In the course of worldwide reforms in health care systems, flexible employment is of increasing relevance in medicine and also includes the highly skilled workforce of hospital physicians. With reference to Hirschman’s seminal work on exit, voice and loyalty, this article analyzes the phenomenon of deploying locum tenens physicians as independent contractors in hospitals. The results of two qualitative empirical studies drawing on 30 qualitative interviews show conditions and consequences of exit– voice– loyalty behavior on different levels. On the meso level of organizations, locum tenens physicians help to enforce improvements in everyday hospital practices because as independent contractors, they gain a new, more autonomous position – they receive voice through exit.

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.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3118-6) contains supplementary material, which is available to authorized users.

Purpose While staffing agencies are gaining importance in work relationships with the highly skilled workforce, their work relations with highly skilled independent contractors have not been investigated yet. Staffing agencies as labor market intermediaries charge a fee to help independent contractors as well as client organizations to create contracts for services while independent contractors remain self-employed. Besides their growing relevance, their exact role remains unclear. Thus, the purpose of this paper is to analyze the role of staffing agencies in work relationships with highly skilled independent contractors. Design/methodology/approach The authors applied a mixed-methods design comprising a qualitative interview study with independent contractors and staffing agencies’ representatives (n=29) coupled with a quantitative survey of staffing agencies (n=81). Findings The analysis shows that staffing agencies are important actors in work relationships with highly skilled independent contractors. However, the relationships can be differentiated into rather standardized ones on the one hand and individualized relations on the other hand. This seems to correspond with differences between sectors. Originality/value First, the authors discuss staffing agencies as new intermediaries and highlight their relevance in the negotiation of working conditions. Second, the authors emphasize variations of the role of staffing agencies in triadic work relationships of highly skilled independent contractors in relation to specificities of sectors. Third, the study also adds on organizational support theory and related research.

In the last decades, managerial instruments have gained importance to medical decisions and the logic of managerialism is juxtaposed with the logic of medical professionalism. Recent changes in the hospital employment structure raise the question of contradictory logics not only at the organizational but also at the individual level. Therefore, we investigate the rise of locum doctors which is a relatively new phenomenon in Germany. Our qualitative interview study with 21 locum tenens, permanently employed physicians, and chief physicians shows that locum physicians re-contextualize professional standards in hospitals. According to their self-perception, patient care stays at the center of their medical practice regardless of economic, bureaucratic, and hierarchical requirements as well as hospital-specific routines. We argue that the interrelationship between professionalism and managerialism exists not only within organizations but also on an individual level of locum doctors.

Cet article compare l'activité syndicale en faveur des droits des travailleuses 1 domestiques aux Pays-Bas, en Allemagne et en France. Même si le nombre de travailleuses domestiques syndiquées y est très faible, les syndicats ont développé des actions pour défendre les droits de ces travailleuses dans ces trois pays. Toutefois, ces actions n'ont été que partielles et n'ont pas pris en compte de manière exhaustive les besoins et les droits de toutes les travailleuses domestiques. La comparaison de l'activité syndicale montre que les actions en faveur des travailleuses domestiques ont été encouragées par le plaidoyer transnational dans les trois pays. De plus, alors que des institutions inclusives ont facilité les actions en France, au contraire, en Allemagne et aux Pays-Bas, les actions syndicales ont été limitées par les caractéristiques "informelles" persistantes du travail domestique et par l'hésitation des syndicats à s'engager de manière globale dans la question des droits des migrants.

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In recent decades most developed political economies have been confronted by structural changes such as tertiarization, globalization, and growing unemployment. As a consequence, innovation has become a pressing issue for both national and local economies as a means of increasing competitiveness (Mawson et al, 1990). Policy makers are therefore being encouraged to develop measures that favor innovative services (Hilpert, 1991), such as those in the creative industries, and attract what Florida calls the``creative class'' (Currid, 2009;Florida, 2002). (1) Accordingly, there is a growing body of literature which aims at improving the understanding of organization and innovation in general and of creative sectors in particular. For instance, studies on creative industries have underlined the high degree of uncertainty in these sectors and have described the ways of organizing work and labor-market processes which rely heavily on flexible cooperation and informal networks. These characteristics are considered to be unique in comparison with other industries (

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