doctors - Moti Milrod - October 12 2011
Prof. Yossi Lessing, chairman of the Israeli Association of Obstetricians and Gynecologists, taking a break from a tough day on the ward at Ichilov Hospital yesterday. Photo by Moti Milrod

Israel's major hospitals will be going into the Sukkot holiday facing staff shortages created by the resignation this week of hundreds of medical residents and the prospect that specialist physicians, including the most senior, will have to fill in over the holiday. Hospitals around the country have made plans that include requiring specialists to do 12-hour shifts and requiring others to be on call, in conjunction with medical interns who will remain in the hospital wards. Yesterday, at least 476 residents failed to come to work, including 129 at Ichilov Hospital in Tel Aviv, 78 at Meir Hospital in Kfar Sava, 76 at Sheba Medical Center, Tel Hashomer, and 74 at Haifa's Rambam Medical Center.

If court injunctions are not issued barring resignations, the phenomenon is expected to widen. Some residents have already said they would not honor court-ordered restraining orders.

Despite the unrest, relative calm prevailed at hospitals yesterday as specialist physicians filled in for absent residents.

This week's walkout by medical residents follows protracted negotiations between the government and the residents' representatives. The residents were dissatisfied with the nine year agreement that was reached this August between the Israel Medical Association and the government on the doctors' terms of employment. Residents have expressed particular dissatisfaction with the long duration of the pact and have also sought wage concessions as well as changes to provisions related to on-call night shifts at hospitals by young specialist physicians.

When hundreds of the residents recently submitted letters of resignation, the government turned to the National Labor Court seeking injunctions that would have at least limited the impact of the residents' resignations by staggering them in departments where more than half of the residents had announced their intention to quit. Medical administrators have been eagerly awaiting possible action by the labor court on the issue. The court deemed an earlier mass submission of letters of resignation by the residents as illegal collective labor action. Hundreds of residents then resubmitted letters stating that they would resign and took the position that each letter should be construed as an individual step.

The number of residents who have failed to show up for work increased yesterday, but hospitals have not taken action that would confirm that their employment has been terminated. The Health Ministry has also refrained from issuing directives to the hospitals requiring that they make the resignations official. The Civil Service Commission said the issue is being held in abeyance until the National Labor Court takes further action.

For his part, Deputy Health Minister Yaakov Litzman has repeated his intention to expedite the integration of Israeli graduates from medical schools abroad, from countries whose medical training Israel does not currently automatically recognize.

Up to now, those graduates have been required to take qualifying exams here before they can practice in Israel. Litzman is proposing that recognition be automatic following medical training in countries in the developed world, as reflected by the countries' membership in the OECD ( Organization for Economic Cooperation and Development ).

In what may be a related development, the exam administered to foreign medical school graduates this month was reportedly much less rigorous than previously. Health officials estimate that scrapping the exam requirement would increase the number of potential new doctors practicing at Israeli hospitals by more than 300 a year.

On a visit to the situation room at the Health Ministry in Jerusalem yesterday, Litzman called on the residents to return to work, adding that their work involves saving lives "in the full sense of the word."

The residents have demanded provisions that would cost the government NIS 400 million, while the Finance Ministry at one point offered NIS 100 million in concessions, in addition to the NIS 2.5 billion that the agreement reached with the IMA in August provides in new funding for the health care system.

The staff shortages appeared to be felt most acutely yesterday in the emergency room at Rambam Medical Center, Haifa, with patients waiting many hours to be admitted to the hospital.

The Prime Minister's Office issued a statement yesterday calling on the residents to "demonstrate responsibility and return to the hospitals," adding that they have been given a generous offer that would substantially improve their work conditions. Benjamin Netanyahu officially also serves as health minister.

A team of experts convened by the protest movement leadership has made a number of proposals related to the public health system, including increases in funding for the system, increasing the number of nurses and the elimination of patient co-payments for medical services.