Is the gig economy a risk factor for adverse health outcomes ?

Addressing social determinants, like where you live, your education level and how much you make, has popped up as a major trend in sick care since, a substantial body of evidence indicates, they contribute to health outcome disparities. Your ZIP code means more than your genetic code.

So, when the gig economy collides with social determinants, there is the possibility that your employment situation or status should be added to the list.

While the term "gig economy" and "sharing economy" are new, people have been working piecework, consulting gigs and feast or famine jobs for a very long time. Actors and those who work in the entertainment industry, or other creative arts, like musicians and artists are an example. Construction workers during booms and busts are another example. In fact, as the gig economy expands, economists are worried about how the system will conform to the new reality. Google " guaranteed minimal income " and you'll see what I mean.

Consider the life of an actor:

  1. Periods of work and non-work
  2. Physically demanding work
  3. Long hours and sleep deprivation
  4. Substance and alcohol abuse and behavioral health disorders (think comedians)
  5. Discrimination, sexism and ageism
  6. Isolation and loneliness
  7. Demanding travel scheduled
  8. Dealing with the emotional costs of fame
  9. Financial insecurity
  10. With few notable exceptions, constantly having to re-invent yourself
  11. Lack of sick care insurance benefits and access to care
  12. Always on the "bubble" and a career that could be instantaneously be cut short due to injury or even minor disability.

However, income instability is not limited to consultants, actors and Uber drivers. Research has found that even those with long-term, “steady” jobs cannot count on financial stability because of the volatility and unpredictability of their incomes and expenses. The major source of income volatility was due not to job changes, but to changing income from the same job. In other words, our households had steady jobs without steady pay.

Taken together, these two forms of inequality mean that some households have incomes that are the worst combination of stagnant (over decades) and volatile (on an annual and even a monthly basis).

As more and more workers enter the gig economy, including doctors, or when confronted with the white coat getting the pink slip, they might be at risk for adverse health outcomes. The irony would be , if they are, they won't have insurance, money or access to do anything about it. Now that's a tough gig.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs