This month, 10 years after the doctors' strike of 2000, which lasted four and a half months, the wage agreements with the doctors, and the subsequent quiet in the public health sector are due to come to a crashing halt.
With this in mind, Dr. Leonid Eidelman, head of the department of Anesthesiology at Beilinson Hospital, sums up his 10 months as head of the Israel Medical Association and speaks about the decisive struggle over the doctors' status in Israel in the coming few years.
Are the doctors in the public health sector heading for a strike?
The wage agreements with the doctors end in July, after 10 years, and our impression is that during the past decade the treasury succeeded in drying up the health system through a murderous diet. They skimped on work slots, investments in infrastructure, payments to doctors - they skimped on everything possible, and now we are facing a hopeless situation and the system is in worse condition than it was a decade ago. The ratio of doctors to the general population has decreased and there has been a dramatic growth in the gap between what a doctor earns here and abroad. In short, the health system has deteriorated in every possible way. Before the High Holidays we shall begin new negotiations with the government and the doctors are ready for organizational steps. For the doctors, all steps are acceptable, including a strike and the most dramatic and difficult of moves, because we cannot stand the situation any longer.
What did you learn from the previous agreement with the state, following the strike in 2000?
For the most part, wage agreements are not long term but in 2000 the doctors took on themselves a 10-year commitment to refrain from striking, and they stuck to it. In short, they felt disappointed because the Finance Ministry succeeded in dragging out the arbitration process for eight and a half years. The original intention was to make it possible to have several arbitration agreements during the 10 years with several wage hikes, but in the end there was only one, and only after we went to court and we forced the state to uphold the agreement it had signed with us. The treasury forced the doctors to go to the court and ask for support, and that is a dramatic change in work relations between us. With regard to the long-term agreement to which we are signatories, the doctors have lost faith in the Finance Ministry. And it is in this situation that we are entering the new negotiations.
In recent years, we have witnessed a serious shortage of doctors in the hospitals. Will this be addressed in the negotiations?
Certainly. We recently began examining the job slots in the hospitals, a subject that is linked with the number of beds in the hospitals and visits to community clinics. It must be remembered that the standards for the public health institutions in Israel was last examined thoroughly during the 1970s and approved in 1976. For 34 years, they refrained from a thorough examination of the issue and the agreement that existed previously for temporarily updating the standard was also ignored. Since then, medicine has changed completely and indeed more treatments have been transferred from hospitals to community clinics but the population has grown older and the cases in the hospitals have become more difficult, the turnover of patients is higher because the period of hospitalization has been significantly reduced, and the doctors also provide preventive medicine services that were not as developed in earlier times. Today a patient in Israel is hospitalized for three or four days - a day for admission, a day for being released and perhaps a day or two for treatment. This is not good medicine. The need for documentation of the medical condition of the patient has also increased significantly and the doctors also carry out more tests for fear of legal suits, and this conduct also places a burden on the system. During the past decade, when the arbitration was taking place, only three medical specializations were defined as being in problematic conditions - anesthesiology, intensive care and neonatology. Now the trouble has spread to other specializations and in these too the salary hikes were not significant enough to change the situation. There are specializations that are already in trouble like surgery, internal medicine and pathology. We are currently looking into the subject in anticipation of negotiations and we shall bring this up for discussion.
In the past few years, the struggle between the medical association and the incumbent health minister has grown more severe, and now your relations with Deputy Health Minister Yaakov Litzman are tense. How do you think you reached this situation?
If there is a feeling that there is a struggle between us, that feeling is incorrect. I don't get up in the morning and think what I'm going to do against the Health Ministry or against Litzman, but unfortunately the ministry provides problems that require our attention. For example, this week we reacted to a call from the director of the Nahariya hospital to get budgetary assistance. How is it possible not to help a director, who is a doctor by profession, who is being attacked by the Health Ministry, to get a budget for his hospital? Who suffers from the lack of a budget? The patients from the periphery, from the Nahariya area. The ministry first tried to penalize southerners by holding back the building of the emergency room at Barzilai Hospital [in Ashkelon] and now they have to understand that they are harming the residents of the north who need treatment at Nahariya. The criticism against Litzman is not personal and I regret if the deputy minister sees it in that light. He is a seasoned politician and perhaps he has decided to consider the criticism as being personal instead of replying to the complaints professionally.
This week Litzman chalked up an achievement with the inclusion of dental care for children in the public health system, a program that will begin tomorrow.
If the children in Israel get free dental care that will be a great achievement and if it happens next year as well, I'll be even happier. But the entire plan is not built on solid ground and it is not yet clear where the money for next year will come from. Everything is based on tacit agreement. It is not merely that the state has not yet approved a budget for the plan for the coming years, they have taken for it NIS 65 million that were meant for medicine for patients. So should I be glad that they are taking money away from the sick? My fear is that in the end there will also not be money for the medicine for next year because of this plan.
How do you wish to deal with the rise of recent years in the number of medical malpractice suits?
We have been trying in the past few years to push compensation mechanisms for anyone whose treatment was unsuccessful without admitting negligence, with a mechanism known in the West as "no contest." All those who have been harmed have to receive compensation, but with lower sums, and the payments have to be spread over several years to ensure that it is given so as to help them to deal with the medical problems that ensued. That is a model that works in Scandinavia and New Zealand. Today it seems the doctors are more wary because of the fear of being sued, but that is merely an illusion. The doctors are not more careful but they learn how to hide things, how not to incriminate themselves. The present mechanism does not teach but mainly answers the need for explanations, and it prevents learning lessons.
There are accusations that the IMA prevents any attempt to carry out comparative checks of the quality of medical care that is administered in Israel. What is your take on that?
I am not worried about saying this: the IMA opposes the system of measuring the quality of the treatment as it is being planned, mainly because no one is planning to invest money to correct the problems that are found. Already now the hospitals examine the quality of treatment in the departments, for example deaths and complications after surgery. But if the intention is that an outside body should carry out checks, like the Health Ministry whose only aim is to find who is guilty but not to correct things, we have a problem with it. Here in Israel, if hospitals are measured according to successes, everyone in the country will want to go to the best hospital. Hospitals that receive low grades will have to improve, and I assume these will mainly be those in the peripheral areas but of course at the moment there is no plan to give them the money to improve, so measuring the quality of the medical treatment will simply perpetuate the gaps. In order to seriously examine such a plan, it is important to know in advance how much money will be allocated for improving the system. If a hospital in the north or the south of the country is given a low grade when the quality is measured, it is important to know in advance what is being planned to give it so that the situation will improve.
A plan is being promoted in the health and finance ministries to take the Scientific Council out of the hands of the IMA. What's your take?
They have been playing around for more than 10 years in the treasury with the idea of moving the Scientific Council, which is responsible for training doctors and for specialization, to the Health Ministry, without any connection to the needs. Perhaps they believe there that they can control the needs of the health system better in this way. The professional elements in the ministry always considered the idea of a move of this sort to be completely crazy because the council is a giant enterprise that is responsible for 5,500 interns at every stage and 1,600 senior doctors in Israel carry out the task on a completely voluntary basis. We see the plan as a declaration of war against the standard of medicine in Israel. If the activity is taken out of the hands of the IMA, the doctors will demand money for it. batsheva tsur etzion