Israel's surfeit of doctors leads to strike

BMJ 1994; 308 doi: (Published 07 May 1994) Cite this as: BMJ 1994;308:1185
  1. J Siegel-Itzkovich

    A 24 hour “warning strike” by 12 000 physicians in Israel last month was the result of frustration at the increasing struggle to find a place to work and a decent wage. The influx of 7000 immigrant doctors from the former Soviet Union during the past three years has increased the proportion of doctors in the population - already one of the highest proportions in the world; there is now one doctor for every 400 citizens.

    Some 1500 elective operations and tens of thousands of outpatients visits were cancelled during the strike, and only emergencies received attention. Doctors in all the country's public sector hospitals, district health offices, family health centres, and community health fund clinics took part.

    More than 95% of Israel's physicians are salaried. They work for government owned hospitals; the labour federation's health fund or voluntary organisations; community outpatient clinics; or as independent or salaried doctors receiving patients on behalf of the three other public health insurers. Many doctors “moonlight” on several jobs at once.

    Senior specialists at government and health fund hospitals are usually permitted to receive patients privately at clinics at their home or to spend their free time seeing patients at health fund clinics. Hospitals owned by voluntary organisations have a special “private medical service” arrangement whereby staff doctors may treat private patients who use the hospital facilities; the fees are shared by the institutions and the doctors. This benefits both sides, eliminating under the table payments while keeping the physicians inside their hospitals for most of the day, where they are available when needed for their public sector patients. Although increasing affluence among the population has led to a growing number of private hospitals and clinics, only a small number of doctors work in these institutions.

    Finance ministry and other employer representatives finally met the heads of the Israel Medical Association (IMA) at the end of April and made some wage offers; the IMA promised to suspend planned sanctions at least until it had considered the proposals. Dr Yoram Blachar, a paediatrician in the Tel Aviv area and head of the IMA's professional committee, says the answer to the current surfeit of physicians is not to restrict the number of medical students; that, he says, would be undesirable and ineffective as only 320 graduate annually throughout the country. Nor would the association dream of restricting doctors' immigration. The IMA is opposing proposals for forced arbitration of labour disputes in the health sector. Dr Blachar says: “What we want is more private medical service arrangements. This will allow more physicians to earn extra money from private patients, but in a supervised, above board manner.”

    The IMA held a protracted strike lasting four and a half months in 1983, which resulted in considerable wages increases, but it says that these have since melted away. That strike did little for the public image of doctors in Israel.

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