Israel Medical Association, Treasury cross swords

Doctors learn to ‘do only what they have to’ instead of ‘everything they can,’ warn IMA heads.

doctors operating room 311 (photo credit: HBL)
doctors operating room 311
(photo credit: HBL)
The Israel Medical Association announced Monday that it was launching a “mission to save public medicine” by demanding additional manpower and budgeted beds in hospitals, an increase in physician salaries in the periphery and incentive pay in specialties with too few doctors.
During a press conference at its Ramat Gan headquarters, IMA chairman Dr. Leonid Eidelman said the money that 80 percent of the population pays health funds for supplementary insurance should instead enable it to choose specialists and surgeons without paying more through private medical services.
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Eidelman argued that a doctor’s basic gross wage (without overtime and duty work) was only NIS 42 per hour and should be raised by 50%.
Retired doctors must also get more money, he said, claiming that some of them earn only a minimum wage. In return, many doctors would be willing to work full-time in the public medical system.
The Finance Ministry’s claim that the majority of hospital doctors leave their workplace at midday to see private patients (in a framework known as “SHARAP”) “has never been investigated, and even now the Health Ministry has never taken a position on the issue,” Eidelman continued.
The IMA will not hesitate to take all legal measures to get what it wants. "We are not talking about small changes but major ones to save public medicine," the IMA chief stated.
Doctors who move to outlying areas to work get a bonus of only NIS 500 to NIS 2,300 for making the move, said deputy IMA chairman Dr. Yisrael Eilig, compared to doctors in the center of the country, where they can work privately after hours. Incentive pay will solve the problem of specialties with too few doctors, added Dr. Yitzhak Ziv Ner, another IMA deputy.
In community clinics, doctors are allowed only a few minutes to see each patient, said Dr. Moshe Kastiner, although they should be given more time – 12 to 15 minutes – for older and sicker patients.
This alone would require 500 more physicians in the system, Kastiner said.
Prof. Avinoam Reches, chairman of the IMA’s ethics bureau, said it opposed the Treasury’s demand for physicians to punch a time clock.
“We teach medical students that doctoring is an altruistic profession without a time clock,” Reches said. “If they have to check in and out, a culture of ‘doing only what you have to’ will set in instead of doing everything you can.”
Doctors who take time away during regular work hours for which they receive pay should be punished, but a time clock system should not be forced on them,” Reches said.
The Finance Ministry commented that wage increases would be directed to physicians working in the periphery, those in specialties with manpower shortages, and young doctors and hospital residents, and not to senior physicians.
In a statement following the IMA press conference, a spokesman said the Treasury would pay for overtime for doctors in exchange for punching a time clock to encourage more work in the public sector. This, the statement said, would encourage public medicine rather than the private sector. Only physicians who devote their time to work in public institutions would get increases, and only if they agree to have their working hours monitored.
According to the statement, more than 80% of the doctors in the public sector have a second job they attend to during regular working hours, while physicians have already received a 24% wage increase as a result of arbitration whose last increment was put in place only a month ago.
“There is no reason to demand anything beyond this amount when the whole public sector has received a salary increase of [just] 6.24%,” the statement said.
To improve service, specialists will be required to work nights, holidays and weekends to ease the burden on medical residents in hospitals, the Treasury said. The doctors’ demands for SHARAP privileges in public hospitals was meant to increase their combined income by “billions of shekels” while making use of public facilities for services that are provided at no cost.
“This will hurt mostly the weaker socioeconomic groups,” the Treasury maintained.
“This is a government decision for the government to take, and not up for discussion with any union.”
According to the Treasury, medical residents in the public sector earn a gross monthly salary of NIS 18,654. A specialist earns NIS 23,705, and a senior physician NIS 34,428, while the average public physician’s salary is 26,322.
The average national wage is NIS 8,340.
The Health Ministry did not comment and said it had not been consulted by the Finance Ministry.
The IMA said it was “very disappointed” by Finance Ministry’s stand.
“The Treasury has proven that it doesn’t understand the seriousness of the situation in the public health system and lacks the will to act to save it,” the IMA said. “Instead of trying to mislead the public and tossing slogans, we expect it to take significant steps to save the health system from collapse.”
Also on Monday, MK Rachel Adatto (Kadima), a physician by training, presented a motion of no confidence in the government due to hospital crowding and the general crisis in the health system. The motion was filed on behalf of both Kadima and the opposition.
Adatto said that Prime Minister Binyamin Netanyahu, who is formally the health minister, has totally ignored his responsibilities and endangered the health of hospital patients who lie in beds in the corridors and are seriously ill but not treated in intensive care units.
The government intends to add only hundreds of budgeted hospital beds over the coming years, when experts have stated that over 3,000 beds are needed by 2015, she said. The prime minister declared that state profits from new natural gas discoveries would be used to boost education and defense, but not health, Adatto added.