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oyee–employer relationship (Cobble and Vosko, 2000; Lips, 1998).While representing less than 4 percent of the US employment market(Houseman, 2001), the TSI represents a threat to labour relations in the US asit encourages a two-tier compensation system, facilitates deunionization, erodes
employer sponsored fringe benefits, shifts risks and costs of unemployment andworkers’ compensation to workers and facilitates corporate downsizing (Peckand Theodore, 2002). These threats are most germane to TSI workers who can
be classified as contingent, non-standard workers, those who work for temporaryhelp agencies, work on-call or as day labourers, work part-time, or justfilling in manufacturing and service industries (Houseman, 2001; Kalleberg
et al., 2000).The professional contingent worker
However, professional contingent employees, especially scientific and knowledge
workers, who Kirkpatrick and Hoque (2006) term ‘gold collar’ workers,
are less affected by the disadvantages of contingent, nonstandard employment
(Hoque and Kirkpatrick, 2003; Kalleberg et al., 2000) because they possess
high levels of human capital (Smith, 1998) and, as a consequence, are better
compensated, and enjoy greater autonomy. This is the case for physicians and
other professionals, such as accountants (Sweet, 1994), attorneys (Rogers,
2000) and clergy (Mueller and McDuff, 2000), due to their high demand, level
of advanced training, specialized knowledge, relative skill shortage,
autonomous work system, societal acceptance of their authority and a code of
ethics focused on service (Herzenberg et al., 2000; Lawrence and Corwin, 2003;
McKeown, 2005; Rogers, 2000; Sweet, 1994). In medicine the shortage and
maldistribution of selected medical specialists and their interchangeability
(Herzenberg et al., 2000; McDuff and Mueller, 2000), has further facilitated
the development and expansion of the contingent physician segment of the TSI,
and has placed them in a stronger negotiating position relative to other contingent,
nonstandard workers. These features may insulate physicians from many
of the negative aspects of contingent employment (Cohen and Mallon, 1999;
McKeown, 2005; Smith, 1998), or what Kalleberg et al. (2000) term ‘bad jobs’.
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Overall, it is perhaps inconsistent to consider health care providers, especially
allopathic physicians, as members of the contingent workforce, where
there is no explicit or implicit commitment to long-term employment (Polivkaand Nardone, 1989). There is, however, an expanding market for other healthcare providers, for example, nurses and dentists (Irons, 2001), who are willingto assume contingent employment arrangements for a specified period of time,for an arranged fee, with only minimal, if any, prospects of permanent employment.The professions, especially physicians, have not received as much attentionin the labour literature as have industrial and service contingent,
nonstandard workers and, therefore, little is known about them as a group,despite the fact that the professional segment of the temporary workforce isincreasing at twice the rate of other contingent workers (McKeown,2005). A
very limited number of studies exists which examine the use of contingent
health care providers and