As the Maidan Revolution of 2014 rocked Ukraine – the precursor to today’s Russia-Ukraine war – Dr. Leonid Braverman decided to relocate his wife and young son to Israel.
“It was then that the changes started in my country and I could foresee the war that is happening now,” he told The Jerusalem Report. “I decided to make aliyah.”
A Ukrainian-trained physician, Braverman, now 37, first enrolled in the Jewish Agency’s Masa Doctors program, through which he completed an eight-month course that helped him pass his Israeli medical licensing exam. In 2015, he formally made aliyah, and then spent five more years studying for a specialty degree in psychiatry, including his residency. Now a father of two, he lives in Haifa and works for Maccabi and Leumit Health Services and in private practice.
In the last few months, following Russia’s latest invasion of Ukraine, he is hearing from many colleagues from Ukraine and Russia who are also interested in coming to Israel, he said.
“It is a great time to move to Israel as a doctor.”Dr. Leonid Braverman
“It is a great time to move to Israel as a doctor,” according to Braverman. “The culture is different, that is true, but the medical training and professionalism is better than in Ukraine.”
He said he was able to work as a doctor after less than a year, and the specialty training he received has given him an edge in a country with close to a million Russian speakers and a shortage of psychiatrists. While he said the move meant leaving his extended family, friends and work in Ukraine, and that transitions are never easy, he did not want to raise his children in a warzone.
“Israel took me in and gave me a chance to progress in my career,” Braverman said. “I got a lot of support from the Masa Doctors program and the country in general. I do not regret it at all. The opposite, I am very glad I came.”
Braverman is one of the hundreds of doctors and nurses who were trained in the former Soviet Union and Russia and who have flocked to the Jewish State in the last decade as the situation in their countries has escalated. Nearly four dozen Ukrainian doctors and close to six dozen nurses have made aliyah from Ukraine in just the past two-and-a-half months, and many more are expected to arrive, according to Shay Felber, director of the Jewish Agency’s Aliyah and Absorption Unit.
The hope, Felber said, is that the influx of professional immigrants will help offset Israel’s growing deficit of medical personnel – ironic, since it was immigrants from the former Soviet Union that in the 1990s bolstered the country’s medical system.
“We are providing these immigrants with the courses they need to convert their medical licenses.”Shay Felber
“We are providing these immigrants with the courses they need to convert their medical licenses,” Felber explained. “This includes ulpan and professional training and the exam at the end. We do it in collaboration with the health funds. We expect the process to take about a year.”
As of mid-May, some 20,000 new immigrants had made aliyah from Ukraine and the surrounding areas since the start of the escalation, the Ministry of Aliyah and Integration said. Some 24% of new arrivals were under the age of 17; 22% 18 to 35; 20% 36 to 50; 16% 51 to 65 and the rest over the age of 66, including 678 Holocaust survivors.
“The ministry has been working to expand employment and training programs,” the ministry said in a statement.
‘A critical crisis’
For perspective, more than 700,000 immigrants arrived in Israel between 1990 and 1997, according to a report by the Economist Intelligence Unit (EIU), boosting the working-age population by 15%.
“Unlike most other mass immigrations to Israel, the Russians arriving in Israel were neither poor nor uneducated,” the EIU said. “By one estimate, 60% of the Russians had a post-secondary education, compared with just 30% to 40% of the existing Israeli Jewish population at the time. The proportion of the population with more than 16 years of schooling jumped from 16% in 1987 to 28% in 2005, although a large part of the increase was also due to the expansion of higher education in Israel.”
Specifically, in the field of medicine, Israel jumped from only 15,000 doctors in 1989 to 23,688 in 2000 – 38% of them Russian-speaking immigrants, according to EIU. This shifted the rate of doctors from 3.1 per 1,000 people to 3.8 over the same period; today Israel stands at 3.3, according to the latest Organization for Economic Cooperation and Development (OECD) report, as these same doctors age out of the system.
“Israel is about to face a critical crisis in its medical system.”Amos Hermon
“Israel is about to face a critical crisis in its medical system,” said Amos Hermon, director-general of Israel Experience, which partners with Masa and Rambam Health Care Campus on its Masa Doctors program. He said the doctors that made aliyah in the 1990s are retiring and leaving a void that Israeli medical schools cannot fill on their own. There are not enough spots in the country’s medical universities, making it extremely competitive for Israeli students to be accepted. Many opt to study outside of Israel; some of their degrees don’t easily transfer over and some new doctors choose not to try to return.
After COVID-19, the situation is expected to become even more acute, as many medical personnel – especially nurses – are opting out of the profession. According to a report published in May by the International Council of Nurses (ICN), as many as 10% of nurses are expected to leave the profession due to the “COVID effect.”
“There is no reason to assume our nurses would behave differently than nurses abroad,” said Prof. Dan Ben-David, president and founder of the Shoresh Institution for Socioeconomic Research in Jerusalem.
According to an OECD report released in January that examines the state of health in member countries from various aspects and a supplementary analysis provided by Israel’s Ministry of Health based on the same data, the rate of nurses in Israel per 1,000 people is one of the lowest in the OECD (4.7 per 1,000). Only Latvia, Greece and Mexico have fewer nurses per capita, said the report.
In terms of nursing graduates, according to data provided by Ben-David, Israel has 23 graduates per 100,000 people. In countries like South Korea or Switzerland, he said, there are around 100 graduates per 100,000 people – more than four times as many.
“In the OECD, the share of practicing nurses per capita has been rising steadily since the mid-’90s. In Israel… it is going down,” Ben-David stressed.
Similarly, the rate of doctors per thousand people is about 9% lower than the OECD average (3.3 per 1,000 people). Only 12 countries have fewer doctors per capita, the report said.
Ben-David said that because Israel has a younger population than most countries, it needs fewer doctors. However, more acute than the current number of physicians per capita is how old they are – a red flag for the future of healthcare in the country.
“In terms of physicians, we are like an old-age home,” Ben-David said. “Israel has 10 times the number of doctors over the age of 75 than the rest of the OECD countries. We are asking these doctors to stay in practice because we don’t have enough younger physicians to replace them. During COVID, we had to ask doctors to come out of retirement.
“I don’t know how many 75-year-olds are still up to date with what is state-of-the-art in their field,” he continued. “This may be a reflection of the quality of care that can be given in Israel.”
Specifically, according to the most recent OECD data provided by Ben-David, an average of 16% of doctors are under the age of 35 in OECD countries, compared to only 12% in Israel. Some 7% are between the ages of 65 and 74 in most OECD countries, compared to 16% in Israel. And, only 1% of OECD doctors are 75 and older, compared to 10% in Israel.
“I cannot say these new immigrant doctors [from Russia and Ukraine] will totally offset the country’s shortage like they did in the 1990s,” Felber said. “Then, we had hundreds of thousands of doctors. But it will help.”
Felber said it costs around NIS 700,000 and takes more than five years to train a new doctor in Israel, and only a fraction of the time and money to help one study and transfer over his or her license.
‘I want to help the country’
It is with this in mind that the Masa Doctors program was started.
Masa Doctors just completed its 14th year, graduating nearly 1,000 doctors from Eastern Europe and the former Soviet Union – places like Russia, Ukraine, Belarus, Uzbekistan and Lithuania. To be accepted into the program, Hermon explained, the doctors need to be eligible to make aliyah according to the Law of Return. Their medical degree also has to come from a list of recognized universities, to help ensure their success in the program.
Nearly 90% of participants pass the medical exam and receive their license to practice in Israel – a passing rate that is nearly 15% higher than the average. Moreover, around 95% of fellows decide to immigrate to Israel and join the healthcare workforce, Hermon said.
Fellows are provided with ulpan Hebrew classes and educational trips to help them immerse into the country.
“When MK Ya’acov Litzman was health minister he used to say, ‘Amos, you will be the sixth faculty of medicine in Israel,’” Hermon recalled. “Obviously, we are not a formal faculty, but this dream is coming true.
“Because of the war in Eastern Europe, we are expecting an even larger cohort in September,” he said. “We think we could have as many as 110 doctors enrolled.”
Natan Livshits, who recently completed the Masa Doctors program, came to Israel after studying and then working as a doctor in Russia. He said that the Russia-Ukraine war broke out toward the end of his fellowship, but had no impact on relations between Ukrainian and Russian students. In contrast, they studied together in hopes of passing their exams and starting new, productive lives in Israel.
“A lot of friendship, no conflict.” Livshits told the Report.
He and his wife officially made aliyah in March.
“I think Israel is going to get a lot more doctors given the situation in the region.”Dr. Natan Livshits
“I think Israel is going to get a lot more doctors given the situation in the region,” he said. “I hope that Russian and Ukrainian doctors come here and help the Israeli system get bigger and better… The program for doctors has really helped me with my move here and helped me and my wife integrate into Israeli society. I really love Israel, this is my homeland, and I want to help the country in any way that I can.”
‘It can only help the health system ‘
But Ben-David said that he would be hesitant to say that increased Ukrainian immigration could “be a solution to the problem.”
Although he admitted that the new doctors might help, alongside other efforts being made by the state, such as the opening of the Azrieli Faculty of Medicine in Safed in 2011 and recent discussions about halting acceptance of high-paying American students who return to practice in the US by 2023 and turning their medical school slots over to Israeli students.
The country is not graduating enough new medical professionals, the January OECD report highlighted, with a high percentage being trained outside Israel.
Israel has the highest percentage of foreign-trained doctors (57.8%) – a 15% higher rate than any other OECD country. Some 9.8% of nurses are foreign-trained. Only four countries train more nurses abroad: Britain, Australia, Switzerland and New Zealand, according to the statistics.
In addition, when looking at immigration versus emigration of physicians to and from Israel, there is greater outflow of Israeli doctors to OECD countries than there are those coming in, Ben-David showed.
“We were net-positive until 2003, and since then, at least until my latest statistics, 2017, we have been net negative,” he said, meaning more physicians are leaving the country than moving here.
The possibility of closing the American programs for medical studies in Israel is being considered, a May report by The Marker, which was shared by Health Minister Nitzan Horowitz, said. If passed, the change would go into effect in October 2023 and make it possible to increase the number of Israeli students by about 120 a year who study medicine at Israeli universities.
The schools would be compensated for their losses, according to the report. American students pay an average of $40,000 a year for four years – about double the amount universities receive for Israeli students.
“After years of effort: Priority for Israeli students,” Horowitz wrote. “It does not make sense, it is not normal, that most Israeli medical students study abroad, at a huge expense, and the expensive places in the faculties in Israel are occupied by foreign students.”
“It does not make sense, it is not normal, that most Israeli medical students study abroad, at a huge expense, and the expensive places in the faculties in Israel are occupied by foreign students.”Health Minister Nitzan Horowitz
Of course, there are still a number of questions that need to be answered before such a transition is made.
Ben-David asked why ending the program is a better solution than using the funds paid by foreign students to offset the growth of the medical schools that would be needed to accommodate more Israeli students so that in the end everyone can win.
In the meantime, Hermon and Felber said, they will keep their eyes set on helping new immigrants make a meaningful contribution to their futures and the future of the Jewish state.
“I am not a prophet, but I can tell you that the numbers of doctors and nurses from Russia and Ukraine will increase,” Felber said, “and it can only help the health system.” ■