US anesthesiologists propose answer to serious shortage of Israeli specialists

The use of anesthesiology assistants (AA) – non-physicians who learn the field and work under the close supervision of specialists – could significantly alleviate the chronic and severe shortage of Israeli specialists in the field.Prof. Michael C. Lewis of the University of Florida College of Medicine and Prof. Gilbert J. Grant of the anesthesiology department at New York University’s School of Medicine, advocate for the new system in the recently published issue of the open-access Israel Journal of Health Policy Research.The shortage of anesthesiologists in Israel at present causes delays in elective operations, according to two senior US anesthesiologists familiar with the situation here.There are not enough specialists to administer anesthesia in Israel because of the minimal opportunity for providing private medical services – known as SHARAP – in the public hospitals, the heavy hospital work loads, the relatively low prestige of anesthesiologists compared to surgeons, and the lower salaries compared to other medical fields.“The shortage of anesthesiologists in Israel today is a critical issue that needs immediate attention. While marketing campaigns to raise public awareness of the profession of anesthesiology can be helpful, we suggest that more comprehensive changes be contemplated to remedy this problem,” they wrote.The authors declare that “alternative models should be seriously considered.” The system of nurse anesthetists who administer anesthesia for simple procedures is recognized and widespread in the US but unapproved in Israel. Nurses could be trained to do this, but the serious shortage of them throughout medical institutions here makes such a development unlikely.Non-physician anesthesiologist “extenders” (assistants), who carry out half of all anesthesia procedures in the US, could be a successful way of increasing the number of professionals available to administer anesthesia, the two authors write. “This pattern of practice would allow physician anesthesiologists to supervise a number of extenders, allow more surgeries to be completed and improve the quality of life for anesthesiologists.”The “low quality of life” among Israeli anesthesiologists “has been one of the main mental hurdles preventing Israeli students considering the profession,” they stressed. “At the same time, a government initiative to increase the financial compensation of anesthesiologists needs to be undertaken to attract and retain physicians to this indispensable specialty.”In 2006, a study found that only 12 percent of Israeli anesthesiologists were graduates of the country’s medical schools, while 65% were graduates of medical schools in the former Soviet Union. As these immigrants from the 1990s are in the process of retiring, and the level of FSU immigration is now relatively low, the FSU cannot be expected to be the source of a large number of anesthesiologists in the future.There are as many nurse anesthetists in the US as there are anesthesiologist MDs, and relatively fewer anesthesiologist assistants, “although their numbers are growing.”Introducing the profession in Israel “would require establishing an infrastructure for anesthesiology assistant training,” they suggested.In the US, Lewis and Grant wrote, the first AA program was started in 1969. Today there are 16 AA training programs. College graduates (with a bachelor’s degree) are eligible to apply to these programs, which require 24 to 28 months to complete. An Israeli system to train AAs could potentially attract individuals with prior training and aptitude for healthcare work. This group, for example, could include medics trained by the IDF, the US researchers suggested.Lewis completed part of his residency training in Israel while Grant worked as a volunteer anesthesiologist several times in the 1990s.The authors both took sabbaticals in Israel and organized the American-Israel Anesthesia Alliance, to support interactions with their Israeli counterparts.