Over the past 50 years or so, there have been dramatic changes in how doctors do business. During the 1970s, individual practices started merging into larger group medical practices. And in the 1980s and 1990s, hospitals started buying those group practices. In addition to these changes, a whole new type of physician emerged during the 1990s, the hospitalist—usually an internist or a family physician, who works exclusively in the hospital and oversees a patient’s care while he/she is there. The latest trend? Freelance doctors. More and more doctors are choosing the flexibility of this type of work, and more hospitals in desperate need of doctors are hiring them.

It may not seem like it, but we have a doctor shortage in the US. Hospitals are finding it difficult to recruit enough physicians to function at optimal levels. As a result, close to 50,000 doctors now employed by hospitals are freelancers—doctors who contract with one or more hospitals for a specific number of hours per month. It can be as little as one day a week or as much as 20 or more days per month.

While most freelancers work in hospitals as hospitalists and specialists, the trend has started to broaden and some freelancers have begun working in large group medical practices. For patients, this new world of doctoring can have both benefits and drawbacks. What you need to know…

Are you safe? For years, hospitals avoided hiring freelance doctors. Hospital administrators viewed them as unqualified. And too often, those hired under contract didn’t perform very well, most likely because these doctors were less skilled and unfamiliar with the setting. Harvard Medical School associate professor Anupam Jena, MD, notes that as recently as 10 years ago, patients of these doctors were more likely to die than patients of full-time doctors. But in his analysis of newer data for a paper under review, he finds that this is now much less of a problem. Many highly qualified doctors are now choosing to work as temporary contract physicians because the flexibility fits their lifestyles. They also frequently earn more per hour and are able to focus on practicing medicine rather than on management and paperwork.

Benefits for patients: Freelancers often ease the heavy caseload of hospital doctors, helping to prevent burnout. And while freelancers are hired in almost all hospitals, they bring an added benefit to rural and inner-city hospitals, which have been forced to close in many cases partially due to the difficulty of recruiting doctors. Now qualified freelance doctors are bringing more and better services to these facilities and allowing them to stay open.

How to protect yourself. If you’re hospitalized for several days or more, you may see a number of different freelancers who are not typically familiar with your medical history. Of course, they report to and are overseen by senior hospital physicians and try to keep your primary care doctor informed, but a lack of continuity of care can cause errors and/or slow down your healing.

Self-defense: Even though this information should be in your medical chart, always bring a list of any conditions you may have (such as diabetes or food, medication or other allergies) along with a list of your current medications when hospitalized or seeing any new doctor. And be sure to review this information with each new doctor you see (in the hospital or otherwise). In this changing world of doctoring, the onus is on you to ensure continuity of care.

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