The severe shortage of doctors in Israel, compared to the situation in other developed countries, is a well-known fact. It’s enough to visit the emergency room of any hospital in Israel in the evening to see the exhausted doctors doing their best through 24-hour shifts and longer to provide care. Not to mention being admitted to an internal medical ward or another department during the night, which would expose you directly to a fatigued medical team that is not always as patient and accommodating as it should be, considering the heavy burden they carry.
During the winter, the number of patients and admissions can easily double or triple, increasing the enormous load on the shoulders of young residents who had recently completed their medical studies and are now on the front lines of the unending struggle for the duration and quality of life of Israel’s citizens. As a result, certainly not due to any fault of the medical team you might encounter, you can expect suboptimal care, and often that is an understatement.
Why does the healthcare system in Israel consistently operate with a shortage of staff, mainly doctors and nurses? To understand the situation, one must be familiar with the history and mistakes that have never been corrected.
Firstly, Israel has a severe planning problem. The politicians responsible for planning focus on the present and, at best, the near future. They have never excelled in long-term vision for the years ahead. In the early 1990s, the country received an unprecedented boom in the form of tens of thousands of doctors and nurses who immigrated from the collapsing Soviet Union and stabilized the situation for decades. However, these welcomed immigrants have aged, and many have now reached retirement age.
Unfortunately, there is no one to replace them, as the state failed to take advantage of the situation and plan for two or three decades ahead. The result is a worsening shortage of doctors in general and specialists in certain fields in particular. This means that within a short time, the waiting times for specialist doctors in hospitals and clinics will be unbearable.
As part of the lack of planning, no adequate assessment or improvement in the standard of care in Israel has been carried out. The population is aging and growing at an impressive and unprecedented rate but the standard – the number of residency positions and, in practice, job positions for doctors – progresses slowly.
The second reason for the shortage of doctors is that Israel’s healthcare system lacks a main leader. Who is leading the system? Is it the Ministry of Health, the Medical Association, or the health funds? Imagine a boat being steered in multiple directions simultaneously. Each one pulls in the direction that seems appropriate at any given time.
Israel’s healthcare boat cannot advance, identify human resources, plan, or reach its destination. The simplest indication is that, up until the moment of writing these lines, the Ministry of Health does not know how many doctors are expected to return from abroad and integrate into the system each year. This is because the ministry has records of the government licensing exams but no record of the American exam, which exempts doctors from the government exam. Thus, a country reliant on foreign graduates has no idea how many graduates will integrate into the system in the coming year.
The third reason is stagnation. For many years, the number of qualified medical students in Israel has remained almost constant. Only in the last two years have efforts been made to expand the number of students studying medicine at each university. Additionally, the state obstructs ideas and initiatives that could provide relief to underserved populations and areas suffering from inferior healthcare services. A current example is the Council for Higher Education’s refusal to rise to the occasion and approve the establishment of an international English-language medical school in Eilat.
Suffering in the South
For many years, Eilat has suffered from inferior healthcare services compared to central Israel, and the direct result is a life expectancy that is five to six years lower. Is it reasonable that Israeli citizens living in Eilat and the surrounding area pay taxes, health insurance, and national insurance identical to those in the central region but in practice receive healthcare services similar to those provided 40 years ago in central Israel?
The solution presented to the Council for Higher Education is to establish an international English-speaking medical school in Eilat. The project would be done in cooperation with Clalit Health Services, which is committed, as part of the project, to elevate the Yoseftal Hospital to an academic level. Additional partners in the project include top European medical schools.
The plan is to build a prominent building in the city center that would house a hi-tech center in the field of biomedical research, led by a top-tier technology company. Such an opportunity has never existed before. However, bureaucratic wheels are delaying the project, which will reduce its potential and lead the entrepreneurs to despair.
What is the solution? First, we should look beyond today and consider the year 2050, implementing immediate measures that would balance the shortage and even bring the system to a surplus, thereby significantly reducing the enormous burden on the medical staff. Second, we must rise above the bureaucratic constraints and adopt innovative concepts, all the while guaranteeing a sufficient standard of education that not only reflects our pride but also enhances our healthcare system.
Finally, we must create a clear hierarchy among the heads of the healthcare system so that there is one head for each task, with others serving as executors. This way, we will reach the promised land, where those seeking emergency room and hospital care will always be received by an alert professional with a broad, supportive, and accommodating smile, as befits our country.
The writer, a cardiologist, is the CEO of Medical Doctor, a premedical school in Europe, and founder of Eilat Medical School.