Pilot project to test part-time hospital residencies

IMA, Health Ministry to assess trial program that would make it easier for women to train as doctors.

By JUDY SIEGEL-ITZKOVICH
AN ISRAELI doctor 370 (photo credit: Baz Ratner/Reuters)
AN ISRAELI doctor 370
(photo credit: Baz Ratner/Reuters)
As women constitute about half of medical students, younger doctors and medical residents, the Israel Medical Association’s Scientific Council and the Health Ministry have just launched a pilot program to enable physicians to complete their hospital residencies in part-time hospital work.
The program, which will be assessed over five and even 10 years to determine whether it becomes permanent, is meant to alleviate doctor shortages in growing numbers of specialties. It will also enable young women to both have families and specialize, and doctors of both sexes to conduct medical research in addition to learning a specialty.
Six years in a full-time job are required to complete a medical degree, followed by a year of hospital internship. It then takes four to seven years to become a specialist in most fields, but subspecialties like pediatric neurosurgery or obstetrical anesthesia take even longer.
The program, similar to initiatives in the US, Britain, Switzerland, Australia and other countries that began as long ago as the 1960s, required a lot of thought, as it has long been the Israeli medical establishment’s doctrine that one can become a good doctor and specialist only through intensive, round-the-clock involvement and constant exposure to patients under the tutelage of clinical teachers in hospitals.
But many women – and doctors of both sexes who want more leisure time and involvement with their families – have said they would not even study medicine or a specialty (beyond being a general practitioner) if they did not have more time to accomplish it. Five or 10 years ago, there was no shortage of physicians, but the growing retirement of thousands of immigrant physicians from the former Soviet Union and the dropping out of native Israeli doctors who seek more lucrative professions have taken their toll.
Writing in August’s issue of the IMA’s Harefuah journal, leaders of the Scientific Council presented the program for half-time study of medical specialties that suffer serious shortages of medical manpower.
Studies of half-time resident programs abroad have shown that not only are these doctors much more satisfied, but specialists who earn their titles more slowly are also better at their job than those who took the standard course.
One British study of doctors in the field of obstetrics/gynecology found that 84 percent of the residents were satisfied with the part-time curriculum, while 81% said that the quality of study was just as high as in the full-time course. The main problems were “a negative attitude” in the medical establishment toward the part-time program and its “discrimination” in favor of the full-timers.
Among the first Israeli medical societies that asked to be included were anesthesiology, neonatology, emergency medicine, family medicine, pathology and internal medicine – all of which suffer from severe shortages in specialists because of the difficulty of finding new residents. (This is because these fields offer little opportunity for moonlighting at private practice and are very time consuming, involving a lot of night work.) The IMA appointed a committee in 2009 to look into the matter and decided to pursue it, but insisted that if the part-time option was found to result in lower-quality residents, it would be discontinued.
Means for assessing quality and comparing the results in full-time and part-time programs are disputed – examination is one method, while judging whether graduates are good, ethical and patient-friendly doctors is another.
According to the IMA, regulations set to be prepared by the Health and Justice Ministries are ready, making it possible to move ahead on the historic step of accepting part-time residents in a number of specialties.
“Will the early enthusiasm for the part-time program last?” the authors wrote. “Will there be differences in their functioning as doctors? Time will tell.”
Since the Health Ministry had not announced that the part-time program had begun, The Jerusalem Post requested its comment on Wednesday. A spokeswoman said that “the ministry was the initiator for the program on the basis of a report on medical manpower, published by a committee headed by ministry economic adviser Dr. Tuvia Horev. Now the regulations that were written require only the signature of the health minister,” – that is, Prime Minister Binyamin Netanyahu.