Teaching and practicing medicine in the desert

Cardiology Prof. Amos Katz takes over the reins as the ninth dean of Ben-Gurion University’s Faculty of Health Sciences.

By JUDY SIEGEL-ITZKOVICH
Doctors oversee patient (photo credit: DANI MACHLIS/BGU)
Doctors oversee patient
(photo credit: DANI MACHLIS/BGU)
As the country’s youngest medical faculty for 36 years until the opening of the country’s fifth – Bar-Ilan University’s Galilee Medical School in Safed – in 2011, Ben-Gurion University’s Faculty of Health Sciences has tried to be different.
Founder Prof. Moshe Pryves insisted on faculty and students being involved in the health of the community in Beersheba and its environs. Each of its subsequent deans – Prof. Lechaim Nagan, Prof. Shimon Glick, Prof. Shimon Moses, Prof. Shraga Segal, Prof. Rivka Carmi (now BGU president), Prof. Shaul Sofer and Prof. Gabriel Schreiber – added new ideas and approaches. Now it’s up to the new dean, Prof. Amos Katz, to continue their traditions while innovating in his own way. BGU’s Faculty of Health Sciences (FOHS) includes not only a medical school, but also academic institutions teaching nursing, pharmacy, physiotherapy and emergency medicine. There is also an international medical school to teach foreigners who use what they learned to practice global health abroad, plus basic and public health research departments, a health system department and research centers that are teaching students for bachelor’s and advanced degrees.
Katz, who was deputy chairman of BGU-affiliated Soroka University Medical Center’s cardiology department and has for eight years been chief of cardiology at Barzilai Medical Center in Ashkelon, went into medicine without having a role model in the family. “I was born in Ramat Gan to parents who came from Poland after the Holocaust,” the new dean told The Jerusalem Post in an interview. “My father was a carpenter, and my mother was a housewife.
My brother is an architect. My wife is a physiotherapist, but none of our three children has gone into medicine.”
He earned his MD as a member of FOHS’s first medical school graduating class, where he did his clinical studies at Soroka. Among his teachers and role models were Glick, an internal medicine specialist and endocrinologist, and Carmi, a pediatrician and geneticist who was dean when Katz was one of her deputies.
An interventional cardiologist, Katz specializes in the electrical functions (electrophysiology) of the heart, and rather than insert stents into clogged coronary arteries, his clinical work involves patients with arrhythmia (irregular heartbeat, which can lead to sudden death; electrophysiology studies and ablation); and those who need implantable defibrillators, pacemakers and radiofrequency ablation. In addition to fellowships in electrophysiology of the heart at St. Vincent Hospital in Indianapolis, he earned a diploma in health system management from the combined program of BGU and the Clalit Health Services. Although some medical school deans and hospital directors-general devote all their time to administration, Katz decided to keep his finger in hospital work, so he spends one day a week at Barzilai’s cardiology department, with an active deputy running it the rest of the time. “I can be involved and help in treatment of patients in eight cardiac intensive care and18 regular beds via the phone and Internet. I wanted to work with patients and do clinical research too,” he said.
THE BGU medical school “is oriented to produce physicians who will be both very skilled clinically and also able to understand the patient and treat him with compassion, as a human being,” said Katz. “The doctor – both men and women – are given a community orientation.” Students and graduates are encouraged to spend time in the public health funds’ community clinics and in well-baby centers.
The presence of a large number of Beduin families in the south, as well as immigrants from the former Soviet Union and Ethiopia who have less information about disease prevention and Israel’s healthcare system, makes this community approach very suitable to FOHS.
A major difference between when Katz studied at the medical school and now is that a bit more than 50 percent of students today are women. “They now go into specialties they never even attempted before, including general surgery and neurosurgery.
There is recognition that women doctors can do everything men can, and society is willing to see them in these jobs. But unfortunately, there is not equality for women as department heads in hospitals, even though I see no reason for there to be a difference.”
Soroka director-general Dr. Ehud Davidson announced last week that the government and Soroka will boost a two-year-old, longterm program to cope with the shortage of physicians in the Negev. Medical students in their fourth to sixth years at FOS will receive annual scholarships of NIS13,500 and receive mentoring from Soroka residents learning a specialty.
The program, titled “Choosing Tomorrow; Choosing Soroka,” is being expanded and will bring in another 150 doctors to work in the hospital during the next five years, Davidson said. Medical interns will get a scholarship of NIS 12,000 to help out with rent or for attending international medical conferences abroad. The money will be supplied by the Ministries of National Infrastructure, Energy and Water; of Regional Cooperation and Development of the Negev and Galilee. FOHS is involved in those programs at an early stage of medical education of the students from their fourth year of medical school; a physician from FOHS and Soroka mentors the students.
As for the nursing school, about 10 percent to15% are men, and this is a good thing, Katz added, because male nurses are needed in the health system.
The FOHS dean said that women doctors with families are more likely to work less than full time. “But their spouses are more willing to share household and childcare duties. Certainly, without my wife, I couldn’t have pursued my career. Although it is common that salaries and prestige drop in professions with a majority of women, I don’t think doctors’ salaries are going down or that there is less respect for doctors.”
The BGU medical school chooses its students differently than other universities.
Most of the other demand not only strictly high grades on matriculation exams and psychometric tests, but also going through a series of simulations dealing with “patients” played by actors.
Besides applications to school, applicants also have had to go through two interviews with senior physicians, social workers, judges, psychologists and other relevant professionals to assess their compassion, empathy and integrity. Recently, the school replaced one of the frontal interviews with a computerized test to check whether the applicants are ripe emotionally to be physicians.
We look for natural compassion, but one can also teach medical students to show compassion to patients. Compassion helps you even when you conduct research,” he added.
“Prof. Schreiber, the previous dean, looked into the success of the new system picking suitable candidates; we think our technique is no less successful than in other schools or using two frontal interviews,” Katz said. “As for the use of actors in other medical faculties, we instead present patient cases at the interview. We accept not only applicants with very high grades. There are young people who haven’t done exceptionally well on their matriculation and psychometric exams, but they make excellent doctors. We have a handful of Beduin medical students who don’t meet all the criteria for admission, so we put them through preparatory courses. Our graduates are appreciated and welcome in all Israeli and foreign hospitals – proof that our way of choosing students and of teaching is producing excellent physicians.”
The interviewers usually ask applicants about smoking, which medical students ideally should not practice if they want to be a model for patients. But one can’t prevent a smoker from becoming a physician, he said. Katz noted that the Israel Medical Association’s ethics bureau recently came out against hospitals giving tags to staffers who had been vaccinated against the flu.
The IMA’s reasoning is that it would cause “discrimination” by patients against those unprotected against the virus, with which sick staffers could infect the sick. “I don’t see a problem with wearing such a tags.” Katz believes that ethically, medical personnel should protect patients and get vaccinated.
“They should also disinfect their hands very carefully and at all times.”
There used to be a requirement that applicants be at least 20 years old – which held back Arabs who unlike their Jewish counterparts don’t first complete Israel Defense Forces services or National Service. But this was changed, and one can now apply at 18 after completing high school.
Over 1,000 high school graduates apply to Beersheba’s medical school every year – usually they apply to all or most of the five schools in case they are turned down – and about 90 are accepted. But next year, the number will rise to 100, as the government decided there is a need for considerably more doctors, and the year after that, the figure is expected to reach 120 – especially as large numbers of IDF training schools will be moving to a town being built in the Negev, and families will need medical care.
Unlike medical schools abroad, where students cover all the costs and accumulate major debts, the government’s Council of Higher Education’s planning and budgeting committee subsidizes medical education by almost NIS 90,000 per student per year.
The question of whether medical graduates who decide to emigrate and take jobs abroad without having to pay back what was spent on them is a touchy subject. “I don’t think we can demand the money. We have to do all we can to keep them here, to give them places to work, especially in the periphery of Israel and in specialties with inadequate numbers of doctors,” Katz insisted. “We do, however, ask in the interview if they want to stay here to work. But those who intend not to stay could tell us what we want to hear.
Still, doctors who want to become sub-specialists in special areas or get additional training need to go abroad for fellowships.
Some don’t return; those who get grants from the medical school for this do have to return that money. “If there were more studying in Israeli medical schools rather than in foreign universities because they don’t get a place here, fewer would be fewer leaving.”
The American pre-med system in which medical students must first complete a bachelor’s degree in sciences, is “interesting and has some advantages, such as making physicians more oriented towards doing research. We could adopt it quickly, as there are some small pre-med programs for foreign students here. The requirement of military service is not the problem, and there are already two medical schools (in Tel Aviv and Safed) with a four-year program like in the US.
ANOTHER DIFFERENCE between medical education decades ago and today is that in the past, students spent long days in libraries seeking out information, and they had to memorize anatomical parts and other technicalities.
Today, fresh information is available from one’s smartphone and the Internet.
This has also led to a change in frontal teaching to give it more added value and a mo v e to smaller groups, with students having to find data and learn problem solving. “The information is out there; we have to teach how to find and interpret it,” said Katz. “As much of the faculty learned medicine differently, we hold workshops for them.”
FOHS is setting up its own simulation center to reach students and doctors in residency.
Autopsies are becoming less required in medicine today, because of computerized simulation, but when it is required, the bodies are “imported from abroad or purchased from Tel Aviv University.”
YET THE biggest limitation on the expansion of medical schools – and the reason why “there shouldn’t be” private medical schools – is the chronic shortage of places where professors can teach the clinical phase in small groups in hospital departments.
“These are a national resource, and there aren’t enough of them,” Katz asserted.
“Without more hospital teaching staff, we cannot produce more doctors.”
Last year, the cabinet approved – at least theoretically – the building of another hospital in the Negev to join Soroka. But as the government has not built a state-owned hospital in many decades and has instead given the job to public health funds and private interests (like the Ashdod hospital, with 25% private medical services, being built and to be run by Assuta Medical Centers).
“I think that the Negev has a need for more than one hospital,” said Katz. “You reach a critical mass of up to 1,200 beds, and then, one should have another one. The recent government decision – after Operation Protective Edge – was that it will be in Beersheba.”
The dean believes that despite financial and other problems, the level of medicine here is “as good and probably better than in the US, especially in its community health system provided by the health funds. And ours is certainly much less wasteful land more efficient.”
At the end of his three-year term as dean, he will regard it as successful “if the strategic targets I set