As the third largest in the government and a provider of many health services, the Health Ministry always "earns" a disproportionate amount of attention from the state comptroller, who devotes more than 200 pages to its shortcomings this year. Although Israel was blessed by a large supply of medical professionals in the 1990s due to the wave of immigration from the former Soviet Union, the ratio of doctors and nurses to the population has steadily declined in the last decade as many immigrant and native-born professionals reached retirement. Already, there are too few anesthesiologists, pediatric intensive care specialists, neonatologists and geriatricians. Shortages are expected in general surgery, pathology, internal medicine, pediatrics and radiology. In addition, there are too few specialists in the country's periphery. These take more than a dozen years to train, so shortages a decade from today are being created now. Because the Treasury often forbade state hospitals from increasing the number of paid employees, the medical centers' managements have tried to evade limits by setting up non-profit "research funds" affiliated to the hospitals. Instead of just financing research and fellowships, they began to hire doctors and nurses and finance salaries from the proceeds of procedures carried out after regular hours. The Health Ministry turned a blind eye to these arrangements, which wreak havoc on patients' waiting in queues for surgery, as well as confusion in hospital payrolls, the comptroller says. As some staffers are both salaried hospital employees and work for private mother-and-newborn baby hotels attached to the hospitals, some get paid twice for the same hours, the comptroller writes. The government decided in 2007 to establish a team for reforming state hospitals' non-profit and for-profit services, but nothing has been done since. Finally, disabled people who need subsidized equipment for their rehabilitation and mobility are forced to deal with multiple agencies to obtain them and get them repaired. The ministry is responsible not only for this supply but also for supervising these services, causing a conflict of interest, the comptroller says. Responsibility for provision of services should be transferred to the health funds, but talks with the Treasury on implementation have gone nowhere. In addition, efforts must be made to cope with inadequate budgets for all qualified disabled patients and advances in technologies, he concluded.