A three-member arbitration team ruled Wednesday that the country's 15,000 public-sector physicians are to get a 23.5-percent wage increase, while those in neonatology, anesthesiology and intensive care will get an even larger wage hike of 31.8%. The arbitrators stated in their long-awaited report that doctors' current salaries "do not give proper expression to their responsibility, education and expectations and the demands of their work on their lives. We see this settlement as a rare opportunity to correct this while carefully taking into considerations the budget limitations." The total cost of the agreement is estimated at NIS 950 million a year. The increase will be phased in over the coming months. The Israel Medical Association (IMA) welcomed the ruling, saying it would prevent a crisis in the medical profession, but added that there was still a need to address proposals for overhauling the public medicine system. The agreement to go to arbitration was reached in July 2000 after a 127-day doctors' strike; in return, the IMA agreed not to strike for 10 years. But foot-dragging by the Treasury delayed the start of arbitration hearings to January 2007. The IMA had demanded a 32.8% increase, while the employers had been ready to offer the same wage hike given the Histadrut last year - just 5%. The arbitration panel was headed by David Bloomberg and included former minister Roni Milo and accountant Uri Neiger. The terms reached by the arbitrators and presented in a 103-page report must be carried out by the employers, including the Health Ministry (which owns the government hospitals) and Clalit Health Services and Kupat Holim Leumit. The Maccabi and Meuhedet health funds have their own agreements. It also will be implemented by the Hadassah Medical Organization and owners of a variety of other voluntary hospitals, such as Shaare Zedek Medical Center and Bikur Holim Hospital. IMA chairman Dr. Yoram Blachar said the ruling "represents the successful beginning of the rescue of Israel's public medicine. If the arbitration had failed, there would have been a significant risk of a crisis among medical professionals. "One of the messages we gave the arbitrators was the danger of an expected doctor shortage in the years to come," Blachar said. The accord was an "achievement" because it was reached without a single day of strikes by doctors and without harming patients, the IMA chief said. But while arbitration "proved itself," Blachar feared the state will not agree to use arbitration when the IMA's contract expires in July 2010, when the association will want an updating of the contract and to discuss private medical services in public institutions, manpower slots and other proposed reforms to rehabilitate public medicine. Blachar said there had been repeated efforts by the Finance Ministry to stymie the arbitration process. "Everything has a limit, and their efforts were not successful. The state and the employers tried to create the false impression that there was discrimination by the arbitrators among the various groups of doctors; in fact, this did not exist." IMA union official Prof. Elisha Bartov said he felt the only active fighters for the health system were the doctors. Dr. Leonid Eidelman added that manpower formulas had not been amended for 30 years. IMA director-general Leah Wapner accused unnamed Treasury officials of "acting as if they had to stop an enemy. They should have been the first to ensure that there are good doctors. Instead of investing in other things, they should have said: 'We now want to invest in the country's physicians.'" Bloomberg said that he and his colleagues on the panel were sorry that the process did not create a new "dynamic" to bring the doctors and the employers closer together. Instead, the sides used the process as an excuse to reject congenial relations and induced the sides to take more extreme views. Thus the arbitrators were unable to dictate necessary structural reforms to the two sides and ensure that they were implemented, he added. The panel of three said they hoped that after publication of their ruling, the sides would discuss other subjects, such as requiring doctors to use time clocks, encouraging young doctors to specialize in fields in which few are interested today, requiring specialists to take their turns doing shifts after regular hours and on weekends and holidays and allowing private health services in state- and Clalit-owned hospitals. Clalit, the country's largest employer of doctors, with 7,000 in its clinics and hospitals, praised the work of the arbitrators, but said it could not pay the required raises. Clalit will thus demand that the Health Ministry and Treasury help it pay part of the extra cost. Clalit bemoaned the fact that such issues as requiring doctors to punch time clocks; giving differential wages to hospital residents and specialists; hiring senior doctors on personal contracts and encouraging doctors to serve in the periphery were not addressed.