Medical interns highlight Israel's health system problem - editorial

For the past few weeks, the medical interns, residents and students have been protesting against having to work 26-hour shifts.

 Medical workers protest over 26 hour shifts (photo credit: AVSHALOM SASSONI)
Medical workers protest over 26 hour shifts
(photo credit: AVSHALOM SASSONI)

The resignation of 2,360 medical interns yesterday highlights a larger problem in Israel’s health system. It is a problem that has been there for a long time, exacerbated by the coronavirus pandemic that needs to be addressed.

For the past few weeks, the medical interns, residents and students have been protesting against having to work 26-hour shifts, demanding that these shifts be significantly shortened. 

Saying members of the Mirsham union for medical residents had signed their resignation letters “with a shaking hand and a heavy heart,” the union accused the Health Ministry of being disingenuous in its offer. The ministry, it said, would only shorten shifts from 26 to 18 hours for non-surgical professions in some hospitals, meaning that 90% of residents would continue working 26-hour shifts. Coronavirus wards, internal medicine and emergency rooms in hospitals were also not included in the proposed plan.

“They lied to us. They deceived us. They sold us. They told us stories,” the union said. “We ask forgiveness from the patients. We are sorry for the extreme step we have to take.”

The union stressed that 25% to 30% of interns should be included in any plan for shortening shifts in 2022.

According to the Health Ministry plan, shifts for interns at 10 hospitals in the periphery will drop to 18 hours, with six shifts per month. Emergency and ICU interns will only have their shifts shortened in six months. The Health Ministry also insisted that a start date for the plan not be announced yet.

Health Minister Nitzan Horowitz called the resignations “unnecessary,” saying he was in contact with the interns and they understood that the process needed to be gradual.

“There are not enough doctors to make an immediate cut across the country,” said Horowitz. “Some steps must be taken. I do not understand how such resignations will help.” 

 A woman wearing a medical scrub in the resident's protests of the 26-hour shifts. (credit: AVSHALOM SASSONI) A woman wearing a medical scrub in the resident's protests of the 26-hour shifts. (credit: AVSHALOM SASSONI)

The resignations go into effect in two weeks, which gives the government another two weeks to continue negotiations to reach an agreement. We urge it to do so.

Despite the announcement from Mirsham, coalition chairwoman and Knesset Health Committee chairwoman Idit Silman called the plan an “important and significant achievement,” stressing that there is a long road ahead.

Silman stressed that she intends to continue working to shorten shifts for all internal medicine and emergency medicine departments within an appropriate time frame.

In an op-ed in Ma’ariv, Dr. Liran Nevat Golan, who specializes in emergency medicine, noted that the interns’ battle has been a protracted one.

“Our struggle has been going on for many years on many platforms,” Golan writes. “As far back as 2011, there was talk of shortening hours and that we must understand how to do this properly.”

In explaining the interns’ plight, Golan says, “To do shifts of 26 hours is terrible and awful. We fall asleep in front of patients fighting for their lives. We make mistakes in doses of medicines and take wrong decisions. Sometimes it takes a day or two for us to realize that we made mistakes.”

Putting it in a nutshell, he adds, “A doctor who works for 26 hours is a drunk doctor. We can’t agree to this anymore. Not for the patients and not for ourselves.”

Of course, Golan is right. This is an untenable situation. But in dealing with it, the Health Ministry should not – as it often does – seek a band-aid solution.

A proper investigation should be carried out by medical experts into the criteria for medical students being accepted and trained in Israel, the work demands that can be expected of them in their internships, and satisfying their basic needs – including rest time and sleep. How can anyone expect medical personnel to work such long shifts, and why would anyone want to be treated by someone working for 26 hours non-stop?

Yes, it may require the appointment of yet another committee, but isn’t it time that Israel begin taking such matters seriously? Isn’t that the wake-up cry of this pandemic? After all, this can very well be a matter of life and death. And if we can’t take care of medical professionals, how can we expect them to take care of us?