Voice through exit: Changing working conditions by independent contractors’ participation

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.