Establishing a new profession of nurse assistants; attracting Israelis studying medicine abroad and Western doctors to make aliya; attempting to close three international medical schools and finding more places for clinical teaching in hospitals are among the recommendations of a committee of experts on ways to cope with the looming shortage of doctors and nurses here.

The 64-page report was presented Monday by its chairman, Health Ministry chief economist Dr. Tuvia Horev, to Deputy Health Minister Ya’acov Litzman after two years of study and deliberations.

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Litzman promised to push to carry out these recommendations immediately in the ministry’s negotiations over the 2011/2 health budget with Treasury officials and told health reporters at a briefing in his office that while “we will not win on everything, we expect to have some good news ahead.

“We will not agree to the new ministry budget unless there are more hospital beds and increases for demographic changes in the population,” he said. “We will put extra stress on facilities in the country’s periphery and on the upcoming wage agreement with the physicians.”

Health Ministry Director-General Dr. Ronni Gamzu said that since it takes 15 or more years to produce a physician, action must be taken now to head off a manpower crisis in the mid- 2020s. There are some 130,000 more Israelis each year, he said; that fact, along with the ageing of the population, the physicians who move abroad, the increase in women doctors who want to work only part time and the loss of doctors to other professions, is making the situation steadily worse, he said.

The huge boost of physician and nurse manpower from the former Soviet Union in the 1990s is dissipating as these immigrants begin to retire.

There are only 3.4 physicians per 100,000 Israelis – about the same as the OECD average – but in those other countries the birth rate is generally much lower, said Gamzu.

The per capita rate of anesthesiologists, intensive care specialists, neonatologists, child psychiatrists, pediatric neurologists, geriatricians and rehabilitation specialists is already too low; in the near future, there will also be too few pathologists, internal medicine specialists and general surgeons.

With the fifth medical school, under the aegis of Bar-Ilan University, due to open in October 2011 in Safed and graduates from Tel Aviv University’s four-year medical school for those who already had bachelor’s degrees, there will eventually be some 520 graduates a year, but 900 graduates will be needed in 2022, Gamzu said, adding that “we must not go below 2.9 working doctors per 1,000 residents.”

The lack of suitable places for clinical teaching in the hospitals is a major bottleneck that must be dealt with, he said.

He noted that Ben-Gurion University of the Negev, Tel Aviv University and Haifa’s Technion all have medical schools where some 150 international students learn in English.

Since these programs take up clinical teaching facilities, these programs should gradually be closed, he said.

But ministry officials conceded that it will not be easy to get the universities to forgo these prestigious programs.

The ministry will also offer incentives to the few hundred Israelis who were not accepted to the four medical schools here and went to Hungary, Italy and Romania instead, to come back and study here, said Gamzu.


There are only 5.5 nurses per 1,000 residents, which is already too low, The ministry has decided to launch a new profession – nurse assistants – who will be specially trained to carry out basic functions that nurses do but do not need to go to nursing schools to learn, such as helping a patient out of bed, operating some medical devices and others.

Litzman noted that this profession could be attractive to haredi women, most of whom do not have matriculation certificates.

In addition, the number of nursing education programs in colleges will be increased. More academics in other fields will be encouraged to retrain as nurses.

However, the ministry has not yet decided whether to recognize the professions of nurse practitioners and physicians’ assistants.

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