Doctors strike - August 24 2011  - Moti Milrod
Doctors on strike in Israel, August 24, 2011. Photo by Moti Milrod
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After months of strikes and sanctions that disrupted the country's health care system, the government and the Israel Medical Association reached an agreement on Wednesday that will change the face of public medicine.

The deal includes a 49 percent average salary increase for hospital doctors, who will now clock in and out, and the addition of 1,000 doctors at public hospitals. The wage hike is not equal across the board; the hikes are much higher for doctors in outlying areas or in specialties that are short of physicians.

Talks to iron out the final details continued late into Wednesday night. The agreement, brokered by mediator Prof. Yitzhak Peterburg during marathon talks this week, involved significant concessions by the treasury, but the doctors did not get everything they wanted.

The agreement is for nine years, retroactive to July 2010, when the last deal expired. The agreement will increase funding for doctors in the public health system by NIS 2.7 billion.

Doctors working in outlying areas will earn an average of 20 percent more than their counterparts in the center of the country.

Differential increases will also be paid to physicians in specialties with doctor shortages, including general surgery, internal medicine, pathology, geriatrics, child psychology, hematology, emergency medicine, nuclear medicine and pediatric oncology.

An especially high increase - 70 percent - will be given to specialists in fields where the shortages are acute, including anesthesiology, intensive care, pediatrics and neonatology.

Moreover, medical residents who move to the periphery or choose to specialize in a field in which doctors are lacking will be given a one-time grant of NIS 300,000. Residents who do both - move to the periphery and specialize in a field with shortages - will receive a grant of NIS 500,000.

Still, the residents' representatives criticized the IMA for excluding them from the talks and called the agreement a "placebo."

"According to the media reports the agreement is a placebo - it brings no improvement to doctors or patients ..... It does not change doctors' basic wages - the raise is based on shifts and overtime," they said in a statement.

Hospitals designated as being in the periphery are Yoseftal (Eilat ), Poriya (Tiberias ), Ha'emek (Afula ), Barzilai (Ashkelon ), Soroka (Be'er Sheva ), Nahariya, Ziv (Safed ) and Hillel Yaffe (Hadera, for some departments ), as well as all geriatric and psychiatric hospitals in the north and south.

An exceptional salary boost will be given to general doctors who work in emergency rooms and internal medicine departments. These doctors, who were never given significant increases in previous agreements, will be getting a salary boost of 86 percent.

Twenty percent of these increases will go into effect immediately, while another 70 percent will be phased in during the deal's first five years. There is also a mechanism for compensating doctors during the second half of the agreement if annual inflation tops 5 percent.

According to treasury figures, a medical resident in the center of the country who does six hospital shifts a month and now makes NIS 15,867 monthly will get a 29 percent increase to NIS 20,481. A resident who works in the periphery who makes NIS 16,175 monthly will get a 52 percent increase and make NIS 24,545.

In a distressed speciality such as general surgery, a resident in the center of the country will receive a 29 percent boost, from NIS 17,732 monthly to NIS 22,933, while a surgical resident in the periphery who makes NIS 18,087 will get a 52 percent increase to NIS 27,463.

In a field with acute shortages such as intensive care, a central-area resident will get a 31 percent hike to NIS 24,864, while a resident in the periphery will receive a 53 percent boost to NIS 29,394.

For the first time, specialists will be required to do shifts, including two full duty shifts a month for the first five years after their residencies and two half-shifts that end at 11 P.M. until age 47. This will reduce the load on residents.

In return, young specialists will get a 44 percent increase in the center of the country, and a 70 percent increase in the periphery.

The 1,000 additional slots include 500 new positions to be opened immediately for residents, with the other 500 to be equally divided between residents and specialists and phased in over four years. Residents will now be required to do only six duty shifts a month; anything over that will force the hospitals to compensate them at an extremely high rate.

The new agreement also adds a new wage level for a position called "service manager," a level lower than a unit or department head. This gives doctors another chance to be promoted, since many department heads remain in that position for years until they retire.

The treasury, however, did not agree to permit doctors to see private patients at public hospitals. Nor does it provide for "full-timers" - doctors who would get extra pay for working only in the public health system and forgoing private practice.