The 1099 Doc

Stay at home docs are growing. ?More physicians want work-life balance, the relief from stress and generational differences are causing women and millenials to question the 7am-7pm work ethic. Both patients and providers are struggling with the new reality that will present some challenges:

1. We are not training doctors to adapt to the changing landscape but instead persist in using an irrelevant hospital based model.

2. There are more and more options for those interested in non-clinical roles particularly as consultants and free-lancers.

3. Medicine is about life long learning and practice, practice, practice, particularly for proceduralists. Are part timers as good as full timers?

4. Generational differences are causing graduates to question their commitment to a full time career, let alone a full time job.

5. More and more women doctors are working more and more part time or job sharing

6. Patients are questioning doctor shift changes?

7. Hand offs are already causing problems. More of them will create more problems.

8. Technology and machines will displace some doctors. They will inevitably find something else to do to add value to patients.

9. The demand for care is infinite. The supply is becoming more constrained, requiring more, not less, effort of those in the trenches.

10. Some believe the economy has fundamentally changes, creating a PartTime Nation with the all the savings, investment, benefits and social upheaval it will cause.

11. ?Job security is a key reason people choose traditional employment over independent work. But declining perceptions of job security, coupled with workers rethinking what they want when it comes to work/life balance, are leading more people to prioritize flexibility, autonomy, and control when choosing where they will work. New data shows that the percentage of traditional full-time workers who believe independent work is more secure than traditional work has increased significantly in the last four years . Because of this shift, to successfully attract and retain top talent in the post-pandemic world, employers will need to give their employees the freedom and flexibility associated with independent work.

COVID has magnified the challenges, particularly for women.

Survey research conducted by economists Lawrence Katz of Harvard University and Alan Krueger at Princeton University shows that?from 2005 to 2015 , the proportion of Americans workers engaged in what they refer to as “alternative work” jumped from 10.7% to 15.8%. Alternative work is characterized by being temporary or unsteady—such as work as an independent contractor or through a temporary help agency.

“We find that 94% of net job growth in the past decade was in the alternative work category,” said Krueger. “And over 60% was due to the [the rise] of independent contractors, freelancers and contract company workers.” In other words, nearly all of the 10 million jobs created between 2005 and 2015 were not traditional nine-to-five employment.

Part time docs are more and more becoming a growing segment of the physician workforce.In 2011, 22% of male physicians and 44% of female physicians worked less than full time, Their numbers will grow and so will the issues they present. Just ask Uber in California. The sooner the medical establishment understands that, the better we can make the adjustments necessary to adapt.

A recent survey identified some growing trends in the independent work force:

1.A current unemployment rate of 4.3 percent coupled with 6 million job openings and an economy that last year added 2.2 million payroll jobs in the past year is giving many independents with in-demand skills a chance not only to find additional work, but to ask for — and get — more money for it.

Some, in fact, are making more money than a payroll job would offer; this year — for the sixth year in a row — the number of high-earning independents has risen. That’s 3.2 million people — almost one in every five of full-time independents (those who work independently more than 15 hours per week). And those high-earners make more than $100,000 a year.

2.?The second trend is the strong job market is allowing some of those they term “reluctant independents” — those who wouldn’t be working independently if they could find a traditional job that offers as much opportunity as independent work — to find payroll jobs and leave the independent workforce behind.

3. The third trend is for more people overall turning to part-time or occasional independent work to boost income.?Here are some things you can do to create passive income. Passive income is a business strategy ?that allows you to sell products or services on auto-pilot, so you can essentially earn money without doing extra work. It is understandably becoming increasingly popular with entrepreneurs who want to support a comfortable lifestyle without working seemingly endless hours.

Locums tenens continues to grow. Locum tenens work has become increasingly attractive to physicians in recent years. In a 2016 survey by Merritt Hawkins and the Physicians Foundation, 11.5% of physicians said they planned to take locum tenens assignments, compared to 9% who said that in 2014. Although physicians don't always follow through on their plans, that number of locum tenens doctors would be nearly double the 6% of doctors who now work in locum tenens positions.

On the demand side, more and more sick care organizations are hiring part-timers and freelancers, particularly in health information technology.? Sickcare entrepreneurs are also looking for consultants and advisors that are not full time employees.

Gigs can be found at a number of websites, such as Upwork.com and Freelancer.com, or through hiring services that connect professional freelancers and companies. And companies that provide shared rented office space, such as WeWork, lets freelancers mingle with fellow contractors.We are likely to see businesses grow that cater to the part-time employment wants of doctors.

The world of work is rapidly changing and healthcare is not immune from the impact. Doctors and other health professionals want part time, contract work that won't isolate them or strip them of other benefits only reserved for the "employed" work force. Uber is only the tip of the iceberg.

If you are interested in being a freelancer of independent worker, here are some tips:

Do:

• Let your closest professional and personal contacts know what kind of work you’re looking for
• Make sure your network includes fellow freelancers
• Find an accountant who can help you set up your finances and make tax filing easier

Don’t:

• Base your rate on your expenses. Instead, figure out what the market offers and what would be equivalent to your most recent full-time salary.
• Wait until after you’ve got your first gig to get paperwork like contracts and invoices in order
• Get discouraged when it takes time to build up a regular flow of business

Here are four more ways to earn suppemental income without having to quit your day job.

Measuring participation in the gig economy, let alone the sick care gig economy is difficult since there are varying levels of participation. For example:

1. Independent contractors (36% of the independent workforce/19.3 million professionals)—These "traditional" freelancers don’t have an employer and instead do freelance, temporary, or supplemental work on a project-by-project basis.
2. Moonlighters (25%/13.2 million)—Individuals with a primary, traditional job with an employer who also moonlight doing freelance work. For example, a corporate-employed web developer who does projects for nonprofits in the evening.
3. Diversified workers (26%/14.1 million)—People with multiple sources of income from a mix of traditional employers and freelance work. For example, someone who works the front desk at a dentist’s office 20 hours a week, and fills out the rest of his income driving for Uber and doing freelance writing.
4. Temporary workers (9%/4.6 million) —Individuals with a single employer, client, job, or contract project where their employment status is temporary. For example, a data entry worker employed by a staffing agency and working on a three-month assignment.
5. Freelance business owners (5%/2.5 million) —These freelancers have one or more employees, and consider themselves both freelancers and business owners. For example, a social marketing guru who hires a team of other social marketers to build a small agency, but still identifies as a freelancer.

Every doctor should have a side gig and the reasons why. Some think founding, advising or consulting to a startup is the answer, even if it means not doing a residency. More than 6 million entrepreneurs start a new business in?the United States?every year, but for every Airbnb, Uber or Reddit, a staggering number of startups don't "make it". Up to 20% of startups don't survive the first year alone. Up to 50% are no longer alive by year 5, and up to 90% ultimately fail. Startup accelerator programs aim to help startups circumvent the different challenges, dilemmas, and pitfalls at different stages of the startup journey - improving their odds of 'making it'. Compare that to finishing a residency and getting into at least the 10% income level and you can see how the opportunity cost math adds up.

?Indeed, the?three C’s ?underlying strong psychological contracts — a career that offers personal growth and upward mobility, a community that fosters social connections and belongingness, and a cause that infuses one’s work with meaning and purpose — are all but absent for independent workers of all stripes. It is evidenced by the lost tribe of medicine.

Even politicians and Presidential candidates are starting to pay attention to this emerging voter constituency.

These folks aren't going away. and neither is the sick care gig economy.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Twitter@SOPEOfficial