In the late 2000s, surging unemployment during the financial crash gave rise to the gig economy, later supercharged by the emergence of ride-sharing and food-delivery apps. Almost two decades later, gig work is as big as it’s ever been, and is creeping into one of the country’s most essential and historically stable professions.
Last year, at least 42 million people were considered gig workers in the U.S., nearly one-third of the total workforce. That includes independent contractors, freelancers, temporary staff, and even workers who hold gigs in addition to a full-time job.
The gig economy has diversified to seep into everything from accounting to law and even medicine. Health care, in fact, has grown to become one of the biggest gig work providers, with a plethora of apps now connecting nurses, technicians, and even doctors to temporary work, just like Uber.
But in a similar vein to ridesharing apps, the gigification of health care might come at the expense of worker security and even allow companies to sidestep regulations, found a new report on the state of nursing gig work.
Much like Uber convinced policymakers its drivers were contractors instead of employees, health care staffing platforms are pushing for legal recognition that would exempt them from obligations to pay minimum wage or provide workers with some benefits, according to the report published Tuesday by AI Now, a research firm focusing on the public impact of AI.
“Uber’s business model—the ‘gigification’ of labor—and lobbying practices have made their way to healthcare staffing,” the report’s authors wrote.
Lowest wage wins
The report details several ways widely used health care staffing platforms have started chipping away at worker protections in different states.
In Georgia, for example, a company called Clipboard Health lobbied lawmakers to exempt gig nursing platforms from state requirements to provide workers’ compensation and unemployment insurance laws, the report found. In Ohio last year, Clipboard Health and Shiftkey, another matching platform, supported a bill that would reclassify gig nurses as independent contractors, removing minimum wage obligations, according to the report.
Another practice the report took issue with was widespread use of algorithm-based management systems on these platforms’ apps, which determine how much a worker is paid for a shift, tracks performance, and uses a points system to connect nurses with jobs. In one example, using Clipboard Health’s app, workers can enter bids on desired wages to work a shift, with the lowest bid winning the contest, according to the report.
“These changes invoke troubling questions about algorithmic collusion and wage suppression,” the authors wrote, leading to a system of “surveillance wages,” in which workers’ personal data and user history becomes the main factor determining pay.
Clipboard Health and Shiftkey did not immediately reply to Fortune’s request for comment.
The creeping gig economy
Nursing has long been lionized as one of the most stable and safe professions for young graduates to pursue. Industry associations frame the career as one with enviable job security, given the ever-increasing need for nurses that supersedes economic downturns. That demand will likely grow as America’s population ages. By 2040, one in five Americans will be over 65, according to the Urban Institute, up from one in eight in 2000. The Labor Department expects overall nursing employment to increase 35% between 2024 and 2034, significantly outpacing the projected 3% in the wider labor force.
But the future of those jobs might not be as stable as was once promised. The AI Now report claims hospitals and other health care institutions are gravitating toward gig workers rather than offering full-time roles, in part because employing contracts gives administrations more control over schedules and wage costs.
How many nurses are participating in the gig economy isn’t clear, in part because some hold full-time roles and do gig work in their spare time, but a growing number of them risk being misclassified and missing out on benefits. Last year, an appeals court upheld a $9.3 million ruling against Steadfast Medical Staffing, a health care matching platform. The case ruled that the company had knowingly misclassified around 1,100 certified nursing professionals as independent contractors, resulting in nearly $5 million in unpaid overtime work.
Advocates of gig models in health care say the shift can help cope with the growing staffing needs of caring for an aging population. Many nurses are also likely to suffer from burnout due to a high-stress work environment and long hours. One recent survey by Joyce University of 1,000 registered nurses found almost three-quarters felt emotionally drained from work multiple times a week.
Gig work comes with benefits, including greater control over the type of work and number of hours on the job. But that type of work comes with tradeoffs, and it’s not clear most nurses are prepared to make the leap. A 2024 survey by the Massachusetts Nurses Association asked more than 500 nurses whether they would be interested in trying to find work through apps where they would be considered independent contractors instead of employees—59% said no.
