Abstract
BackgroundIn contrast to other countries, the appearance of locum physicians as independent contractors constitutes a rather new phenomenon in the German health care system and emerged out of a growing economization and shortage of medical staff in the hospital sector. Locums are a special type of self-employed professionals who are only temporally embedded in organisational contexts of hospitals, and this might have consequences for their professional practice. Therefore, questions arise regarding how locums perceive their ethical duties as medical professionals.MethodsIn this first qualitative study on German locum physicians, the locums’ own perspective is complemented by the viewpoint of permanently employed physician colleagues. Eighteen semi-structured interviews were conducted in 2014 to explore the professional practice of locum physicians from both groups’ perspectives with respect to doctor-patient-relationship, cooperation with colleagues and physicians’ role in society. The data were analysed using qualitative content analysis, including a deductive application and an inductive development of codes. The results were related to key tenets of medical professionalism with respect to the question: how far do locums fulfil their ethical duties towards patients, colleagues and the society?ResultsThe study indicates that although ethical requirements are met broadly, difficulties remain with respect to close doctor–patient contact and the sustainability of hiring locums as a remedy in times of staff shortage.ConclusionsFurther qualitative and quantitative research on locum physicians’ professional practice, including patient perspectives and economic health care system analyses, is needed to better understand the ethical impact of hiring independent contractors in the hospital sector.
Highlights
In contrast to other countries, the appearance of locum physicians as independent contractors constitutes a rather new phenomenon in the German health care system and emerged out of a growing economization and shortage of medical staff in the hospital sector
Physicians who work in leadership positions in the hospital sector feel that their professional autonomy is threatened by misguided incentive systems which promote quantity instead of quality of care and can lead to a financially motivated broadening of medical indications [8]
The qualitative study to investigate how locum physicians perceive their ethical duties towards patients, colleagues and society is based on 18 semi-structured interviews conducted face-to-face or on the telephone
Summary
In contrast to other countries, the appearance of locum physicians as independent contractors constitutes a rather new phenomenon in the German health care system and emerged out of a growing economization and shortage of medical staff in the hospital sector. The bureaucratisation of the medical job forms a major driving force for physicians leaving the patient care sector and Salloch et al BMC Health Services Research (2018) 18:333 seeking alternatives in other medicine-related branches or abroad [9]. These structural developments have a great impact on individual working conditions and prompted the emergence of locum physicians as a new type of freelancer on the German labour market scene. Whereas locum physicians already form a well-established type of self-employed workers in other countries [10], their appearance in German health care is a rather recent phenomenon
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