The Medical Association has long needed surgery or intensive care

The Medical Association has long needed surgery or intensive care
The Medical Association has long needed surgery or intensive care

1. After repeated threats, it happened yesterday: Dozens of interns in dozens of wards in hospitals scattered throughout the country Submit a letter of resignation. “Registry” – a small and kicking organization that represents a small part of the interns, about 1,500, but leads the protest, clarified: “As long as there is no change in the outline of shortening shifts in the coming days, hundreds of additional resignation letters will be submitted in dozens of other departments across the country.” The language of the announcement of the organization that started the struggle to shorten the shifts, but has already provoked a call for much deeper changes in the health system.

Read more in Calcalist:

Contrary to what happened last week, a collective but legally invalid letter of dismissal was then filed by 25 interns in the emergency room at Ichilov, which was intended for the Minister of Health – this time, the letters were genuine and admissible. This is an unprecedented move: Dozens of doctors, led by the chairman of the prescription organization Dr. Ray Bitton, have submitted personal resignation letters. Until yesterday, Calcalist checked and found that not a single valid letter of resignation had been submitted, and the steps taken were a publicity exercise based on the “Hold Me” strategy.

After yesterday’s events, the things he told Calcalist, a very senior member of the health care system who wished to remain anonymous (and there are many who are forced to say so and we will immediately explain why) – took on new validity:

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Demonstration by medical interns, at the Ray Bitton Center, Chairman of the Prescription Organization. The struggle is creating a mini-revolution in the health care system

(Photo: Moti Kimhi )

There is almost no question that a prescription, starting a mini-revolution, is not certain that this breast can be returned to a bottle. It is certainly not clear whether there is a desire or a need for it. It’s no longer just them, the interns. Medical students also have a clear interest in shortening shifts. After all, every year of academic progress, they see how the “Via Dolorosa” of 26-hour shifts is getting closer to them. Many joined a protest organized by a prescription, sat down and blocked roads.

Unlike other students from all other fields, who are not characterized by special power, those who study medicine – each and every one – are of strategic importance to the State of Israel. And the state has a clear interest not only in promoting them, but in doing so as quickly as possible. After all, as mentioned, there are doctors, but in short supply.

2. One of the big questions raised by this wave of protests is where the Israeli Medical Association is known as the RI for short. Strong lies in one interesting fact: Hari has a double hat. On the one hand, it is a representative workers’ union, but at the same time it is also a professional union that controls the level and firmness of the entire medical professional world of Israel. This is mainly through the Scientific Council – an omnipotent body that, among other things, determines, in practice, the number of doctors in the system.

Through the Scientific Council, the unions and the other branches that operate in it, the RI regulates the number of doctors in Israel and ensures that they are in constant shortage while creating pressure on salaries. It can also de facto determine the composition of doctors – some in neurology, some in ENT and some in cardiology. This is done by increasing the difficulty of one test or another, or setting minimum quotas in the hospital for the purpose of recognizing a specialization in one profession or another.

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Info The very low indices of doctors in Israel

The struggle now reveals the irrelevance of the organization. Here’s a small example. Last Thursday, a headline appeared on Hari’s website: “Senior members of the Medical Association on the correct way to implement the shortening of interns’ shifts.” Anyone who clicks on that headline will find the following message: Indeed, the RI was caught with the doctors robe down.

The primary difficulty of the RAI is to join the move of the ultimate nemesis. A prescription organization was established 10 years ago after the negotiations on a collective wage agreement in 2011 that once again abandoned the interns. For the first time, the organization dared to challenge the 100-year-old RI. But the real difficulty, as senior doctors explain anonymously, is that the RI is an organization composed mainly of senior and senior physicians (Israel is the highest-ranking physician in the OECD). As they noted in the few interviews they have given since the outbreak of the crisis, the motto is “what has been is what will be. I mean, like we did 26-hour shifts 50 years ago – everyone will. ”

According to the Registry website, the vast majority of the members of the Rebbe, 73%, are senior physicians who sit on the organization’s management and therefore their preference will be around the interests of the senior physicians. Absolutely to the decisions of the RI management. Therefore, the RI’s silence on the current event is not only thunderous, but it is also not accidental.

This is also the reason why this organization, which is devoid of reporting obligations (Ottoman Association), has invested millions of shekels in a campaign to increase the health budget. There is no doubt that the sources must be increased, but also optimized and made depth changes. One of them is clear: for 61 years now, the Ministry of Health has been handing over these powers – which are supposed to be ministerial for all intents and purposes – to a union. Or in more blunt words – the doctors’ guild. Even in the electricity and ports economy, the Histadrut does not have such power, which is why so many senior officials and doctors support the struggle, but “quietly.” They express themselves in his favor, but anonymously. No one wants to get involved with the RI.

Let it be clear: there will be no real shortening of shifts, as long as the doctors’ tap is not released and their number in Israel is significantly increased. This issue must change, and immediately. The picture before us is very disturbing: the aging of the population in Israel is one of the fastest in the world; The number of doctors approaching retirement age is the highest in the West; The rate of those receiving a medical degree in Israel is among the lowest in the OECD; The rate of doctors trained abroad is the highest in the developed world. Israel is left without doctors and without extreme, structural and urgent measures. The result is clear: the citizen will be harmed.

In fact, he has been injured, and he feels it when he has to wait 8 months to see an orthopedist or gynecologist. It is not possible to shorten shifts, certainly not in the periphery, at the patient’s expense. This is an option that is out of the question, and the interns also do not agree with it.

3. The attitude of the change government led by Naftali Bennett to recent events in the health and medical system is very puzzling. Finance Minister Avigdor Lieberman’s attack is out of place, similar to Health Minister Nitzan Horowitz’s warm hug at a dramatic press conference declaring a “solution to the intern crisis” has been found when nothing substantial has changed since the previous outline was presented a week and a half ago.

They do not need a hug, they need a real solution. We, the citizens of Israel, need a solution. Even senior Ministry of Health officials are as silent as fish. They’re still stuck in Corona. Not to mention Economy Minister Orna Barbibai who took out the guard and threw the grenade into the sky in the hope that someone would already catch him. Any solution that is obtained is not related to it because it does not have the tools to deal with such a complicated problem.

Contrary to estimates (or expectations), this problem will not go away. Therefore, it is worthwhile to hurry up and present some receipts to the protesting interns. A kind of long-term outline. It is clear that not all interns agree on everything: some interns would prefer to leave shift hours intact but reduce their number. There is no consensus in this sector either. But the government can promote uncomplicated solutions that are right under your nose.

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Right: Chairman of the Medical Federation (Hari) Zion Hagai and Minister of Health Nitzan Horowitz. The Ministry of Health has been abandoning significant powers in the hands of the Ministry of Health for 61 years

(Photo: Shaul Golan, Kobi Cuenx)

Here is an example: It turned out last week that there are 2,387 Jewish doctors around the world who have expressed interest in immigrating to Israel recently and the Ofek Israel organization – the executive arm responsible for bringing immigrants to Israel – has already located them and is in contact with them. The same is true of 1,195 nurses. It also became clear that in the last 12 years, the “Israeli experience” – a subsidiary of the Jewish Agency’s education – has brought to Israel more than 700 doctors from Eastern European countries and in cooperation with Rambam Hospital and a travel organization that prepares them for the licensing test. To Israeli doctors. About 90% of physicians successfully pass the test and 97% of them pass.

It is not clear how the minister most identified with the new immigrants who also controls the tap of public funds misses such a level to discount. This solution is relatively quick and inexpensive. After all, the Israeli health system can not wait another seven or eight years for today’s students to finish their studies. She does not have that time. But there are other solutions that can be promoted. This is a golden opportunity to produce a regulation and start implementing the “physician assistants” and “specialist nurse” model that will significantly reduce the load. After all, some of the medical operations that a doctor performs today can be done by medical assistants. Not to mention the huge lost hours that doctors spend on administrative and bureaucratic activity. It is time for change and also for taking certain risks, otherwise, we will again “miss the crisis”.

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