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Israel is usually a whiz at managing emergencies, but it's often a bungler when long-term planning and reforms are needed. This is so regarding the looming shortage of doctors (not to mention nurses) which will affect everyone and is already hitting us in the face.
Only about 300 students graduate yearly from the four university-affiliated medical schools; it takes seven years to "manufacture" brand-new general practitioners and more to train them for specialties.
As our health reporter Judy Siegel-Itzkovich wrote in "The doctor is OUT" on August 19, the number of working physicians per 1,000 Israelis is in steady decline from the apex 15 years ago - a high that was created by the influx of thousands of ready-made physicians, mostly from the FSU. Many of these doctors, who arrived in mid-life, are due to retire soon.
Some of the most creative and dedicated young people are going into hi-tech professions, in which lives are not at stake and employees needn't leave their beds at 3 a.m. to rush to their jobs. In addition, a growing number of Israeli-trained physicians are seeking better-paying jobs, switching to hi-tech in mid-career or emigrating for more generous research funding and more comfortable facilities.
Many rejected but fine applicants go to lower-quality Eastern European medical schools and return to work with less knowledge and skill than that imparted here. In addition, half of medical students are women, making doctoring an increasingly female profession; they are no less qualified or talented, but many have families and choose to work part-time, do fewer night and weekend shifts and avoid going into highly demanding specialties.
What to do? The Council for Higher Education decided last month to establish a fifth medical school (in addition to the ones in Jerusalem, Tel Aviv, Haifa and Beersheba), and to locate it in the Galilee to promote the development of that neglected region and to boost its medical services. It's a nice idea in theory, but a mistaken one in practice, at least for now.
The leading candidate to establish the new school is Bar-Ilan University in Ramat Gan. But it is unlikely that BIU would be able, or willing, to quickly build a medical faculty and dormitories in the Galilee, find professors qualified to teach medicine at a high level and locate clinical departments in the periphery that can adequately cope with students from their fourth through seventh years.
The Council's powerful planning and budgeting committee, which restricts the number of medical school admissions because it must subsidize the cost of each student by tens of thousands of shekels, should have instead allocated generous sums to the four schools so they can accept more applicants. Also, many Israelis studying medicine abroad could then be accommodated.
There is a measure that can be taken almost immediately to raise the number of new medical students by 50 percent: cancelling the MD degree programs that currently train 150 Americans yearly at Tel Aviv University, Ben-Gurion University and the Technion-Israel Institute of Technology. While foreign graduates are good "ambassadors" for Israel after their four years here, the faculty, infrastructure and clinical departments in hospitals could be better used to produce Israeli physicians. These universities should, however, be compensated financially for the loss of income from the higher tuition earned for teaching the Americans.
Furthermore, better organization, such as changing schedules so medical students don't all sit simultaneously in classrooms for preclinical work and in hospital departments for clinical studies between October and June, will make teaching more efficient, but it will also require state funds for additional teaching slots.
The Health Ministry - weaker and more demoralized today than it has ever been and kept on its knees by powerful Treasury budget personnel - has given in to Finance Ministry demands to freeze the number of hospital beds until 2010, further limiting places for clinical study. The Health Ministry must insist that averting the doctor shortage is a priority, with the government instructing all relevant state organizations to pitch in.
Restoring the high status of MDs and upgrading their working conditions will contribute to a reality in which every Israeli mother again dreams of having at least one of her children become a doctor. If we are to avoid a worsening doctor shortage, we must increase the motivation of young people to enter the medical profession and the capacity of our universities to absorb them at the same time.