nahariya hospital 298.88.
(photo credit: Ariel Jerozolimski)
More general practitioners should go for specialization in family medicine, and more primary-care (non-specialist) and specialist doctors should serve in the periphery, according to a new Health Ministry survey to be released on Monday.
The 63-page objective report, called "Physicians in the Community: Sociodemographic and Professional Characteristics" was issued by the ministry's health economics division and written by the ministry's Annarosa Anat Shemesh and by Gabi Bin-Nun, the ministry's deputy director-general for health economics. It was researched with the full cooperation of the four public health funds and in cooperation with other ministry departments.
The report found that there were 9,176 physicians working in health fund community clinics and independent clinics around the country. These constitute less than a third of all the MDs with a license to practice in Israel, with the rest of them in hospitals.
Sixty-one percent of doctors in the community who treat the family are not specialists in family medicine but general practitioners (GPs) who have a regular MD degree; family medicine specialists go on to do an additional six years of study and clinical work to get their advanced accreditation. There are some financial incentives from the health funds for specialists in family medicine, said Bin-Nun, but not enough.
A quarter of community physicians who treat children are not pediatricians, while 20% of GPs who treat orthopedic problems are not orthopedic specialists.
Bin-Nun said there are many GPs who are excellent physicians, but that he and the ministry feel there should be more in the community who formally study the specialty. "The rate should be higher than 39%," said Bin-Nun, who at the end of this year is due to retire from 30 years in the ministry to move to an academic position. "The National Council for Community medicine has recommended this policy as well."
Bin-Nun noted that there will soon be a serious shortage in neurologists and otolaryngologists (ear-nose-and-throat specialists) working in the community, as many of them are older and will soon retire. "I hope there will be a joint effort by the ministry, the Israel Medical Association and the health funds to increase the number of needed specialists," he said. The report was printed and distributed among 1,000 decision makers and others with influence in the health system.
Women constitute 35% of all community physicians, 44% of the GPs and 25% of the specialists, the report found. Israeli-born physicians or graduates of Israeli medical schools constitute 42% and 46%, respectively, of specialists in the community, while those born in Eastern Europe or graduates of Eastern European medical schools comprise 47% of primary physicians. There is an unfair distribution of physicians in the country, the study found, with 10.7 doctors per 10,000 residents in the North and 12.3 in the South, compared to 16 in Haifa, 14.9 in Tel Aviv and 14.8 in Jerusalem. Of these, there are only 4.2 specialists per 10,000 in the North, compared to more than twice that number in the Tel Aviv area.
The authors concluded that planning of the medical workforce "must take account of the heterogeneity of the patient population and make allowances for a multitude of cultures, with all the differences of language, custom and tradition" among both the patients and the doctors.
Asked to comment, the Israel Medical Association (IMA) noted that the actual data on doctors in the community was collected by the Health Ministry in 2003 (and it took some time to process and analyze them), so the number of family physician specialists has probably increased since then.
The IMA added that the health funds "employ very good doctors who have accumulated a lot of experience in their field even though they are not specialists. Since Israel is a country that absorbs immigrants, this trend has deepened. The shortage of doctors in the periphery does not allow only specialists to be hired." The medical association said that it too was worried about the "lack of equity" in medical care between the center of the country and the periphery and about the soon-to-be shortage of physicians in a variety of specialties and areas. The number of medical students must be increased immediately, the IMA said.