Medical system braces for mass resignation by residents

Petition filed with National Labor Court to prevent implementation of plan that threatens to place nation’s healthcare in jeopardy.

By JUDY SIEGEL-ITZKOVICH
doctors protest 311 (photo credit: Marc Israel Sellem)
doctors protest 311
(photo credit: Marc Israel Sellem)
The Health Ministry is preparing as best as it can for the worst if 702 medical residents and 32 specialists indeed carry out their threats and do not appear at their hospital jobs during the coming days, starting on Tuesday.
But officials intimated that the letters of resignation submitted over dissatisfaction with the labor contract reached last month could be retracted in time, having served primarily as a pressure tactic to improve conditions for young doctors without really abandoning ship.
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The residents and senior doctors reiterated their call on Prime Minister Binyamin Netanyahu, who is also formally the health minister, to find a solution to the dispute they say could cause the collapse of the medical system.
The hospitals where they work are Sourasky Medical Center in Tel Aviv (142 resignation letters), Rambam Medical Center in Haifa (102), Sheba Medical Center at Tel Hashomer (100), Meir Medical Center in Kfar Saba (100), Rabin Medical Center in Petah Tikva (71), Bnai Zion Hospital in Haifa (41), Assaf Harofeh Medical Center in Tzrifin (33), Wolfson Medical Center in Holon (31), Schneider Children’s Medical Center in Petah Tikva (30), Hadassah University Medical Centers in Jerusalem (24), Kaplan Medical Center in Rehovot (11), Emek Medical Center in Afula (7), Carmel Government Hospital in Haifa (4), Soroka University Medical Center in Beersheba (1) and Shalvata Mental Health Center in Be’er Ya’acov (5).
Most of the residents work for government hospitals in the center of the country and will benefit less from the nine-year contract negotiated in August by the Israel Medical Association – and not in the periphery, where there is much less access to the best health care.
Only a minority of the doctors come from Clalit Health Services or voluntary institutions. Sourasky Medical Center, which is always voted by residents’ “the country’s most desirable medical center” for doing one’s study of a medical specialty, would be hardest hit if the residents don’t show up.
The Tel Aviv District Attorney’s Office and the Labor Disputes Department filed an urgent request to the National Labor Court on Sunday night asking the court to issue injunctions preventing residents’ resignations.
In the request, filed by state attorneys Orit Podmasky and Doron Yefet, the state asks the court to order the Israel Medical Association and all those doctors who submitted resignation letters on September 4 to refrain from any labor disruptions and to remain in their posts.
The District Attorney’s Office has also asked the court to prevent Mirsham, the voluntary organization representing the residents, from encouraging “illegal activities” of doctors in violation of the National Labor Court’s ruling on September 4.
Mirsham, the state’s request claims, is “conducting illegal activities and doing everything possible to drive a wedge between residents and [the IMA] and between the state.”
The request also asks the court to rule that the doctors’ resignations are collective in nature and therefore illegal and void.
In its precedent-setting ruling in September, the National Labor Court issued an injunction ordering 1,000 residents who signed letters of resignation to report to work as normal.
Residents had been ordered to return to their normal work in government hospitals and health clinics without any further interference or disruption.
“Failure to report to work as stated will constitute an unauthorized abandonment of their jobs by the workers, and will be subject to the appropriate consequences,” the court ruled.
In that ruling, Court President Nili Arad and Judges Yigal Plitman and Amiram Rabinovich decided that the collective resignation letters signed by the residents were illegal and therefore null and void.
Following the ruling, doctors decided to submit individual letters of resignation.
However, in its request to the court, the state argues that those individual letters are also illegal because they remain part of a collective action.
“These measures are illegitimate collection labor relations that undermine the collective labor law, and are a use of illegal and unacceptable force,” the state claims.
Following the state’s request, the National Labor Court ruled on Sunday that the IMA and Mirsham will submit their response by noon on Monday.
If the parties fail to reach agreement, the court will hold a hearing on Monday evening.
The IMA said Sunday that the state petition to prevent the resignation of doctors throughout the country was an aggressive attempt to prevent doctors from making their own professional decisions, Army Radio reported.
A veteran hospital source told The Jerusalem Post on Sunday that senior hospital administrators who came out in favor of the resignations had hoped the labor agreement would lead to the institution of Sharap (private medical services) in public hospitals but were disappointed.
Residents were tight-lipped about what will really happen starting Tuesday.
Some suggested that doctors who received highly subsidized medical educations should be required by law to pay the government back if they leave the country to practice medicine abroad after only a short service in Israel, as leaving was taking advantage of the country’s generosity; in other countries, private medical schools charge large sums for such an education.
Ministry Director-General Prof. Ronni Gamzu said “the majority of resignations were made in groups; entire departments will go home together; in some departments almost 50 percent have quit,” implying that it was an organized campaign rather a matter of individual consciences and plans.
Gamzu added that if all – or most – of the 734 doctors made good on their threats, it would be very difficult to continue the hospital departments’ functioning, as round-the-clock care of patients depends largely on the young residents.
The resignation letters, 80% of them due to come in to effect between Tuesday and Saturday, followed an injunction by the National Labor Court that ruled a mass resignation by 1,000 doctors was illegal.
Gamzu said if hundreds of medical residents and dozens of specialists actually resign, the most affected departments will be internal medicine (129 resignations), pediatrics (70), orthopedics (67), obstetrics/gynecology (57) and general surgery (41).
In the eventuality that the signers of the letters are not bluffing to increase pressure on the government and the IMA to change the labor agreement, outpatient clinics will minimize their services; the number of nurses and midwives in obstetrics departments will be increased; and non-emergency operations will be reduced to a minimum.
Vacations by department heads and other senior doctors will be canceled.
Departments that have a serious shortage of manpower will be assisted by duty doctors in the community, and veteran doctors – even pensioners – will do work that residents usually do. But these arrangements cannot go on for more than a few weeks.
The ministry will issue a press bulletin daily if the doctors do not show up at work. The ministry will set up a situation room to inform patients and relatives of the latest developments, and a ministry team will visit affected hospitals and try to alleviate problems that arise.
MK Uri Ariel said resignations endanger the lives and health of Israelis and they must not be carried out.
“Both sides must climb down from the tree and talk together within a limited period. Apparently there is no one to blame for this difficult situation, but instead of solving the problem, the two sides are digging in and risking lives of patients. I beg Deputy Health Minister Ya’acov Litzman to find a solution that will prevent the resignations – before the first victim pays for it with his life,” Ariel said.