About six out of every 10 (58%) physicians working in Israel in 2016 went to medical school overseas – at their and their families’ expense.
This is the highest incidence in the Western world of doctors being trained outside their home countries, almost three times the OECD average, according to a new Ministry of Health report comparing Israeli data in the fields of medicine and health with those of the 35 international organization’s member countries.
The significance of this statistic is that Israel relies to an enormous extent on subsidization by private households and individuals when it comes to financing its future doctors’ medical studies abroad. Such costs can often reach tens of thousands of dollars a year – hundreds of thousands of dollars over the course of the studies.
The main destinations for these students are Hungary, Italy and Romania. After completing the programs abroad, they must take additional licensing exams in Israel, a process that usually includes a preparatory course and also substantial sums to cover licensing fees.
Accordingly, the number of students graduating from medical schools in Israel is almost the lowest in the OECD: 6.8 graduates a year per 100,000 residents, compared to an average of 12.1 overseas.
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The demand to go to medical school in this country is immense: Over-the-top grades in high-school matriculation courses and psychometric tests are required, and the disappointed ones who dreamed of becoming doctors and weren’t admitted – including excellent candidates with very high marks – are left with the option of displacing their lives and studying for many years in a foreign country, and at their own expense.
Medical studies are the most expensive and demanding of all disciplines in the higher education system. They require extensive infrastructure in the form of labs, operating rooms and animal-testing facilities, all of which are heavily subsidized by the state.
But the most serious bottleneck preventing an increase in the number of medical students in Israel is what is referred to by professionals as “clinical fields” – namely, positions in top-flight hospital departments where students can be trained at a high standard under the supervision of senior physicians. The number of such places is limited, which makes it impossible to significantly raise the number of students overnight.
On the other hand, there are illogical aspects of this whole system. For example, there are some 100 Americans studying medicine in Israel, as part of a dedicated program that has access to the limited clinical training positions, even though it’s known up front that the vast majority will return to the United States at the end of their studies.
Furthermore, local health maintenance organizations have for years been calling for creation of such training possibilities within their own system, outside the framework of the hospitals. This would allow the entry of additional, much-needed students into the pool of trainees.
In tandem a debate is going on regarding whether there is a scarcity of doctors in the country to begin with – or whether the current situation, in which between 1,200 and 1,300 Israelis complete their medical studies each year (in 2016, the majority of these were overseas, as noted), actually meets the demand.
Medical schools deans claim that Israel has an adequate number of doctors if one takes into account those studying abroad. The HMOs argue, however, that there is a severe problem of long waiting times in the healthcare system and an urgent need to inundate the country with more physicians.
Thus, despite clear-cut data showing the dependence of the Israeli health system on doctors trained overseas, TheMarker reported in 2017 that local medical schools strenuously objected to setting up a new school of medicine at Ariel University, in the West Bank. The heads of medical faculties argued that there already is a shortage in hospital training positions, so “taking this step will significantly hamper the ability of existing schools of medicine to provide adequate clinical training.” [The cornerstone for the new medical school in Ariel, underwritten by American casino tycoon Sheldon Adelson, was laid last summer – eds.]
Education Minister Naftali Bennett, who supports establishment of the new medical school, says that its opening will reduce the number of students needing to go abroad for their studies.
In response, the deans of existing schools say that even if the number of medical students in Israel rises substantially, hundreds will still continue to go overseas because their grades are too low or because of other reasons that make them unsuitable for acceptance here.
One idea suggested by the deans is partial subsidization of studies abroad, but so far there is no concrete plan to pursue this.
The recent report published by the Ministry of Health’s Financial and Strategic Planning Administration also shows that the life expectancy of Israeli men rose from 80.1 in 2015 to 80.7 in 2016 – two-and-a-half years more than the OECD average, which stands at 78.1. In 2000, the life expectancy of Israeli men was 76.7. Among their female compatriots the gap is smaller – their average life expectancy is 84.2, compared to 83.4 in OECD countries.
The overall population life expectancy in the country, as of the latest data, from 2016, is 82.5, putting Israel in sixth place among OECD countries.
This number is surprising and particularly interesting given the report’s dismal portrayal of the dwindling resources in Israel’s healthcare system and of the heavy burden placed upon it.
Also reported is the fact that in 2016 there was a continuing trend showing that healthcare expenses in Israel were among the lowest in the West, standing at 7.3% of GNP, compared to an average of 8.9% in other OECD countries. However, private payments for medical care in Israel are among the highest, standing at 37% of all such expenses, compared to 26% in the other countries.
Despite the abundant resources invested in the addition of MRI machines and in the licenses required to operate them, Israel still trails behind most OECD countries, with 4.9 machines per million people, compared to an average of 15.8 machines per million people in the OECD, according to 2016 data. Only Mexico and Hungary have smaller numbers.
Once again, the ministry report reminds us how problematic Israel’s situation is with regard to smoking. The proportion of smokers in 2016 among the population was 19.6% – 2% higher than the OECD average and among the highest in the Western world.
In contrast, Israelis do not have a serious alcohol problem. They consume an average of 2.6 liters a year, one-third of the OECD average, making Israel the second from the bottom on the list, above Turkey. For the sake of comparison, the average consumption of alcohol in France or the Czech Republic is 11.7 liters per person.
In Israel the rate of suicides is also the second-lowest – one-third of the OECD average. In Israel there are 4.1 suicides a year per 100,000 people, compared with 12.4 in the member countries.
When it comes to birthrates, however, Israel still leads the pack with an average of 3.1 children per woman, compared to 1.7 in the OECD.
What the recent ministry report doesn’t reflect is the gaps – geographic, gender and socioeconomic ones – that are at play in areas including life expectancy, MRI testing, rates of smoking and suicide, types of disease as well as level of medical services.
The closing of these gaps should be the focus of investment and concern among policy makers.