The state is planning a revolution in the administration of the country’s public health system. According to information obtained by TheMarker, the Health Ministry and the Civil Service Commission have recently drawn up a proposal that would impose term limits on the heads of hospitals and hospital departments, together with a rotation system for these positions.
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The Prime Minister’s Office and the ministries of finance and justice also worked on the proposal, which would affect government hospitals and possibly city hospitals as well – Ichilov in Tel Aviv and Bnei Zion Medical Center (Rothschild) in Haifa.
Under the new plan, in most cases hospital directors will be limited to 12 years in two six-year terms, and 18 years at most.
The government hopes to introduce the changes soon. A cabinet resolution on the issue has already been drafted, but the Israel Medical Association – which represents the country’s physicians in salary and other negotiations – is balking, in part because its representatives were presented with the proposal as a fait accompli rather than being brought into the planning process.
The IMA’s cooperation is essential to the plan’s implementation. The terms of employment of the directors and department heads of the government hospitals are stipulated in the physicians’ collective bargaining agreements with the state.
“There’s no axiom that says it’s necessary to carry out rotations. There are directors who serve for many years and do excellent work, and setting term limits would actually hurt the system,” says Leah Wapner, the IMA’s secretary general and legal adviser.
She admits, however, that a system of rotation can prevent burnout and allow for professional advancement, adding, “Traditionally, the IMA was in favor [of rotation], on condition that at the end of their term the directors maintain their employment terms and are given equivalent positions elsewhere.”
If a consensus can be reached, it will be one of the biggest revolutions in the Israeli medical system in decades, addressing one of the system’s greatest perceived shortcomings: the “lifetime” (until retirement age) appointment of these directors, which reduces not only their incentive to improve but also the motivation and likelihood of advancement of physicians farther down the ladder.
The change, if adopted, is not expected to affect current department and hospital heads.
In Israel’s government hospitals, there are more than 1,000 department directors, division directors and service managers. Their contracts are open-ended, and they serve for 16 years on average (from the age of 50-66), with some staying on for more than 20 years.
Under the new proposal, department heads would be hired initially for a period of six years – like today through a tender process – with an option to leave after the first year. At the end of the six years, the hospital director will have the option of extending the department head’s term for another six years. If the hospital director chooses not to extend the term, the department head can appeal the decision.
In certain cases, the civil service commission – acting on the hospital director’s recommendation – would have the authority to extend the term of a department head by up to three years.
After serving 12 years, a department head would have the right to submit a bid in a new tender process, and if chosen could remain in the job for an additional six years – but not more than 18 in all.
In order to counter the argument that senior physicians – knowing that once they become department heads risk losing the position and the higher salary attaching to it after six years – will have no motivation for taking the job in the first place, the new proposal includes a mechanism for preserving the salary and grade steps of former department heads once they rotate out of the position. That provision is expected to cost the state millions of shekels per year.
The proposal also includes a highly detailed protocol for rotating the directors of government hospitals of all types, as well as senior officials in the Health Ministry. Here, too, terms are open-ended and it’s not uncommon to find a hospital director with 15 or even 20 years’ seniority.
Clalit Health Services is an exception to the rule. The country’s largest health maintenance organization maintains a strict rotation for the directors of its hospitals, who serve for only a few years before going on to the next hospital or to the headquarters of the HMO itself.