Some 1,100 medical residents submitted letters of resignation on Thursday, even as the government was embarking on a reform that the residents have long been demanding to shorten their long hospital shifts.
More than a year and a half into the coronavirus pandemic, it doesn’t appear necessary to explain to anyone what the impact of such a move will mean if the residents make good on their threat. The resignation letters are due to take effect at the end of the month.
How, of all days, did it come to pass that they announced their resignations on the same day that the Israeli government declared that it was reducing the length of residents’ shifts – a move that the residents have been campaigning over for years? Is it really the historic event as the health and economy ministers were claiming or the “dark day” that Mirsham, the residents’ association, have described it?
The answer, in short, is that it’s both.
Health Minister Nitzan Horowitz is correct when he says that shorter shifts are indeed a revolution. He is also right in saying that over the years, “no one wanted to touch” the issue. It was a difficult and complicated problem involving sharp differences of opinion and conflicts of interest, intense lobbying and other pressures. “No one wanted to devote the resources to it,” the health minister said.
He is also correct in noting that after years of empty promises, the current undertaking marks the first serious effort to address the problem of the residents’ long work hours. He’s right in pointing out that the move has budgetary backing in the pending state budget and that, unlike the empty promises of the past, this time the prospects are high that it will be carried out.
For their part, Health Ministry officials are justified in feeling that it’s unfair that the fire is being directed at them precisely when they have taken significant steps to end the injustice of hospital shifts that run 26 hours straight. But the residents, who are angry and see no cause for celebration, also have a case.
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They are right in saying that the new rules are being applied too narrowly: In the first phase, only a very small share of them – those working at hospitals in outlying areas of the country (and aren’t in surgery, intensive care or anesthesiology) will see their hours reduced. But the main reason that they are right to complain is that the plan is open-ended and doesn’t include a clear timeline as to when the process of cutting back the hours will be completed.
The situation of surgical residents, who make up nearly 30 percent of the total, is clouded in ambiguity. The plan also doesn’t make clear when residents in every specialization will transition to shifts of less than 26 hours. (The issue of surgery is complicated, but officials can’t simply ignore it when undertaking an initiative such as this.)
The residents are also correct in saying that the reduction in hours could have already begun in the coming year – even at internal medicine departments and emergency rooms all over the country. It’s complicated to carry out, but it’s possible.
No matter how you look at it, however, the reduction marks a tectonic shift for a health care system not accustomed to rapid change. It promises to become a catalyst for reexamining the quality of the residency system itself; the constellation of power in the health care system; the deeper problem of a shortage of doctors; and the issue of adding auxiliary staff to reduce the burden on doctors and give them more time to practice medicine. All of these are critical issues that are now being addressed.
Past experience, such as the strike in 2011, demonstrates that when residents have the backing of their managers to fight to the end with the threat of resignation, they’ve managed to chalk up exceptional accomplishments.
This time around, the residents have recently been gaining increased support from their departments and hospitals in their campaign to shorten shifts. As a result, more and more residents have signed the resignation letters.
The next month will see the pressure shift from the Health and Economy Ministries to the Finance Ministry, which will come under pressure to find the money to fund the implementation of shorter shifts for a broader group of residents. At the same time, counter-pressures, which have already surfaced, will intensify. The drama over the issue has just begun.