Israeli medical students training
Medical students at Hadera’s Hillel Yaffe hospital. Photo by Alon Ron
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The Knesset Labor, Welfare and Health Committee voted Wednesday to exempt Israelis who studied medicine abroad, as well as immigrant physicians, from the Israeli medical licensing exam if they have passed the U.S. licensing exams.

The committee also approved the retroactive licensing of any physician who has passed the U.S. exam, the USMLE, during the past 10 years. However, the committee also ruled that candidates who failed the Israeli medical exam cannot take the USMLE instead.

“We are trying to make it easier for people who graduated medical school abroad as well as for new immigrants,” the director of the Health Ministry’s department of medical professions, Dr. Amir Shanun, told the committee. “The Israeli exam is the best, but there is an American exam of a suitable level and we believe it can be an alternative to the Israeli exam for people who graduated abroad.”

Committee chairman Haim Katz (Likud) said he would continue working toward easing the personnel shortage in the health-care professions.

Every year, Israeli medical schools produce 700 graduates and another 500 return from their studies abroad, mostly in Eastern Europe and Italy. But the two groups do not take the same licensing exam. There are two separate tests − one for students graduating from medical schools in Israel, which more than 80 percent pass, and the other for people who finished their medical studies abroad, which is considered much more difficult and only an average of 30 percent pass.

Those who studied abroad have long claimed that the harder exam constituted unwarranted discrimination, but for decades the health establishment insisted it was the only way to ensure that those who are licensed are truly qualified.

Experts had also warned that this differential testing would make it more difficult to cope with a looming shortage of doctors. But it was only in late 2011, after the social protests and in the midst of the medical residents’ strike, that the complaints of those who had studied abroad began to be heard.

The Knesset panel’s decision yesterday was based on conclusions reached by a committee appointed by Health Ministry Director General Dr. Ronni Gamzu to examine the issue.

The USMLE has three different stages: The first is an eight-hour written exam, the second is an evaluation of clinical knowledge and clinical skills, and the third determines the physician’s ability to apply his knowledge independently. The clinical skills test requires the candidate to examine and diagnose actors posing as patients, and can only be taken in the United States.

Despite its complexity, the American exam is considered easier to pass than the Israeli exam administered to foreign graduates and immigrants, which consists of 220 tricky multiple-choice questions. A passing grade is 60, and only those who get between 55 and 60 can appeal the result. In 2009, of the 1,085 foreign graduates who were trying to be licensed so they could do an internship, only 27 percent passed. Of the 380 immigrants who had already worked as physicians abroad, only 15 percent passed.

After 2009, the test was apparently made somewhat easier and the pass rates improved: According to the Health Ministry, of the 2,580 people who took the test between 2009 and 2011, 41 percent passed. Still, the pass rate for those who study outside the U.S. and take the USMLE is between 72 percent and 78 percent.

Shanun said that while the decision to accept the USMLE would make it easier to be licensed to practice in Israel, it didn’t mean that the level of medical care would decrease.

“We’re fine with this decision, which will offer another option and resolve some of the complaints about discrimination connected with the Israeli licensing exam,” Shanun said. “We will monitor the process, but I don’t expect it to undermine the level of medical care.”

The number of doctors employed in Israel (3.5 per thousand people) is lower than the ratio in some Western countries such as Germany (3.64 per 1,000), Spain (3.78), Norway (4.02) and Austria (4.77). It is still higher than the rates in Britain (2.71 per thousand) and the U. S. (2.44). But the real problem lies in the future: The State Comptroller’s Report in May 2009 warned that because of population growth and the number of doctors approaching retirement age, by 2020 the ratio of doctors in Israel would drop to only 2.76 per 1,000.

Over the past three years there have been various plans mooted to “import” doctors in specialties with serious shortages from places like Georgia and India, but these plans never came to fruition.

Other proposals, however, are being implemented. For example, medical studies have been shortened by six months and the final exams moved up. In addition, medical school deans are now working toward unifying the five final exams required at the end of six years of medical school, before internship begins (two at the end of the fifth year and three and the end of the sixth year). The plan is to create a single exam similar to the American National Board of Medical Examiners test. This would shorten medical studies by another month.

Shanun noted that the next licensing exam for those with foreign degrees is scheduled for next month, and he is expecting at least some registrants to cancel and try their hand at the American test instead.