The Sick Care Gig Economy

The US is increasingly becoming a gig economy. Part-timers and freelancers are creating?portfolios, not careers. Corporate loyalty is dead and only a fraction of employed workers are engaged. The American dream is on life support, if not dead. The fundamental future of work is changing, wages remain stagnant for most and the workforce of the future need new skills and new ways to get them other than buying into a broken higher education model that comes with?a questionable value proposition for most and a very high price tag for all.

With more and more Americans turning to the gig economy amid soaring unemployment during the COVID pandemic, longtime gig workers say they’re?struggling to compete.

A recent Intuit study estimates that 34 percent of the current workforce belongs to this growing pool of workers and predicts that 40 percent of American workers will be independent by 2020. But, are they independent contractors or employees?

Online freelancing platforms are transforming work, organizations, and their business models. Ranging from start-ups to multinational enterprises (MNCs), platforms enable firms to tap into resources and expertise beyond their traditional boundaries. These platforms allow hiring managers to connect with millions of freelancers around the world—doing so at a speed and scale that was unimaginable just a few years ago. Between 2016 and 2017, there has been a 26% increase in the number of projects sourced via these platforms.?

Moonlighting may actually help you do better at your day job. This study showed that supplementary work frequently enables side hustlers to feel empowered by taking ownership of self-directed work—which was especially true for those who were motivated beyond making money, says Dr. Sessions.

A career change for physicians used to mean changing specialties, whereas now, it means leaving medicine itself. A research study published in Mayo Clinic Proceedings reported that 9.7% of the 6,695 doctors surveyed between August 28, 2014, and October 6, 2014, planned to leave clinical work for an administrative position in healthcare, while 1.9% indicated that they planned to leave the practice altogether to pursue a different career.

As we are all living longer, it is getting harder for older Americans to find well-paying jobs, resulting in bigger retirement savings shortfalls.

Some think it's time to rethink the social contract and let people work from anywhere. How about co-working spaces for radiologists, pathologists, and all those bean counters and administrators that no one sees anyway? Since more and more physicians are employees, side hustles can help you climb the corporate ladder.

Here are the problems with being a digital nomad.

A recent report by FlexJobs, an online resource for those seeking flexible work, found that opportunities in government and politics, engineering, project management, communications, and travel and hospitality grew on the website by over 50% between July 2015 and June 2016, more than any other career fields. According to FlexJobs, these are defined as professional-level jobs that have a telecommuting, flexible schedule, freelance, or part-time component.

A review by Linkedin showed that of all the users who list freelance work on their LinkedIn profiles, 20% have a full-time job in addition to their freelance business. That means full-time freelancing still dominates, but the side-gig model is quickly catching up. These are the top five industries for full-time professionals who freelance on the side:

1. Financial services and insurance
2. Professional services
3. Technology and software
4. Entertainment
5. Staffing

The pandemic has not only cemented working from home on a quasi-permanent basis for many, but it's also boosting the remote paycheck. Remote positions paying $80,000 or more rose to about 15% of all job listings in the U.S. and Canada,?per recent data, compared to 4% in early 2020. Among the industries with the?biggest bump in lucrative remote work?include finance and insurance, legal and accounting, and retail and consumer goods.

Most are full-timers doing a side gig, which might be a stepping stone to portfolio careers or entrepreneurship. The difference between one and the other is that freelancers get paid to work in a business. Entrepreneurs create value by working on a product, model, or process that adds user defined value.

Uber has not only changed the taxi business, it is part of the transformation of the future of work and laws and regulations that advance or impede it. As reported, all this comes alongside a heavily publicized proposal for the creation of a system of worker protections for the gig economy by two Democrat big hitters – Alan Krueger, a former chair of the White House’s council of economic advisers, and Seth Harris, a former labor secretary. It argues a hybrid category of “independent worker” is needed to accommodate situations in which an “employer” exerts control over much of what a worker does at the same time as the individual retains the right (like the self-employed) to work as much or as little as they want when they want. Many doctors are pursuing portfolio careers and abandoning the full-time practice of medicine.?

Here are some of the benefits.

The opportunity is big in sick care to educate, train, recruit, and develop low income workers using new teaching technologies.?In addition, it is not just the lower-skilled workers that are getting into the act. There are more 1099 Docs too.

The sick care workforce of the future is being created every day, but several things are becoming clearer:

1. Digital health will create jobs that have yet to be defined

2. There is a gap for workers that can't be filled by present offerings

3. Wage stagnation will persist until we figure out ways to replace exported manufacturing jobs that are unlikely to return

4. We need new business models for education that starts in k-12

5. Employment status classification, pension and benefits packages will need to conform to the new gig economy

6. Medicine will have to change its mindset and approach to using paramedical personnel to help doctors practice at the top their licenses.

7. Market-based learning objectives should drive sick care gig learning

8. We need a different approach to defining competencies and using learning management systems to measure life long learning and improvement. Doctors screwed up MOCs and we should not repeat their mistakes.

9. We need to use the experiences and insights of low wage?minorities to deliver care, particularly when it comes to using community-based resources to manage the crushing burden of non-communicable diseases

10. New gig workers need to have an entrepreneurial mindset.?They also need to learn how to negotiate the terms of service agreements if they are agile talent.

11. Sick care gig workers have unique challenges when it comes to career development

12. All of these challenges will be opportunities for business process outsourcing, HR firms, policymakers and recruiters to meet the needs of potential clients with innovative product offerings and business models.

13. Like most other service dating service models, the intermediaries will be replaced with online matching platforms for much less. Think about what happened to travel agents as a model for what will happen to locum tenens headhunters.

14. Older Americans?are working more even as those?under 65 are working less, a trend that the Bureau of Labor Statistics expects?to continue.?By 2024, 36 percent of 65- to 69-year-olds will be active participants?in the labor market, the BLS says. That’s up from just 22 percent in 1994.

15. 54% of gigers say it takes too long to get paid. Insist on automatic fund transfers, negotiate the time (a week or two), or on a recurring basis if an advisor, and monitor payment. You might have to terminate your contract if you are repeatedly not being paid on time.

16. Gig workers have a hard time affording health insurance and that is trouble for them and the people who care for them.

17. Regulators are getting into the act. California’s bill would put the burden on corporations to establish that a worker is a legitimate contractor. It codifies and broadens a State Supreme Court?ruling?last year that held that companies must meet a three-part test: demonstrating that the worker operates autonomously and is free to work for other companies, and that the work is not central to the company’s business. This is common sense: An expert brought in to fix a computer problem would qualify as a contractor; a person on hand every day to help with computer problems probably does not.

18. More and more health professionals are doing side gigs.

19. There are many reasons why knowledge workers and their employer/clients resist gigification.

The legislation excludes a?laundry list?of professions, including doctors, dentists, lawyers, and real estate agents, in which workers tend to benefit from their status as independent contractors and fought to be exempted. Uber, Lyft, and their allies wanted to be added to that list, arguing their workers also enjoy life as contractors. But the dearth of drivers willing to make that case speaks for itself.

Increasingly, employers are looking or ways to trim full-time payrolls, and eliminating patient-facing workers will be no exception.

There are many ways to participate in the sick care gig economy, so before you create your LLC, decide how you want to work and why. Do you want to be a freelance, an independent business owner or run a consulting company? Even if you have an MBA, here are some reasons to join the gig economy.

Remember there is a difference between a teacher (educates), a coach (teaches a skill), a mentor (helps you improve as a person), and an advisor (helps your company). Being a consultant and running a profitable consulting company has its own issues.

On the contrary, sickcare work means sacrifice and placing the needs of patients above your own. Many times there is little room for work-life balance, self-fulfillment, and flexible work schedules so there will be a conflict between generational attitudes and the demands on the ground. Here are some stories about the dark underbelly of the contract workforce.

Here are some common reasons why your side gig, like your startup, is likely to fail.

Making money doing a side gig requires the 4P's: product, pipeline, pitch, and an engagement and marketing communication plan.

Product: How to build your personal brand

Pipeline: How to build a 30,000 member Linkedin group

Pitch: Your pick up line: what to know about value propositions

Plan: Do you have a strategic marketing and communications plan?

If you are thinking of "going gig", here are the skills you will need to succeed.

Here are the benefits of doing strategic side gigs.

Some work at home sick care side gigs include:

1. Supporting the sickcare admin infrastructure, like utilzation review and management
2. Medicolegal consulting
3. Writing, editing and social influencing
4. Subject matter expert for research organizations
5. Teaching and creating online CME content
6. Startup advisor or consultant
7. Not for profit executive
8. Mentor or participating in medical school education programs
9. Coaching
10. Entrepreneurship

The sick care work force is changing before our eyes. For many to succeed, the knowledge economy takes a brain and a computer with WiFi access. It can no longer be sustained by mostly rich white folks wearing white coats. We need to change the mix to close the gaps.

Just don't try to do it in California.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Twitter@SoPEOfficial and Co-editor of Digital Health Entrepreneurship