Several days ago, Finance Minister Yuval Steinitz received a letter from Shmuel Reifman, who heads the Ramat Hanegev Regional Council. "For the first time in decades, public health in the periphery has been made a priority, both for those in the field and for residents of the Negev and Galilee," Reifman wrote. "After decades during which residents of the periphery suffered from limited access to doctors, who preferred to work in the center of the country, the agreement allows the periphery access to public health services that are not inferior in quality or availability to those in the center of the country."
Reifman touched on the heart of the agreement - the revolution in the outlying areas of the country.
The problem is that it is precisely because of this revolution that a rebellion against it is underway. The protests are coming from the country's three largest hospitals - Ichilov Hospital in Tel Aviv; Sheba Medical Center, Tel Hashomer; and Rambam Medical Center in Haifa - because in the center, they don't like to be No. 2.
The "guilty party" is Leonid Edelman, who wanted to put an end to the ridiculous situation under which anyone who lives beyond the boundaries of the center of the country gets second-class health-care services. Edelman also secured significant salary increases and special grants for doctors in understaffed specialties such as pediatric intensive care. He is now paying for all of that - with interest.
Angry at the advantage being given to the outlying areas, doctors in the center of the country are saying the agreement doesn't give them anything. They even claim that they will continue to make less than a housekeeper. The numbers, however, tell a different story. This is a good agreement, one that gives doctors an average salary boost of 47 percent during a tough economic period, with the increase to be paid out gradually over nine years. This is a realistic salary bump, because most of it (70 percent ) will be paid within three years. The state will also provide another respectable increase, of 11.5 percent, to improve the health-care system overall, with the total cost coming to NIS 15 billion.
In an effort to ease the pressure on the medical residents, the agreement mandates an additional 1,000 jobs for doctors - a move that would reduce the frequency of on-call shifts to six a month for each resident. In addition, 15 percent of specialists will be able to be promoted to the post of service director, which comes with a higher salary and status. And there are other achievements too, like more continuing education days - with pay, along with issues such as compensation for answering a call when you're not on duty and a shorter (five-day ) workweek.
To remove any further doubt about the quality of this deal, let us note that pension and other benefits amount to 70 percent of a doctor's total salary, including on-call shifts and overtime. If only the rest of the country could make the same boast.
A significant portion of a medical resident's salary comes from the on-call shifts they are obliged to do to receive their residency certificate. But whereas other public-sector employees get overtime of between 125 percent and 150 percent of their base salary, residents get between 400 percent and 600 percent more for every hour of the shift. This is reasonable compensation, which currently yields a gross average of NIS 16,694 a month for a resident in the center of the country who has six on-call shifts a month. The agreement gradually pushes this number up to NIS 21,634.
For specialists just starting out, the current salary of NIS 17,100 a month will gradually increase to NIS 23,366, as long as they do two full on-call shifts a month and two partial ones. Senior specialists will get NIS 29,000 a month, and service directors will get NIS 40,000.
But take note of the periphery, where the salary increases are much larger: The salary of a medical resident in outlying areas will rise from NIS 17,016 to NIS 25,887. Starting-out specialists in the periphery will see their salaries rise from NIS 16,334 a month to NIS 27,516. In other words, doctors who work in outlying areas will earn about 20 percent more than those who work in the center of the country.
But this is just, since the doctors in the center of the country can bring in a second salary by working in hospitals after hours, by consulting, by working for a health clinic, or by going into private practice.
Doctors in the center of the country need to realize therefore that this is a reasonable social-benefits agreement, and that this is the maximum the state can offer. After all, Supreme Court President Dorit Beinisch said this week that "talks will be just within the existing agreement" - meaning that no major changes will be made.
No one argues with the view that the medical field is a noble one, or that its practitioners are the salt of the earth and that their jobs - saving lives and improving their quality - constitute holy work. But the day is coming when they, too, will have to raise their hands in surrender, go back to work, and wait patiently until the next round, in another eight years.
קראו כתבה זו בעברית: צדק חברתי לגליל ולנגב
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