Israel's Top Doctors, the Real Lords of the Land

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It took only about 90 seconds for the provision to be removed from the draft of the 2013-14 Economic Arrangements Law. The Finance Ministry has stopped counting the number of times it has tried to push something similar through. The ministry should be lauded for its persistence in promoting important programs that have no hope of passing. Even more, you have to hand it to the people with political power who repeatedly scuttle the ministry's efforts to cut them down to size. I'm talking about hospital heads and department heads.

The Finance Ministry wanted to make clear that hospital chiefs are not royalty in power for life. The most recent attempt at term limits, the one in play for a minute and a half, was the product of a year's work at the finance, health and justice ministries. The provision would have limited to six years terms at the top at government hospitals, with an option for another four years. So no one would be able to serve more than 10 years.

If that sounds reasonable, note that the country's most powerful hospital director, Gabi Barabash at Ichilov in Tel Aviv, has been on the job for 17 years. Zeev Rotstein at Sheba Medical Center in Tel Hashomer is nearing nine years at his post. The average time on the job for the heads at Israel's 23 hospitals is about nine years; at government hospitals it's 11 years. So limiting terms to 10 years would make a difference at many government hospitals.

The 90-second life of the 10-year limit was enough to prompt media reports that Barabash and Rotstein were being dismissed; that they were being harassed by the Finance Ministry for their stances during a major doctors' strike. But remember, the government has been trying to push through this change for the past two decades.

In any case, the finance and health ministries took the hint and retreated. They know who they're up against – the senior doctors' lobby, apparently the most powerful lobby in Israel. In a country where most medical care is still provided by the public health system and you need connections to gain access to senior hospital doctors, no one wants to fight with the hospital heads or department directors.

So it seems that hospital directors, who at government hospitals oversee a collective budget of NIS 10 billion a year, have jobs for life. No one limits their terms and no one makes them meet targets.

The prospect that hospitals would become the domains of people at the top may be a concern, but don't worry: Each hospital is divided into sub-domains, headed by the directors of hospital departments. They have similar life appointments.

The latifundia system

In the health system, a dispute rages over who is more powerful: the hospital heads or department heads, though clearly both sides enjoy rare power and handsome salaries. Hospital chiefs earn on average NIS 74,000 a month, while the average salary as of August of last year, when only the first third of the latest salary agreement had taken effect, was NIS 39,000 in the center of the country and NIS 48,000 in the outskirts.

And this comes on top of what the doctors are earning at their private practices. If you're a department head, you can boost the rates you charge from patients' supplemental insurance.

Of course, younger doctors pay the price; their advancement is blocked because most senior positions at departments are filled for life. The damage of this lack of advancement was exposed in full force during the last doctors' strike.

But don't worry, Israel's health system has found a solution to this, too. Since the system's top positions are filled for life, there are hundreds of new senior positions: unit heads. And they too are appointed for life.

The latifundia system – I manage my estate for life – has reached a new peak: Nearly every senior doctor at an Israeli hospital is now a manager of some sort. He might only be managing himself, or himself and a nurse, but no matter – he's recognized as a manager and receives a salary accordingly.

Based on data from the Finance Ministry wages commissioner, of the 3,590 doctors at hospitals, 1,189 – or 33% – were defined as managers. The most recent salary agreement created a new category – service manager. This created new positions for 300 doctors. This means that around 1,500 of all hospital doctors will be managers – 40%. Managers, by the way, earn about NIS 35,000 a month, about one-third more than what senior doctors who aren't managers receive.

This ridiculous pyramid stems of course from senior doctors sticking to their seats for life while crassly ignoring the damage to younger doctors and the health system as a whole. It's true no one wants to fight with the department heads or hospital heads, but maybe the time has come?

Doctors at Sheba hospital.Credit: Ilan Assayag

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