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What does Israel's acute water shortage have in common with the already manifest shortage of physicians? Both were eminently foreseeable. There were ample warnings about both. In both, predictions of looming problems were either ignored or dismissed as doom-mongering. In both, though preemptive action was highly feasible, superficial palliatives were allowed to mask the inevitable. In both cases, nothing was done because the Treasury persisted in its agora-wise and shekel-foolish predispositions.
The water shortage was forecast consistently from before the start of the decade, but the wet winter of 2002 was seized upon by the Finance Ministry as reason not to construct essential desalination plants that would have anticipated and addressed the parched conditions of the last five years. The shortage of physicians, particularly in some less financially lucrative surgical specializations, was a foregone conclusion given the draconian academic requirements and difficulties inherent in studying medicine in this country. Instead of investing in more medical schools - a pricey proposition which demands facilities and infrastructure - the Treasury allowed the influx of immigrant doctors from the former Soviet Union to mask the underlying symptoms.
Instead of overhauling Israel's inadequate medical education structure, the latest bright stopgap solution is to import anesthesiologists and general surgeons from the former Soviet republic of Georgia. Needless to say, they will constitute cheap labor. Though we are loath to generalize, it is widely acknowledged that medical training in the FSU often falls below Western standards. Israel will create a sub-class in surgical scrubs who'll work for less and risk reducing standards precisely where they matter most.
Moreover, as is the case in the building trades and elsewhere, foreign labor - whether legal or not - pushes out locals. Perhaps the subtext is wiping out any bargaining power from Israeli hospital interns and residents who work round-the-clock and are compensated by miserly civil service criteria. From now on, runs the implication, those who balk at putting in impossible hours at ludicrous pay will be replaced by third-world scabs. In medicine, this boils down to an unconscionable gamble with life and limb.
Admittedly, this is a worldwide problem. Increased life expectancy, along with the costs and rigors of quality medical training, all factor in. But the root ill in our particular setup is the fact that Israel has only four medical faculties, which between them produce only 400 new physicians annually, a number that fails to keep pace with the aging and retirement of practicing doctors. For years there has been talk about the need to double the four schools' annual crop of graduates, as well as to add another medical school.
Many Israelis are driven to study medicine overseas. They must subsequently pass additional qualifying exams here. Lately Hungary has replaced Italy as the most popular venue for Israeli medical students. In all, the Health Ministry licenses some 600 new doctors a year, not enough to meet our needs.
Simultaneously, 150 available medical school slots are taken up by Americans, few of whom remain here. Originally the intention was to attract these Americans to make aliya. That vision is largely unfulfilled. Americans constitute a considerable proportion of the overall numbers accepted to our medical schools. At $22,000 a year for foreign students, Israeli medical education is a bargain by US criteria. The irony is that Israelis pay roughly the same in Bologna or Budapest.
The shortage of anesthesiologists and surgeons is only one symptom of what ails our medical system. In all, it's over-regulated and over-planned. The number of students and practitioners, their pay scale and fee charts, and the medications and treatments at their disposal are all predetermined. Little can be changed without officialdom's approval. Minimal initiative is possible. Even the proposal that a fifth health fund be established has evaporated. This unavoidably serves the state hospitals' monopoly and the health funds' cartels.
Israel has the potential to become a first-class international medical Mecca. Instead we've endured a marked regression for decades, primarily because a penny saved isn't always a penny earned. The cures that the medical framework needs are expensive in the short-haul and demand imagination. Bureaucracy's knee-jerk inclination is to apply a band-aid to cover up systemic failure. The "Georgian solution" is only the latest case in point.