California’s health care workforce is a scramble of independent contractors, part-time workers and full-time staff.
Some people work directly for hospitals, while others work for medical groups that hospitals contract with. In clinical or group practice settings, anyone from a lab tech to a neurologist could be working independently.
That's why some health professionals are taking issue with AB 5, a California bill that would require many employers to make their independent contractors employees, with a few exceptions.
Some medical professionals say they want to be exempt so they can make their own schedules and work at multiple facilities.
“It’s really because of the flexibility it provides in order to deliver the best patient accessibility and care as possible,” said David Monks, a California employment attorney. “It’s created a scenario where the use of independent contractor model has become so prevalent that there’s a great reluctance to give it up.”
The bill aims to codify a 2018 California Supreme Court decision, Dynamex Operations West, Inc. v. Superior Court of Los Angeles, which creates stricter guidelines for who is a contractor and who is an employee.
It could have big implications for gig economy workers such as Lyft and Uber drivers, who aren't classified as employees. That means they often don't have access to paid time off, health care, retirement funds and other employee benefits.
Some independent health workers feel similarly disenfranchised, and hope the bill will grant them those perks.
The California Nurses Association opposes adding exemptions to the bill, even for health workers who have multiple independent contracts.
“If you’re working as a nurse in a facility, and you have another job as a nurse, you should not be an independent contractor,” said Stephanie Roberson, a lobbyist with the group. “There should be no misclassification there.”
The bill already allows physicians, dentists and podiatrists to remain independent contractors. The California Chamber of Commerce is pushing for an amendment to expand that language to include more health care professionals such as nurse anesthetists, therapists, optometrists and social workers.
Rochelle Perper, a clinical psychologist in San Diego, works as an independent contractor and also owns a group psychology practice.
“Psychologists don’t have a history of exploitative working environments, perhaps compared to other fields that this bill was really intended to capture,” she said. “I feel as though psychologists, mental health professionals and probably a lot of other health care professionals are getting the ‘trickle down’ effect.”
Under AB 5, employers would have to hire as an employee anyone who does work that’s directly related to the service the company provides. So though Perper might not have to hire her custodians, she would likely have to employ all the therapists.
She said complying with the law would be an overwhelming financial undertaking.
“I’m facing the real possibility of closing the group,” she said. “And that means the therapists would not be able to provide the care their clients so desperately need.”
The California Hospital Association has concerns about patient care. They say hospitals rely on independent contractors to provide low-volume specialty services, or to fill positions when employees are on leave.
The bill’s backers say employers should have to find a way to give their contractors the benefits of employment.
Given the wide variety of employees in the health care industry, Monks says it will be a challenge to satisfy all the groups asking for exemptions.
“There are dozens of kinds of services providers that are scrambling to get onto this bandwagon, and many are not gonna make it,” he said. “As of right now, they don’t have a clear path to maintaining that independent contractor status.”
The bill awaits an Aug. 30 hearing in the Senate Appropriations Committee.