The medical establishment came in for widespread criticism in the State Comptroller's report, for problems that included a severe shortage of doctors and nurses, long waits for surgery and poorer health among people living outside the center of the country.

The report also alleged that the heads of two of Israel's largest hospitals, Sheba Medical Center at Tel Hashomer and Sourasky Medical Center in Tel Aviv, spent much of their time employed in outside pursuits not directly related to their duties as hospital director.

The comptroller's report said the shortage of doctors and nurses in Israel resulted in the early discharge of patients from the hospital, an increase in infection among premature babies, delivery of babies without the presence of an anesthesiologist, delays in surgery and a decline in the quality of treatment.

There has been a gradual decrease in the number of doctors under the age of 65 since 2000, a decline which is projected to result in a 26% drop in the number of physicians by 2020. Doctor shortages are expected to be especially acute among anesthesiologists and intensive care physicians for children and the elderly.

The report noted long waits at government hospitals, at times of over a year, for essential surgery, including operations to remove bladder tumors and tonsillectomies and ear operations for children. The comptroller acknowledged that these operations were not considered urgent, but said delays could affect the patients' health nonetheless.

Lindenstrauss noted major gaps in the availability of medical services in the north and south of the country compared to the center. He said the general state of health of the population outside of the center is worse and that the rates of illness and mortality are higher outside the center. The report noted that it is more difficult to recruit quality medical staff in the north and south.

The Ministry of Health said in response that it has developed programs to encourage doctors to work in peripheral areas. It noted that in 2007 a decision was taken to increase the number of medical intern positions outside the center, which it pointed out included Eilat's Yoseftal Medical Center.

With regard to the two hospital directors, State Comptroller Micha Lindenstrauss wrote that Sheba director Zeev Rothstein was employed by 11 outside parties, four of them without the approval of the hospital. The report also contends that Rothstein's income from these outside activities greatly exceeded the permitted amount, and that he reported fewer hours of private work to the Ministry of Health and to the Civil Service Commission than he actually worked.

Rothstein contested the allegations. He said that five of the purported places of outside employment involved membership in bodies associated with the hospital by virtue of his position as hospital director and did not involve additional compensation. He added: "I find no reason to apologize for teaching medical students. From my standpoint, this is not outside employment." With regard to the claim that his compensation exceeded permitted limits, Rothstein said that his accountant and the state comptroller are in dispute on the issue.

With regard to similar allegations involving Sourasky Medical Center director Gabi Barabash, the hospital said: "All of Prof. Barabash's outside employment was approved by the Tel Aviv Municipality [which runs the medical center jointly with the national government]. In addition, although approval was not required by the state civil service commission, the commission also approved Barabash's private employment, at his request."