A looming “catastrophe” of too few physicians, clinical slots to teach medical students in hospitals and budgeted hospital beds was predicted on Tuesday by medical administrators, causing opposition MKs attending a conference in the Knesset building to pledge their support.
The nearly unmentioned opponent was the Treasury, represented by only one person – the new liaison of its budgets division for health matters, Yair Zilberstein, who only listened and remained silent.
The conference, attended by dozens of people from the health system, was initiated by Kadima MK Rachel Adatto, a physician, medical administrator and lawyer by profession, who has taken up health as her main legislative interest. The two-hour meeting was an “emergency session,” she said, “as the Treasury will soon present its plans for health expenditures for 2011-2012.
“Only those who are blind or want to be blind can say there is no shortage of hospital beds or doctors,” said Israel Medical Association chairman Dr. Leonid Eidelman.
The Treasury has indeed made these claims. Yet one investigatory committee after another has declared there is a growing shortage of doctors, not only in the periphery but also in the center in the country, and in most specialties, Eidelman said.
Dr. Yitzhak Berlovich, formerly a senior Health Ministry official who is now director-general of Wolfson Medical Center in Holon, said the most serious decline is among physicians up to the age of 45 who have decades of work ahead of them. It is not for the lack of would-be medical students, he added, but because the Treasury decides almost everything affecting the health system, including how many students may be accepted to medical school.
With the ageing of the population, the increasing share of chronic diseases among the elderly that requires more patient care and the growing number of doctors who drop out of the profession or emigrate, Israel’s health system is in big trouble, said Berlovich.
The number of new medical licenses has dropped below that of young medical graduates who begin to learn a specialty. That means, Berlovich said, that hospital department heads can no longer choose the best among applicants but are lucky to have those who arrive. Many public sector doctors move to better-paying jobs in private hospitals and clinics.
There are only 1.9 hospital beds per 1,000 residents, bed occupancy is 95% and the average hospital stay is just four days, not because medical centers here are super-efficient, said the Wolfson director, but because patients are often discharged too early.
When he meets foreign medical administrators, they “pity us” and “can’t believe our statistics,” he said.
The number of magnetic resonance instruments (MRIs) in the country is so much lower than in Western Europe that Adatto and fellow physician and MK Arieh Eldad are preparing a private member’s bill to allow hospitals to purchase them (with their own funds) without having to beg the Health Ministry for a license.
These devices speed diagnoses without exposing patients to the radiation of computerized tomography (CT) scanners, which are best avoided in children.
Eldad, a maxillofacial surgeon by profession, said Treasury officials were “suffering from denial.” He suggested that advocates of increasing health budgets for training doctors, encouraging more to go into specialties with critical manpower shortages and getting emigrant doctors to return need to plan their course of action.
He added that it was unusual that only opposition MKs came to attend the meeting, while those from the coalition stayed away. Coalition legislators have to be persuaded that there is a crisis, Eldad said.
Kadima chairman Tzipi Livni popped in between commitments to say she put her full backing behind Adatto’s demands and that her party would support any moves she recommended.
Because the government fails to make urgent decisions, Eldad suggested
that laws should be passed – such as setting hospital manpower
requirements or cancelling the need for MRI purchase permits – to force
it to do so, even though such decisions do not ordinarily require
legislation. Even just threatening to do so could scare the government,
the MK said.
Tel Aviv University Sackler Medical Faculty dean Prof. Yossi Mekori
took a different tack, saying that if significantly more students were
accepted to medical schools, there would be no veteran doctors to teach
them at the bedside during their three years of clinical study.
When only a few students are taught by each senior doctor at the
bedside, their knowledge increases, while too many reduce the quality
of their abilities and knowledge, Mekori said.
Meanwhile, five Israeli non-governmental organizations published a
position paper detailing “the serious gaps in the health of various
communities” between Arabs and Jews; Ethiopian immigrants and the
general population; and between income-support recipients and others.
The organizations found that the Arab and Ethiopian communities as well
as welfare recipients suffer from various diseases at a much higher
rate than the rest of the population. The organizations called on Prime
Minister Binyamin Netanyahu to initiate a multidimensional national
program to reduce health gaps and proposed steps to carry out the plan.
“Israel must join developed states in working to reduce health disparities,” Adva Center director Barbara Swirski said.
“Despite efforts by the Health Ministry and health funds to this end,
Israel’s health policy does not include concrete steps to reduce the
gaps. Israel must channel the information provided toward the
formulation of a national health plan to reduce health gaps.” A full report on the Knesset conference will appear on the Health Page on Sunday, June 27.