The long-sought agreement signed on Thursday between the Israel Medical
Association and the doctors’ employers will not resolve all the serious problems
of the public health system. But it will make a significant contribution over
the next eight years to increasing the number of physicians, encouraging them to
live and work in the periphery and specialize in “unattractive” medical fields,
and minimizing their regret that they did not become a computer whiz, lawyer or
So believe leading physician and outgoing Hadassah
Medical Organization director-general Prof. Shlomo Mor-Yosef, and senior Ben-
Gurion University health economist Prof. Dov Chernichovsky, who were interviewed
by The Jerusalem Post.
Mor-Yosef, a gynecologist by profession who will
conclude 10 years as Hadassah’s chief administrator later this year, has been
closely involved in the negotiations as representative of an employer of the
largest group of physicians in the capital.
“The agreement has an
ideology; it is not an across-the-board wage increase,” said Mor- Yosef. It
deals with the years of fewer doctors and a lower level of medicine in the
periphery, the public hospitals’ shortage of medical manpower, the lack of
equity and the many night and weekend shifts whose burden is carried largely by
young medical residents, he continued.
“The accord focuses more on a
doctor in intensive care in Safed’s Ziv Medical Center than an ophthalmologist
in Tel Aviv,” he continued.
Unlike the agreement that ended the previous
IMA sanctions in 2000, “in which wage rises were uniform, it will not be the
same benefits for all this time. And that is good. The Treasury agreed to
allocate more public money because it was the way to promote improved medicine
in the periphery and in those specialties that few doctors want to study because
they offer lower incomes.”
One section in the agreement involves what the
Treasury has long aspired to – that physicians will punch a time clock or use
some mechanism such as a cellphone application so that employers will know where
hospital doctors are when they are supposed to be on duty.
noted that neither the two Hadassah University Medical Centers, Shaare Zedek
Medical Center nor Bikur Holim Hospital – all Jerusalem institutions owned by
voluntary organizations, will use time clocks for doctors. They have had
Sharap (private medical services) as options for those patients who can afford
or have insurance to cover it. So managements know that their more senior
doctors are in the hospital beyond mid-afternoon because they perform private
consultations and perform surgery late in the day and into the evening because
of the arrangement.
According to the new accord, per-hour basic wages
will be paid according to a five-day, rather than six-day week, and those who
work more will get overtime. Medical specialists will not have to work
late-night and weekend shifts six times a month like the residents, but they
will do a number of shifts, usually until 11 p.m., each month so that they can
respond on site rather than be consulted only by phone or called in if
The Hadassah director-general gave much credit to Prof.
Yitzhak Peterburg, a former director-general of Clalit Health Services (still
the largest public health fund), who is now a deputy CEO of Teva Pharmaceuticals
and previously was head of Cellcom. Peterburg’s name as a non-binding mediator
was raised by a senior Health Ministry official, and he agreed some 10 days ago,
even though he was about to fly abroad to conclude a deal for Teva.
worked almost round the clock, even 50 hours at one go – to bring the two sides
“Yitzhak has a great deal of know-how and experience as a
doctor and management abilities as an administrator,” Mor-Yosef said. “He
learned the issues very fast. He understood what was important and what was not.
Without his work, the agreement would not have been reached.”
intensive involvement by National Labor Court President Nili Arad failed to
forge an agreement. Mor-Yosef said that no major changes were made in the draft
agreement reached a month ago when IMA chairman Dr. Leonid Eidelman
halted his 12-day hunger strike in Jerusalem. That seeming “breakthrough”
collapsed under pressure from medical residents who claimed it was unfair to
“The new agreement clearly benefits medical residents, doctors in
the periphery and in short-handed specialties. The result is very impressive. It
was because of ideology that some doctors oppose it, because social justice was
boosted. Those in the center of the country will not get as much an increase as
they wanted,” said Mor-Yosef.
The 1,000 doctor slots that will be added
to the system under the agreement will not come immediately. It will take a few
years, concluded Mor-Yosef, as they have to finish medical school, get their
medical licenses and learn their specialties. In the meantime, idealistic
physicians could return to public hospitals and others could return from abroad,
he said. “But I hope that the atmosphere in clinics and hospitals will be
improved due to the agreement.”
Chernichovsky, who along with his
position at BGU is also a senior economist at the Taub Center for Social Policy
Studies, told the Post that “on the face of it, there is a significant wage
increase. It won’t be the same for all doctors, and some of it could be reduced
by inflation. I am for differential pay as incentives for where improvements are
needed. But I don’t believe that the Finance Ministry brought about real
structural change in the system – and that was due to a weak point at the
The large amount of copayments by ordinary people for
medications and various services will remain high, and the public share of
healthcare expenditures will remain too low, Chernichovsky said.
health economist declared that if he had been able to orchestrate the agreement
by himself, he would have the Treasury adding another billion shekels, with
money from the four health funds’ supplementary health insurance going to
increase the number of full-time physicians in the hospitals and much less money
leaking out into private medical institutions.
“If this extra money were
injected, we would get different health care; it would literally save the public
health system,” he said.
“If I headed a major network of private
hospitals, I would not lose sleep over the new agreement, as people with means
will continue to spend their money on private care. I am worried in the context
of Israel in general that now that the agreement has been concluded, the
government will say: ‘We have solved the health system’s problems.’ But there is
more to do. Doctors will continue to leave the public system for the private
one, as the demand for them is still there. I don’t yet see the doctors who will
fill the 1,000 job slots that are urgently needed in the hospitals. These
fundamentals are not being resolved.”
Chernichovsky noted that if the
Treasury is not ready for new wage demands from the nurses and other medical
professionals in the system, the doctors’ agreement will not end the trouble.
Nurses are also needed in the periphery, he said.
But he did not want to
end on a sour note. “I see some good tidings in this agreement. We
see cracks in the doctors’ wage structure in the public health system, which is
new. This could lead to more individualized contracts – not private contracts
but for the first time wages dependent on where you are and what you do. This is
a blessing, even though it could weaken the solidarity in the IMA, as there
would be tension among groups. But nevertheless, this is the right
Asked about the large number of community doctors who work in
the various health funds and as independent physicians for them, Chernichovsky
said: “They are getting a wage that is good compared to that in the hospital.
They don’t have to do shifts. They can finish their job every day and do work at
a second or third job,” he said.
As for Prime Minister and formally
health minister Binyamin Netanyahu and Deputy Health Minister Ya’acov Litzman,
Chernichovsky said: “Despite their formal titles, they were not in the game in
an explicit way. They were not a partner in the negotiations. The Health
Ministry has almost no say on the economic side of the system. The minimal
involvement of the ministry in the whole process is a symptom of the office’s
relative weakness in the system.”