“A physician who heals for nothing is worth nothing.”
(Talmud: Baba Kama 85a.)
By JPOST EDITORIALdoctor 311(photo credit: Avi Hayoun)
Unless a last-minute agreement is reached, doctors will strike for the the first time in 11 years. Termed a two-day “warning strike,” some 20,000 unionized physicians will be working on a reduced “Shabbat schedule” on Tuesday and Wednesday.That means non-urgent medicine (a special committee will determine what is urgent) will not be performed. Cancer patients will not be accepted to outpatient clinics, some fertility treatments will be postponed and some MRI and CT scans will not be performed. (Dialysis treatments for kidney patients – three per week – will be conducted, as will in-vitro fertilization treatments in community clinics rather than the hospitals.) This will cause tremendous suffering for those who have been waiting weeks, even months, to receive medical care.Doctors, quite aware of the suffering they will cause to thousands, feel that after eight months of fruitless negotiations they can wait no longer.A doctors’ strike is always ill afforded, particularly in the present situation in which the distance between the sides can be bridged. It is about time that a labor dispute is settled preemptively without resorting to extreme measures.While it is true that physicians’ base pay is very low, many manage to earn quite decent salaries, as befits a profession that demands a minimum of seven years of training and often deals with decisions that mean the difference between life and death. According to Israel Medical Association data, physicians’ base pay is an embarrassingly low NIS 26 an hour while specialists earn just NIS 42, excluding overtime and shifts. To rectify the situation, doctors are demanding a 50 percent increase.The Treasury, in contrast, says medical residents in the public sector earn a highly respectable gross monthly salary of NIS 18,654, a specialist earns NIS 23,705, and a senior physician NIS 34,428, hardly low salaries considering that the national average is about NIS 8,300. However, Treasury data is misleading since it factors in the overtime paid to the thousands of doctors who regularly endure several marathon shifts a week. According to Treasury data, 80% of doctors supplement their low base salaries by providing private medical care. In Jerusalem this can be done in all the major hospitals under a scheme known as SHARAP.Some hospitals also allow doctors to supplement their salaries by working for health funds. In places where hospitals are owned by the Health Ministry or by Clalit Health Services, doctors must leave the public hospital and go to one of about a dozen private hospitals and branches such as Tel Aviv’s Assuta.A partial solution put forward by Deputy Health Minister Ya’acov Litzman, is to make it easier for doctors to work privately by expanding the SHARAP arrangement to public hospitals around the nation. The Treasury, however, has countered that a two-tier medical system – one for the rich and one for the poor – is potentially discriminatory.However, Treasury officials, never known to be particularly concerned with the rights of the poor, seem to be opposed to expanding SHARAP to public hospitals for another reason: it would cost the state more money. About 80% of Israelis hold supplementary insurance provided by the four public health funds. This insurance usually covers a portion of SHARAP’s cost.If SHARAP were expanded, demand would increase, resulting in the need for more state funding transferred to the insurers to defray the added insurance coverage provided.
Expansion of SHARAP services would also necessitate additional investment in equipment and hospital space.Expanding SHARAP, however, would not solve the problem of low base salaries, which translate into low pensions at retirement and insufficient reimbursement when doctors do reserve duty. Also, it would not help, say, anesthesiologists and neonatologists, two of the specialties that are not paid for privately.Nevertheless, Treasury officials have shown some understanding of doctors’ gripes. They have, for instance, offered to direct wage increases at physicians working in outlying areas as an incentive to attract more doctors there and improve medical services. Aware of the dearth of anesthesiologists, internists, neonatologists and other hard-to-comeby specialists, the Treasury has offered to boost salaries in these fields. The Treasury has also proposed to focus on improving the salaries of young hospital interns and residents, the most low-paid and overworked in the profession.DIFFERENCES BETWEEN doctors and the Treasury can be resolved, including the refusal by doctors to acquiesce to the Treasury’s demand that they punch a time clock. We are sympathetic to the argument put forward by the doctors that theirs is an altruistic occupation. But this week’s strike is hardly motivated by altruism.The issues are complicated and intricate, but both doctors and Treasury officials – who in the end answer to Prime Minister Binyamin Netanyahu, who is officially health minister – have an obligation to hammer out their differences without causing suffering to our nation’s sick.Let’s hope they succeed – the quicker the better.
