers (only after the work is completed), it may have far-reaching implications. And even though a similar compensation process is followed even for permanent, full-time physicians (so this may not be new for the specific profession), being a gig-worker may prompt physicians to focus on maximizing their working hours and minimizing time spent on non-billable activities. 

Personally, I place great value on my interactions with my physician. I appreciate their medical expertise but also the quality of our discussions regarding what I should be considering in terms of preventive care. So the prospect of my physician becoming a gig worker doesn’t sit well with me.

While the gig economy typically offers more flexibility and choice to workers, there’s the risk that this shift backfires, especially in professions with limited room for flexibility and experimentation, given that lives are at stake. It’s crucial that any potential transition is handled with caution and forethought. As you know, I’m not a fan of overregulating, but adequate regulation and monitoring should be in place to ensure marginalized communities do not suffer unduly from these shifts.