Industry Voices—50 years ago healthcare was a gig economy leader. So, what happened?

Doctor with patient
The healthcare industry is playing catch-up when it comes to offering physicians and clinicians freelance work. (Getty/wutwhanfoto)

Nearly 50 years ago, the healthcare industry implemented a freelance job market that provided a glimpse into the gig economy of today and marked it as a true innovator for its time.

Photo of doctor
Alexi Nazem, M.D.
(Nomad Health)

But as we approach the 50-year mark of this innovation in mobility and freedom of work in healthcare, progress has not kept pace with the rest of the world. New tech entrants have moved the rest of the world leaps and bounds ahead in how we work—and healthcare has been left behind.

By many accounts, travel nurses and locum tenens, are healthcare’s early iterations of the sharing economy. These innovative business models were both conceived in the 1970s and more widely accepted in the 80s. These professions were first brought about as a means for health institutions to address local provider shortages and bring care to rural areas in need. An unexpected secondary benefit arose as providers had more flexible employment to fit their lifestyles. Adoption was slow—only a small percentage of clinicians explored the “gig economy” lifestyle as finding this contract work was still a laborious process. Everything was manual.

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Today, the freelance job market is growing rapidly with some studies predicting that half the U.S. workforce will be freelancers by 2020. The last decade’s emergence of widely accepted gig and sharing economy companies such as Uber and Airbnb, as well as technological innovations and changing attitudes toward work, have fueled this growth. However, in comparison to these tectonic shifts in processes and technology in the broader labor marketplace, healthcare is a glaring laggard when it comes to innovation. This is a shame considering that healthcare was a pioneer in freelance work.

While more meaningful shortages of doctors, nurses, and other clinicians have driven modest growth in the number of medical professionals choosing freelance work, the innovative system that could draw exponentially more into the freelance workforce has yet to materialize.

There has never been a greater need to supercharge the growth of the freelance clinician. This has evolved beyond simply having local implications to becoming an important contributing solution to combat the growing nationwide trend of clinician shortages and burnout.

This is not a future problem; this is a now problem.

Industry experts are all in agreement that the increasing elderly population of Baby Boomers already poses a major challenge to the healthcare delivery system and it is only going to get worse. For example, these changing demographics have made nursing professionals more important than ever, and travel nurses have helped fill in the gaps when short-staffed healthcare institutions haven’t been able to keep up.

Other areas of the healthcare sector have already begun to come up with solutions for this influx of healthcare needs—such as introducing artificial intelligence to older technologies, developing new care settings and provider types, and implementing telemedicine more widely. But what has the staffing industry done to help alleviate this problem? Not enough. Especially when considered in the context of a growing body of evidence suggesting that quality of care, patient satisfaction, and clinician turnover are linked to staffing.

Clinician burnout has reached record highs as a 2018 report found that provider burnout is an issue at 83% of healthcare organizations. High physician burnout mixed with an aging population and lack of industry innovation is a recipe for poor quality healthcare services.

Given how much rides on the continued growth of the healthcare gig economy, innovation is critical. The antiquated system of staffing is no longer adequate. Technology needs to be integrated into the freelance staffing process at every step—from the initial touchpoint to when the clinician starts working—and beyond.

Legislation can open up the floodgates of innovation as well, as was the case with the catalyzing nature of the Affordable Care Act. Many legislative and regulatory interventions could substantially improve the liquidity of the healthcare workforce. In the same way that many believe in the clear value in health insurance being offered across state lines, modernizing licensure regulations with either state-to-state reciprocity or better yet federal licenses, would go a long way towards deepening the staffing marketplace and our healthcare bench.

Additionally, adopting standards for credentialing and privileging clinicians across the nation would eliminate billions of dollars of waste while also making it easier for clinicians to work where and when they are needed most. With changes to policy, innovation in terms of models for employment would surely follow.

Technology will also play a key role in maximizing the capacity and impact of freelance work in healthcare. For decades, a balkanized, opaque landscape of human-powered staffing agencies have worked to facilitate the matching of freelance clinicians with healthcare providers who need them. While they were pioneers at the outset, the exploding demand for freelancers has exposed the shortcomings of this high-friction manual model and shown how it cannot achieve the necessary scale to meet the needs of patients.

Transparent, self-service marketplaces that provide robust search tools, artificial-intelligence-powered matching, one-click applications, automated vetting and employment compliance can and likely will become the dominant systems underpinning the healthcare freelance market. These kinds of modern, innovative tools will become necessary in healthcare as an ever-larger portion of the workforce is made up of millennials and other digital natives who have become accustomed to having easy-to-use tools in every aspect of their lives, from booking a vacation rental on Airbnb to paying their rent via Venmo.

Encouraging freelance work may in fact also prove salubrious for both clinicians and the patients they care for. Allowing clinicians to decide how and when they want to work and control where they want to provide their services will help address clinician burnout. Providing clinicians with the tools to find the jobs they want without extra busywork will also surely encourage more and more healthcare professionals to join the ranks of freelancers, thereby helping combat clinician shortages and getting care to patients in need.

Healthcare may have been an early proponent of the gig economy, but no one—and rightfully so—would call it a leader of the gig economy today.

While the healthcare staffing industry has stalled out, still using phones and fax machines as the tools of the trade, Uber is working on driverless cars and releasing a new version of its app each month. Other industries are perfecting something healthcare has been doing all along and our medical professionals deserve the same degree and pace of innovation.

Alexi Nazem is co-founder and CEO of Nomad Health, an online marketplace for short-term clinical work.

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