The year was 1920 and in an emotional letter to doctors in the Diaspora, the medical association in Palestine urged them not to immigrate to the country. A short article that appeared in the journal Kuntres explained that there were 85 doctors already in the country, double the number before World War I.
“The number of new doctors entering the country is disproportionate and excessive,” the article said, adding that solution was “to approach doctors in every country by means of an open letter that explains the difficult economic situation and how impossible it is here to manage. Let us be wise, lest we multiply!”
Nearly a century has passed and Israel counts more than 20,000 physicians, but the attitude toward the issue of supply and demand and medicine as a profession in Israel remains the same. In their research medical historians Prof. Shifra Shvarts and the late Prof. Haim Doron documented the opposition from the medical establishment every time a new medical school was due to be opened.
When Tel Aviv University prepared to launch its faculty of medicine in 1964, Hadassah Medical School at the Hebrew University of Jerusalem, the first and only such facility in Israel, fought to stop it. A few years later, both schools tried to block the Technion-Israel Institute of Technology in Haifa from opening its own medical school.
When Ben-Gurion University of the Negev proposed setting up its own school in Be'er Sheva, the three incumbents ganged up to try and stop it, and the story repeated itself once again when the new medical school was established a few years ago in Safed. Now, in light of plans to establish a sixth medical school, this time at Ariel University in the West Bank, opposition from the deans of the other schools has surfaced yet again.
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Despite that, the planning committee of the Council of Higher Education this week approved the new medical school in Ariel and its first class of 70 students, with a plan to increase the combined student enrollment at all the country's medical schools to 950 a year.
The expansion of medical education in Israel is an unavoidable step: At a time when the institutions involved are quarreling over the number of students they can accommodate, many future doctors are going abroad to get their training. In the last few weeks TheMarker has revealed figures showing that the country has a larger proportion of foreign-trained physicians than anywhere else in the West – 58% as of 2016.
New figures from the Health Ministry obtained by TheMarker show that the number of new, foreign-trained doctors entering the healthcare system nearly quadrupled over the last decade from 238 in 2007 to 895 last year. By comparison, the number of graduates of local medical schools who apply for a license to practice rose to just 590 from 310, during that period.
This means that Israel has no control over the curriculum, content, type of instruction and quality of practical experience that the majority of its future doctors are receiving. This is also evident in the widely varying rates of those passing the Israeli licensing examination among med-school grads from different countries.
The fact that Israel has gotten itself into this situation is due to the multiple players in the medical education sector – the universities, the CHE, the Health Ministry and the hospitals – none of whom has overall responsibility.
The confusion is most apparent in the fact that hundreds of Israelis are not being accepted into local medical schools at the same time as hundreds of young people from North America are being trained in special medical programs set up for them in Israel, even though the great majority will never practice in the country.
All efforts to eliminate or reduce the number of foreign medical students, which bring in 500,000 shekels ($137,000) of tuition revenues per student to the schools – have failed, most recently last week at a meeting of the CHE.
If Israel is perhaps slowly and haphazardly addressing its medical education crisis to some extent, it is still failing to ensure there are enough specialists to meet the demand. The number of specialist positions hasn’t grown at the pace of the patient population, which has resulted in longer waiting times for appointments and shortages of experts even in Israel’s peripheral areas, where demand isn’t high.
The severity of this shortage is anyone’s guess because neither the Israel Medical Association nor the Health Ministry has any statistics. But Mirsham, an organization representing the interests of medical specialists, reports that waiting times have lengthened to months. In some of the most high-demand specializations, the waiting time can stretch to two years.
If Israel is going to cope successfully with its shortage of doctors, it needs to draw up a comprehensive plan that covers not just medical education but the healthcare system as a whole.