STUDENTS AT the Technion’s Rappaport Medical Faculty listen to internal medicine lecture..
(photo credit: Courtesy)
The “unique characteristics of the next generation of doctors in Israel, combined with the current model of physician employment,” are likely to pose a “tangible threat to the high quality of public clinical care and medical education in the near future and to the continued flourishing of clinical research.”
That statement by doctors and researchers at Bar-Ilan University’s School of Medicine in the Galilee and its partner hospital, Ziv Medical Center in Safed, was recently published in the Israel Medicine Association Journal. The authors looked at this growing dilemma and offered a number of recommendations to overcome it.
The IMA’s guidelines for Israeli physicians are similar to those in other countries – a doctor should place the patient’s interests foremost in mind. But these obligations may not be compatible with the realities of 21st-century medicine, according to the researchers, who questioned whether altruism is still a legitimate component of the modern medical world.
“We grew up working endless hours and complaining about it politely and quietly, but never actually making any significant protest about it. In addition, we are required to conduct clinical research and to teach without actually having any additional time allocated for it,” wrote Dr. Peter Gilbey, of the Otolaryngology Department Head & Neck Surgery Unit at Ziv. He wrote the paper with Prof. Mary Rudolf and Dr. Sivan Spitzer-Shohat of the medical school and Prof. Anthony Luder, of the school and the pediatrics department of Ziv.
“But times are changing. Young people today are more aware of their rights, more willing to stand up and demand their rights, and there is greater awareness of the need for the so-called ‘work-life balance.’ People don’t want to work endless hours anymore,” they wrote.
As more than half of medical students are women, their double obligations to family and work will add to this dilemma.
The generation to which Gilbey refers was born in the 1980s and 1990s and has been characterized as ambitious, self-focused, entrepreneurial, lacking loyalty to their employer and seeking immediate gratification.
Altruism and self-sacrifice are no longer assumed by the new generation. And in a recent media interview, a representative of a newly-formed union that protects workplace interests of Israeli doctors stressed that altruism cannot and should not be a substitute for appropriate pay and conditions.
The researchers concluded that teaching, learning and research can no longer be done on time “stolen from unrelenting and ever-growing clinical duties, which create an overwhelming workload that nobody can handle. Altruism must be encouraged, but not in the same, outdated way. Today we can demand circumstantial or conditional altruism within the framework of defined working hours and conditions, but no more than that. We should aim to produce the ‘dedicated-enough’ doctor, and not for more than we can possibly hope to achieve,” they wrote.
The researchers also suggested ways to modify the system to suit today’s needs, including: Allocating protected time for research and teaching – a step that will require extra staff and a change in the current professional and employment paradigm; medical schools should aim to conduct an admissions process focusing on humanistic, as well as academic, criteria; education should be recognized for academic promotion purposes and consideration given to fully accredited teaching tracks; and exposing students early in their training to positive clinical role models.
These steps will help to ensure Israel maintains the quality of doctors, they wrote.
“It can’t go on like this, because the system will collapse,” Gilbey said. “So either we change and adapt, or we are headed for a serious crisis.”