PHYSICIANS AND THE GIG ECONOMY

By Peter Alperin, MD
September 8, 2020

As the COVID-19 pandemic shapes our new normal, telehealth and locum tenens work are redefining healthcare — how it’s delivered and what that means for Americans.


From Lyft and Uber to Postmates and Instacart, more than 57 million Americans have been employed through the gig economy which, according to a recent Intuit survey, had been expected to comprise 43 percent of the workforce this year.


The gig economy trend has extended to healthcare as well. Consumers across the country have more accessible healthcare thanks to apps and startups that connect them to a physician via a telemedicine video appointment or to schedule care online. So, how have doctors and other medical professionals been impacted by the gig economy?


Currently, COVID-19 is the top concern of providers. Telemedicine’s potential for virtual care will be essential in treating those with the virus and protecting the healthcare professionals leading the charge. Expanded access to care through digital tools also addresses other problems, including lack of rural healthcare, physician shortages, and burnout.

GROWING INTEREST IN TELEMEDICINE, PART-TIME WORK


The popularity of telemedicine has steadily increased over the years. A report1 issued last year revealed that from 2015 to 2018, the number of physicians who self-reported telemedicine as a skill doubled; the number continues to increase by approximately 20 percent per year. This implies that the number of doctors leveraging telemedicine is growing quickly. This finding is also consistent with significant growth in the number of telemedicine patient visits, which increased annually by 261 percent between 2015 and 2017, according to a recent study2 published in JAMA.


With the global pandemic of COVID-19, telehealth has seen a huge surge in the past few months. As of March 2020, 18 states had enacted emergency regulations to increase the use of telehealth against the epidemic; some states now allow doctors and patients to collaborate by phone.3


A Doximity study showed that in addition to telehealth, a growing number of physicians are interested in locum tenens work. Locum tenens is a long-standing fixture of the medical world and can be defined as a physician who temporarily fulfills the duties of another doctor. For example, locum tenens may fill in for a physician who is on family or maternity leave, or the locum tenens may be temporarily employed by a hospital or practice that is under-staffed. These temporary positions can be part-time or full-time.
Looking at these trends along gender lines, it is interesting to note that women were 10 percent more interested in telemedicine jobs than were men, but in evaluating physician interest in locum tenens opportunities by gender, women were significantly less engaged than their male counterparts.


When examining physician interest by age, the study found nearly equal engagement in telemedicine job postings across various age groups, proving that older physicians are equally interested in adopting digital health technologies.


TREATING COVID-19 AND OTHER INFECTIOUS DISEASES


The COVID-19 pandemic is putting healthcare workers under tremendous stress; much is unknown about treatment and long-term effects, and it’s not always clear when patients need to be seen by a physician.


Virtual care has the potential to ease concerns among patients by broadening access to care and providing consumers with important health information no matter where they live. Physicians can see their patients via video, discuss symptoms, and ultimately decide if COVID-19 testing is required. This reduces the stress of healthy individuals who are concerned that they might have the virus, and it helps prevent contagion from those who have contracted it by limiting unnecessary travel or visits to clinics, hospitals, and other care settings.


Because a two-week quarantine is recommended for those who have been infected with COVID-19, telemedicine tools give physicians the opportunity to check on patients to ensure they are recovering without additional health concerns or complications. This also protects physicians by allowing them to advise and treat concerned or infected patients from a safe distance.


Dealing with new and deadly viruses could be the new normal. Telemedicine tools can help the world better prepare for these epidemics by connecting doctors to patients virtually and protecting both from higher risk of infection.


BENEFITS FOR PHYSICIANS


Telemedicine can provide physicians more flexible hours and scheduling than traditional care settings might. Eliminating lengthy commutes or allowing doctors to work around personal obligations such as child or family care may help alleviate the burnout that physicians feel in more traditional care settings and improve overall attitudes about the profession.


Physicians also benefit from being able to expand their patient base, reach new patient groups, and view patient cases in distant venues that they may not have otherwise encountered. Part-time work in both telemedicine and locum tenens can help offset medical school debt as an additional source of income.


According to the Association of American Medical Colleges, 75 percent of medical school students in the class of 2018 graduated with an average loan debt of $196,520, which included debt from medical school, undergraduate studies, and other higher education expenses.4 With a $197,000 student loan balance, a young doctor on average would owe $2,212 a month on the standard, 10-year federal repayment plan, (assuming a 6.25 percent average interest rate).


Included in the costs associated with running a practice is malpractice insurance, the cost of which varies from state to state. In California, a surgeon can expect to pay between $22,000 and $34,000 per year.5 With telemedicine work, malpractice insurance typically is covered by the telemedicine staffing organization.


PATIENTS BENEFIT TOO

Telemedicine offers many benefits for patients as well — the most notable being affordability and increased access to care. Patients’ out-of-pocket costs are often less than for traditional care. A 2017 Health Affairs Study6 found that on average, a telehealth visit costs about $79, compared with about $146 for an office visit. This difference can be life-changing for patients who are struggling to pay for certain health services and could reduce what the nation spends on healthcare annually.


While the benefits for patients were outside the scope of our report, other studies have shown that patients benefit from more flexible access to physicians via telemedicine, especially for routine medical questions and checkups, mental health care, and post-natal care. Telemedicine also expands access to care in rural areas, where doctor shortages have been most acutely felt.


In rural areas, telemedicine helps patients access both primary care and specialists that are otherwise unavailable. Nearly one in five Americans lives in a rural area and depends on local hospitals that may not have all specialties represented on their clinical staffs. During the past 10 years, 120 of those hospitals have closed,7 leaving millions of patients across the country with limited access to care, particularly specialty care.


With the increased use of telemedicine tools, patients get “on-demand” access to care, which means that parents with a question about their infant can conveniently connect with their physician, as can a full-time professional who must fit mental health care around a busy work schedule. Locum tenens work can also encourage physicians from urban areas to work temporarily in rural towns to help mitigate the losses experienced when a hospital closes.


Mental health is also an area where telemedicine improves the delivery of care. One in five adults in the United States lives with a mental illness,8 but the stigma associated with mental illness often prevents them from seeking treatment.9 Because of the stigma attached to mental health issues, some patients are daunted by the thought of visiting a doctor’s office. With telemedicine, patients can conveniently connect with their doctor or therapist at any time or place, even on vacation, all from a private venue. This can lessen the pressure or anxiety a person feels about seeking help.


With telemedicine, patients can choose mental health professionals across the country with the assurance that they will not have to switch doctors if they move to a different area.


Telemedicine platforms are increasingly being offered and covered under major health insurance plans as well as via apps, which makes them affordable for patients. Payers are also signaling their support for telemedicine, praising10 the many positive changes in federal and state policies in 2018. These factors have contributed to the 1.7x rise in telemedicine health benefits among large employers (27 percent in 2015 to 74 percent in 201811).



TRANSFORMING THE HEALTHCARE LANDSCAPE


Clearly, physicians are embracing the gig economy and turning to telemedicine as an alternative to traditional clinical settings. Outstanding among the many benefits of telehealth are flexibility, safety, and convenience. The trend toward increased adoption of telemedicine — which is certain to continue unabated — will transform the healthcare landscape; physician shortages, access to care, and affordability will be eased.


As physicians across a broad range of specialties, age groups, and geographic regions are drawn to telemedicine and temporary positions, more patients will gain access to quality care. Whether it be a potential case of COVID-19, a video chat with a mental healthcare provider, or a follow-up visit with a provider for a patient who lives 100 miles from the closest hospital, doctors and patients across the country will benefit from the rise of telemedicine.

 



Peter Alperin, MD, trained as an internal medicine physician at UCSF and currently is vice president at Doximity, where he leads the development of products geared toward clinicians. He has also had roles in product development with Archimedes and ePocrates and served as director of informatics with Brown and Toland Medical Group. He remains in active medical practice in San Francisco. palperin@doximity.com

 


REFERENCES

1. Doximity. 2019. 2019 Telemedicine and Locum Tenens Opportunities Study. https://s3.amazonaws.com/s3.doximity.com/press/2019TelemedicineAndLocumTenensOpportunitiesStudy.pdf.
2. Barnett ML, Ray KN, Souza J, Mehrotra A. Trends in Telemedicine Use in a Large Commercially Insured Population, 2005–2017. JAMA. 2018;320(20):2147–49. doi:10.1001/jama.2018.12354. https://jamanetwork.com/journals/jama/article-abstract/2716547
3. Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19) in the U.S. (2020, March 12). CDC. https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html.
4. Nykiel T. What Is the Average Medical School Debt? Nerd Wallet. December 17, 2019. https://www.nerdwallet.com/blog/loans/student-loans/average-medical-school-debt.
5. Huneck J. Understanding Medical Malpractice Insurance. Trusted Choice. March 2, 2020. https://www.trustedchoice.com/professional-liability-insurance/medical-malpractice.
6. Ashwood JS, Mehrotra A, Cowling D, Uscher-Pines L. Direct-To-Consumer Telehealth May Increase Access To Care But Does Not Decrease Spending. Health Aff (Millwood). 2017; 36(3): 486–91. https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.1130.
7. University of North Carolina. 170 Rural Hospital Closures: January 2005 – Present (128 since 2010). UNC Cecil G. Sheps Center for Health Services Research. (n.d.) https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures.
8. National Institute of Mental Health. Mental Illness. February 2019. NIH.
https://www.nimh.nih.gov/health/statistics/mental-illness.shtml.
9. Henderson C, Evans-Lacko S, Thornicroft G. Mental Illness Stigma, Help Seeking, and Public Health Programs. Am J Public Health. 2013 May; 103(5):777–80. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3698814.
10. American Health Insurance Plans. Telehealth: Connecting Consumers to Care Everywhere. AHIP. March 2019. https://www.ahip.org/wp-content/uploads/IB_Telehealth-031219.pdf
11. Kaiser Family Foundation. 2019 Employer Health Benefits Survey. KFF. September 25, 2019. https://www.kff.org/health-costs/report/2019-employer-health-benefits-survey.

 

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