Physicians, Israel Medical Association, clash on nurse practitioners

The profession of nurse practitioners has been highly praised in the US and other Western countries for decades.

A women speaks to a nurse (illustrative photo) (photo credit: INGIMAGE)
A women speaks to a nurse (illustrative photo)
(photo credit: INGIMAGE)
Prominent physicians have endorsed the use of nurse practitioners to treat patients in hospitals and in the community, a practice which the Israel Medical Association has voiced its opposition to the Health Ministry and even declared a work dispute over the issue.
The IMA recently sent a letter to ministry director- general Moshe Bar Siman Tov and to medical institutions that employ doctors, charging that allowing nurse practitioners – all with at least a master’s degree a decade of experience – to perform some clinical services that until now have been allowed only to doctors, undermines the doctors’ authority. Shaare Zedek Medical Center and Herzog Hospital in Jerusalem and Sheba Medical Center at Tel Hashomer are only three of the hospitals that employ nurse practitioners.
The profession of nurse practitioners has been highly praised in the US and other Western countries for decades, and about 170 have been allowed to work in Israeli hospitals, mostly in geriatrics and palliative medicine.
When the ministry sent the IMA a document stating that it wants to introduce nurse practitioners in public health funds facilities in the community, IMA chairman Prof. Leonid Eidelman strongly objected and filed for a work dispute with the Finance Ministry’s office in charge of labor relations.
Eidelman maintained that “transferring responsibilities and medical activities in the field of medicine to that of nursing will seriously harm the quality of health services.
“Each member of a team complements the other instead of replacing him,” he continued. “This is the proper model of care. Transferring authority [to nurse practitioners] undermines patient-doctor relations, will distance the doctor from the patient and compromise the status of the physician.”
But Rambam Medical Center director-general Prof. Rafael Beyar, a prominent interventional cardiologist, and Prof. Jonathan Halevy, director-general of Shaare Zedek, begged to differ with the IMA position. Halevy, asked to comment by The Jerusalem Post, said he is “definitely in favor of nurse practitioners. They reduce the burden on the physician and add a positive dimension in patient/carer relationships. They undergo serious and high-level training for this.”
PROF. NATHAN Cherny, director of Shaare Zedek’s cancer pain and palliative medicine service, wrote to Eidelman, saying that he strongly objected to “this petty, small-minded policy. Clinical nurse specialists have been an outstanding success in almost every place they have been developed. I personally work with two clinical nurse specialists in palliative care, and they are vital active members of my clinical service. We need skilled personnel at all levels, and highly skilled nurses are a blessing, not a burden.”
Cherny added that the IMA’s position “does not explain how its policy was developed. I think that it is shortsighted and makes the IMA look like a self-serving guild to look after the interests of its members rather than as a professional organization to promote Israeli healthcare. I have every intention of making my dissent public and inviting others to join in speaking out against the puerile policy.”
Dr. Shoshy Goldberg, head of the Health Ministry’s nursing division, told the Post that while the ministry was reluctant to approve nurse practitioners for years, it changed its mind a decade ago regarding some specialties and now wants them to move into healthcare in the community as well.
“The IMA really doesn’t oppose their working in hospitals, but they have come out against them being employed by the health funds. The hospitals where nurse practitioners work are very satisfied with them, and they work with full cooperation with the doctors. There is a growing health crisis with the elderly and the chronically ill, and without giving more responsibility to highly trained nurses, who will care for them? Who will help with ventilation equipment and with the supervision of chronic patients at home? The health funds are very interested in hiring them,” she said.
Goldberg said she wasn’t sure why the IMA was opposed to doctors getting help from nurse practitioners. “Maybe it is ego or the fear of losing authority. The work dispute is unjustified.”
Nurse practitioners earn more than regular registered nurses and less than physicians.