A historical fairytale

Recent agreement with doctors historic - instead of rescuing distressed public medical system, it'll result in mass of doctors leaving public medicine.

By CHARLES MILGROM
Doctors demo311 (photo credit: Marc Israel Sellem)
Doctors demo311
(photo credit: Marc Israel Sellem)
The government is correct. Its recent agreement with the doctors is historic. It is historic in that instead of rescuing the distressed public medical system, it will result in a mass of doctors leaving public medicine and in many cases even leaving the country to work abroad. This becomes clear if one reads the actual agreement and not articles based on media advisers.
I am a veteran of the Israeli medical system since 1982, when I immigrated with my family after qualifying as an orthopedic specialist in the United States. Next year I retire with the rank of full academic professor from Hadassah University Medical Center in Jerusalem after 30 years of work, and I am looking forward to a pension of NIS 7,702 a month.
I am a veteran of four doctors’ strikes in my medical career. The first was America’s first doctors’ strike, which took place in New York in 1975. In that strike, we had the support of the Hospital Workers Union, but our demand to lower our 100- hour work week did not succeed. That only came about after the tragic death of 18-year-old Libby Zion at the hands of two sleep-deprived doctors at the end of a 36-hour work shift.
The 14-week Israeli doctors’ strike in 1983, including a hunger strike, did achieve an increase in our salaries, but by the 2000 doctors’ strike, these increases had been wiped out by inflation. Because the doctors could not reach an agreement with the government in 2000, we entered into binding arbitration.
Eight years later, in 2008, the mediator finally published his findings. The government’s response was that it did not have the money to pay for the agreement. To this day the government has not fulfilled the “binding” arbitration agreement.
Bearing in mind this past experience, I sat down to read the actual “historic agreement” proclaimed by the government a few days ago. However, what this agreement really says raises a number of questions:
1. Where is the big pay increase? Over the nine years of the contract, doctors’ salaries will increase gradually by 32 percent. When this figure is corrected for the expected yearly rises in the consumer index, the real increase in salary over nine years is in the range of 0.5% to 3% – if inflation stays low. If inflation is high, we are in trouble. The contract says that if for any given year the consumer price index is above 5%, only then will we be compensated, but only for the amount above 5%. This means that if the consumer index increases by 5.5% for a given year, we get a 0.5% increase.
2. What happened to the salary increases we are still due from the 2000 strike agreement? That increase has now been deferred again and will appear in doctors’ salaries in installments beginning between 2012 and 2016. This means that doctors like myself, who are retiring soon or have retired, will never see this money they are owed for the last 11 years of work.
3. Where are the 1,000 new work slots for residents? These slots will be divided between residents and senior doctors. In addition, the contract clearly states that the slots are only for public hospitals. They therefore do not include hospitals like Hadassah and Shaare Zedek in Jerusalem. The positions will be added over the next four years. The 1,000 positions are not all new and include those previously announced by the government in February of this year. No new slots will be added in the Center of the country for the next 18 months.
4. Where is the announced reduction in on-call nights to six per month for residents? The contract states only that the “goal” is to lower the number of night calls to six per month. This same goal, however, was stated in previous agreements and was never fulfilled.
5. What is this new residency that never ends? Until now senior doctors did not have to do residents’ night call once they finished residency. The contract now states that senior doctors, if requested by the hospital, are required to do residents’ night call twice a month for the first five years after they have finished their residency. Also, if requested, they must to do two resident half-shifts a month until 11 p.m.,up to the age of 47. Unlike a resident, when the senior finishes a 24-hour resident shift, he does not get a day of rest. This means the day after the night shift, the senior doctor will do his usual operations or procedures without having slept the night before. I would not like to be that doctor’s patient.
6. What happens to the right to strike if the government does not keep its commitments, as has been the case in the past? There is no right to strike or carry out work action until 2020.
7. Where is the NIS 300,000 incentive for doctors to go work in the periphery? In spite of the media claims, the contract does not contain any such clause.
8. What about the work clock? This was one of the government’s demands so it could be sure doctors were really working 40 hours in the hospital. It achieved its goal in this contract. For the first time, doctors will punch a clock. What the government does not understand is that for doctors, work does not end when we leave the hospital. At home, we think about our problem cases. We plan operations. We read to find the solutions to our patients’ clinical problems and to maintain our general knowledge. The government’s demand shows it does not understand the difference between the work of a clerk and the work of a doctor.
9. What are the good points of the contract? A resident who works in the periphery will get a 52.5% raise in pay instead of a 32% raise, and will receive that raise in the first three years of the contract (though since the base pay is so low, a 20% differential is probably not enough of an incentive to get someone to work in the periphery). Residents who work in fields that lack residents, such as anesthesia, will also get a pay differential. However, these contractual benefits only affect a small percentage of doctors. Another small improvement is that community doctors will get an extra two minutes to see each patient. This is not a lot of additional time, but it is something.
I am sad to see a great social tradition coming to an end. A government that says it believes in the free market should know that there is a worldwide shortage of doctors. The residents, who have given in resignation letters, can immediately find much better paying jobs in the US, Canada, Australia, Norway, etc.
The government won the labor negotiations with the doctors this time. But its “historic” agreement has struck a death blow to Israeli public medicine. Why the Israel Medical Association signed this agreement is hard to understand. If it had required the approval of the member doctors, they would have never agreed.
The writer is a professor at Hadassah University Medical Center.