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Giving Care

My friend L is a physical therapist and works with elderly people who need help in their homes or assisted living facilities. She loves her job and the patients but truly resents the mountains of paperwork she needs to do each day. Most of it is to make sure that the services are paid for by insurance but there is an insane amount of busy work that drains her out. 

L would love to have more control over her schedule, pick the gigs she wants and ideally have the admin part of her job gone. She could take that time back to further her education, keep up with the latest research and so on - things that would add value for those she cares for. Reading this essay about the uberization of nursing brought L to mind. It seems as if there is no winning scenario for those who care for others and rightfully want to do in way that is sustainable for them.

For workers, the old adage of equal pay for equal work has gone out the window. Personalized pay is all the rage (Teachout 2023). On-demand nursing companies such as Clipboard Health and ShiftKey encourage workers to join in on personalized pay schemes by bidding against each other. On ShiftKey, Ashley not only expresses her availability for a shift but bids for one against peers by indicating the lowest hourly rate for which she will work. To win the shift, she lowers and lowers her rate until it’s well below a living wage. Like other gig workers who spend a considerable amount of work time not being paid (see Attoh et al. 2024), Ashley is not paid for the time she spends each month updating her profile, reviewing available positions, bidding for shifts, and sending messages in the app about errors in her wages. Some days, she says, ShiftKey feels like a race to the bottom. 

If the system is set up to be a race to the bottom for care providers, there is no way it results in good outcomes for those in need of care. 

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