Health Ministry warns of alarming decline in doctors, nurses

There has been a 5.9% decline in the number of physicians since 2000.

By JUDY SIEGEL-ITZKOVICH
doctors 224.88 (photo credit: )
doctors 224.88
(photo credit: )
Fewer Israeli mothers are boasting about "my son/daughter, the doctor," according to a Health Ministry report released for publication on Monday. The reduction of aliya from the former Soviet Union, increasing retirement, a failure to expand Israeli medical schools, and the rise in women doctors, who may prefer part-time jobs have decreased the number of working physicians and doctors in certain specialties, according to the report. There are now only 3.5 working physicians per 1,000 residents compared to 3.7 in 2000, said the report, written by a team led by Ziona Haklai of the ministry's information and statistics department. In the 1990s, when the rate of Israeli physicians per capita was one of the highest in the world, largely due to the immigration of thousands of physicians from the FSU. There are now 32,687 physicians here, 25,314 under the age of 65 and 40.3 percent of whom are women. The proportion of female physicians is up from 37% a decade ago, a trend that looks set to continue as just over half of current medical students are female. Overall, there has been a 5.9% decline in the number of physicians since 2000. Only 546 new medical licenses were issued in 2007 to Israeli medical school graduates, Israelis who graduated abroad (mostly in Hungary, Romania and Italy) or new immigrants. The number of residents per physician under the age of 65 has risen from 267 in 1997 to 286 last year. Thirty-nine percent of physicians under 65 were born in Israel, 44% in Eastern Europe and a 10th came from the Americas. Because of the decline in immigration from the FSU, 37% of physicians under the age of 65 graduated in Israel, compared to 33% a decade ago. While 142 physicians from the Americas were licensed in 1972, just 44 olim from there received their licenses last year. More physicians are going into medical specialties and fewer into general practice. Half of physicians under the age of 65 are specialized today, compared to only 38% a decade ago. More women are going into specialties than before, including more to certain specialties such as pediatrics, psychiatry, genetics, hematology and geriatrics, and fewer to gastroenterology, anesthesiology, obstetrics and surgery. Internal medicine and pediatrics have the most specialists - 2,335 and 1,839, respectively - but there are only four pediatric clinical immunologists, six anatomical pathologists and one specialist in clinical chemistry under the age of 65. Just 26 doctors received their licenses as anesthesiologists last year, causing the shortage in this field to grow. Dr. Yoram Blachar, chairman of the Israel Medical Association - which is currently involved in arbitration with the government over raising doctors' wages and providing incentives to work in shorthanded specialties and in the periphery - said the shortage of physicians "is even more serious" than that reflected by the ministry report. This is because only 21,400 physicians are actually working in medicine, with thousands of others in administrative and other jobs. Thus the number of doctors per 1,000 residents was "lower than three," Blachar said. This all pointed to "state bankruptcy in planning medical manpower," he continued. The IMA "has been warning about this negative trend for years, but the state reacted with apathy," he said. Blachar also worried that more Israeli physicians would emigrate to the US and other Western countries, where a shortage of 80,000 to 200,000 physicians is expected in the coming years and private hospitals offer much better conditions. "It takes 12 years to produce a medical specialist - seven for an MD degree and five years for the average specialty," Blachar said. "There is no alternative but to initiate an emergency program to train more doctors and improve their salaries and status," added the IMA chief, whose organization almost 10 years ago agreed to eschew strikes for a decade. Dr. Chezy Levy, the ministry's deputy director-general in charge of medical administration, told The Jerusalem Post that the findings were sad, but that "an explosion of decisions" would soon be released as a result of deliberations by the Health, Finance and Education ministries, the health funds and the arbitration mechanism dealing with the IMA. There are 54,899 practical nurses, 41,571 of them under 65, of whom three-quarters are registered nurses - a 3% decline over seven years. There are only 5.7 nurses per 1,000 residents compared to six a decade ago. More than 560 practical nurses graduated to become registered nurses in 2007. Higher life expectancies and the ageing of the population mean there will be a growing shortage of doctors and nurses. The proportion of dentists under 65 has remained steady, but the rate of younger dentists is declining, with only 40% under 45 compared to 51% in 2000. In addition, the rate of dental technicians (who produce crowns and other devices) under the age of 65 dropped from 0.52 per 1,000 in 2000 to 0.48. A total of 170 new dental licenses were granted last year, 63 of them to women. Sixty-five were trained in Israel, 57 in Eastern Europe, 27 in Asia/Africa, 11 in the Americas and 10 in Western Europe. However, the number of pharmacists and psychologists is on the rise, and the number of medical lab workers and clinical geneticists is holding steady. Three-quarters of psychologists are women and 56% are specialists. The rates of most paraprofessionals including physiotherapists, dietitians, optometrists, occupational therapists, X-ray technicians and clinical communications specialists are on the rise.