Here are my conclusions after carefully reading the government’s 'historic' contract, which was only presented to the Doctors Union membership after it had been signed by the leadership.
By C. MILGROMdoctors scalpels surgeons cartoon 521(photo credit: Avi Katz)
THE RECENT LONG AND BITTER ISRAELI doctors’ strike ended after six months with an agreement that the government described as a “historic” cure for the ailing public medical system. In fact, the contract that ended the strike will have the opposite effect.I am a veteran of the Israeli medical system since 1982, when after qualifying as an orthopedic specialist in the US, I immigrated with my family. I am a veteran of four doctors’ strikes. In my first strike in New York in 1975, we unsuccessfully demanded shorter working hours. This demand was only achieved in the wake of the tragic death of 18-year-old Libby Zion at the hands of two sleepdeprived doctors at the end of a 36-hour work shift.In 1983, there was a 14-week-long doctors’ strike in Israel and we achieved a significant increase in our salaries. However, these increases had been wiped out by inflation by the time the doctors went on strike again in 2000. The doctors and the government were unable to reach an agreement and we entered into binding arbitration.Eight years later, in 2008, the mediator finally published his findings.The government’s response was that it did not have the money to pay for the agreement. The government has still not fulfilled the “binding” arbitration, which included promises to create 600 additional positions for doctors and a pay raise.Before the turn of the century Israeli medicine lived off a steady supply of immigrant doctors. The country got these doctors free of charge.In the 1990s, 50 percent of all licensed physicians had received their education in the former Soviet Union. Because the salaries they had received in their home countries were so low, these doctors did not protest their Israeli salaries, which for a resident is currently $7.20 an hour.But now things have changed. There are relatively few new immigrant doctors. The government, following American economic models, has promoted private medicine and has not invested in public medicine.Despite Israel’s growing population, there has been no increase in the number of hospital beds or in the number of doctors working in public hospitals. The public hospital system is only kept functioning day by day by the heroic efforts of residents.Here are my conclusions after carefully reading the government’s “historic” contract, which was only presented to the Doctors Union membership after it had been signed by the leadership: 1) Where is the big pay increase? Over the course of the nine years of the contract, doctors’ salaries will increase gradually by 32 percent.When this figure is adjusted for anticipated inflation then the real increase in salary over nine years is in the range of 0.5 to three percent – if inflation stays low.2) What happened to the salary increases still due from the 2000 strike? That increase is now deferred again and will appear in doctors’ salaries in installments beginning between 2012 and 2016.3) The government promises 1,000 new public doctors’ positions over the next four years. This is after they have not added positions for decades. No new positions will be added in the center of the country for the next 18 months in spite of immediate needs there.4) A goal of reducing doctors on call to the American standard of six per month has been set. This same goal, however, was stated in previous agreements and was never fulfilled.5) What about the new residency requirement that never ends? Until now senior doctors did not have to do night calls once they finished residency. The contract now states that senior doctors, if requested by the hospital, are required to do residents’ night calls twice a month for the first five years after residency.They are also liable to be called to do two half-shifts a month until 11 p.m. up to the age of 47. Unlike a resident, when a senior doctor finishes a 24-hour resident shift, he/she does not get a day of rest. This means on the day after the night shift the senior doctor will carry out operations or procedures without having slept the night before. I would not like to be his/her patient.6) What happens to the right to strike if the government does not keep their commitments as has been the case in the past? There is no right to strike or carry out work action until 2020.7) The government states that there is a 300,000 shekel incentive for a doctor to move to work on the periphery, but does not fund this provision.8) What are the good things about the contract? There are modest incentives for doctors to work on the periphery and in fields lacking residents.Following this “historic” agreement, 1,000 residents resigned. The Labor Court declared their resignations illegal because they were collective.Now the residents have begun to resign individually. They are smarter than my generation of doctors, who allowed themselves to be exploited and underpaid.Next year I will retire with a rank of full academic professor from Hadassah Medical Center after 30 years of work, and am looking forward to a pension of $2,100 a month. My daughter, an internal medicine resident, has submitted her resignation.A good leader corrects situations before disaster strikes. Although Deputy Minister of Health Yakov Litzman (United Torah Judaism) has charge of the ministry, the official Minister of Health is none other than Benjamin Netanyahu – maybe he should shoulder the responsibility for the country’s health system. •The writer is a professor of orthopedics at the Hadassah-University Medical Center in Jerusalem.
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