The massive stress of medical school and grueling conditions at hospital work are starting to take their toll on a new generation of medical students, driving rising numbers of Israelis to reconsider their future in medicine. Many are attracted to the more rewarding and less demanding careers available in high-tech.
“I see friends working in high tech and making big money. Friends who served in [military intelligence] Unit 8200, left the army and right away were earning 30,000 shekels a month. They work normal hours, raise children, and can already buy themselves an apartment. You don’t see such things with us,” says Hila, a fourth year medical student at Tel Aviv University, describing what is considered the classic route to Israeli high-tech.
“My younger brother is a programmer,” she says. “If once my parents had boasted that their daughter was studying to be a doctor, today it’s first of all ‘our son’s in high tech,’ and only later they’ll mention me as well. Something has changed in the way people see medicine as a profession, it didn’t used to be like that.”
Conversations with medical students show that the medicine faculty and hospital walls are not impervious to the incessant noise generated by the high-tech industry. Stories about breaking records are coming out every other day it seems, from exits to wages and perks, these trickle down to the medical students, making some of them wonder about their future career.
They’re enrolled in prolonged, tough and in many senses outdated study programs. The study program itself hasn’t changed significantly, but today’s generation no longer accepts the hard conditions previous generations took as axiomatic. They want to preserve their physical and mental well-being in what is increasingly being perceived as the abusive work environment of hospitals – and to find a new balance between work and life – even if it means being ridiculed by senior doctors.
On the other hand, they also want to “move fast and break things,” as Mark Zuckerberg phrased his motto when Facebook was starting out. But very quickly they discover that their options are limited, that they’re treated like rookies and that they have no way of standing out as individuals.
Into the gap between their expectations and the depressing, humdrum hospital work sneaks in high-tech, with its glittering image, high pay and focus on quality of life for workers.
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“The word high tech is a trigger word for us. It activates us. From what I heard, I know with a fair certainty that if I want to, I could find a good job in a high tech company in the medical field,” says Hila, who is in her late 20s.
“Medical students in Israel have such a high ability that they can easily adapt to high tech,” says Dr. Dina Van Dijk from Ben Gurion University’s Department of Health Systems Management. “Many of them studied medicine because they could, and because it’s prestigious. But already during their studies they start getting a sniff at high-tech, some take courses in it during their studies, some even complete their residency to add another achievement to their CV – then they go to fulfill their dream in high-tech.”
“The high tech companies head hunt them, they’re not looking only for graduates of Unit 8200. The people who go into medicine are the cherry on the top of the cake for these companies,” Van Dijk says.
“They’ve already passed through such a tough selection process that all that remains is to pick them at the end of their studies, or even earlier. And they’re doing it more and more.”
An Haaretz expose this year found that the health system is rife with abuse of employees. It is tainted with authoritarian tendencies, power and pay gaps and workers’ dependence on their superiors – who influence almost every aspect of their work and promotion.
Medical students see what’s going on and are influenced by it. “I dedicated more than three years just to getting into medical studies, but the future is daunting. I’m afraid to become a victim of the system,” says Nadav (not his real name), a medical student in Tel Aviv University.
“I can give a lot to the health system, but I don’t want to feel used, to feel that I’m sacrificing a lot more than I’m ready to – the best years of my life, the time with my wife whom I recently married, with the children I’ll have and the family I want.”
“I ask myself if I want to be in a place with such abusive work hours, where residents and interns get sick because of their workloads, suffer from stress and mental disorders,” Nadav says. “A place where women have difficulty getting pregnant and the divorce rates are higher than usual. I’m not naive, I knew more or less what I was getting into, but gradually I’m realizing the meaning of the sacrifice that this profession demands and I ask myself: is it worth sacrificing my life for?”
“Senior doctors say medicine is an altruistic profession, a way of life. But I see it differently – medicine is first and foremost a profession. All kinds of conventions that belong to the previous generations, that I have to sacrifice part of myself all the time to look after someone else’s health – that’s distorted. They stem from a view that is no longer relevant to 2021. A doctor deserves to have a normal life,” they add.
Hila and Nadav believe they’ll complete their studies before deciding if to go into high tech, but others have decided to cut the program short.
For Karim Nasrallah, 28, all the roads led to studying medicine. His father and older brother are doctors. He started studying medicine in Milan, but his doubts grew with every passing year.
“I wasn’t happy in the first two years of my studies, but told myself it would get better. In the third year I looked ahead at the study years I still had to do, the internship and residency – and realized these studies weren’t my thing, and that I want to go into computers,” he says.
Nasrallah recalled his brother’s first years in medicine and didn’t like what he saw. “I saw how many hours he worked, how doctors were expected to sacrifice their personal lives for the profession and realized I wasn’t interested in living like that. There’s no clear line between your personal time and the time you devote to work. I saw there was a very big gap between what I was willing to give and what the system demands. It’s mostly to give, and to get hardly anything.”
He returned to Israel and graduated with a first degree in computer science. Two months ago he started working as a programmer in Eko, one of whose founders was entrepreneur and musician Yoni Bloch. The company developed a technology that enables creating interactive video clips.
“My father is over 70 and has a private clinic in Shfaram. Sometimes he works there 12 hours a day,” he says. “For him it’s a vocation. But I see friends who completed medical studies and started working, and it’s not what they thought it would be, they regret their choice. There’s even a difference between my friends and my brother’s colleagues, who are four years older than me. The younger generation wants different things, it’s no longer such a ‘wow’ to be a doctor.”
Meanwhile, Nasrallah, who lives in Tel Aviv, is enjoying life in high tech. “There’s an amazing atmosphere in our company. There’s freedom, the hours aren’t too long. Maybe it’s because I’m very new, but everything is simple so far. I see my friends coming home from hospital shifts and only wanting to sleep, and here everyone’s relaxed and easy. Even if there’s a work load – it’s not like the load doctors have to deal with.”
Not everything is rosy in high tech, however. Some employees have to work long hours and be available during U.S. work hours as well - especially daunting when trying to sync Israeli time to Silicon Valley’s. Tech workers are subjected to pressures of their own: from keeping supply schedules, working with clients and the need to “deliver the goods” to shareholders who invested huge sums of money in the company.
Limited tool box
Beyond the super high wages and cushy work conditions in high tech, medical students also see personal growth as an issue. They say that many of their former colleagues who left medicine excel, rise swiftly in the ranks within their companies, make achievements and gain personal recognition for their work.
“During my studies, and especially after entering the hospital wards, I felt that my ability as a doctor to have a significant effect on patients was very small,” says Uri Zelichov.
Zelichov, 34, studied medicine in Ben Gurion University but didn’t go on to his internship. Today he works as the medical director of Nucleai, which developed an artificial intelligence system that helps develop cancer treatments.
“A doctor usually has a limited tool box that someone else built, and with that they have to work with; its a given. Even the most talented doctor cannot change a patient’s diagnosis without rolling up their sleeves, entering a laboratory – or code – because the medical world has become digital – and build new things, that is to reinvent the tool box,” he says.
Nadav, who is in his fourth study year, is looking for a job in high tech, possibly as an analyst in medical startups. He plans to combine this work with his studies. “I want to learn technology and have as many options as possible for when I do finish studying,” he says.
“When I tell my classmates that I’ll graduate from medical school but I’m not sure I’ll be a doctor, they shift uneasily. We’ve all sacrificed a lot to achieve this dream and it’s hard to give it up.”
Dr. Moshe Cohen, the owner of Medical Doctor, said earlier this year that a doctor’s training in Israel costs some 60,000 shekels a year, 80 percent of which is state-subsidized. The state’s overall investment in training a doctor is about a quarter of a million shekels.
“The state invested a lot in my training, but it seems this will be a failed investment,” says Hila. “The chances are that I’ll take my training and work as a doctor overseas, or move to high tech. I’m still hoping to fall in love with some field and specialize in it, but at the moment it doesn’t appear so.”
The Health Ministry said they don’t have an estimate of how many of those who have a license to practice medicine don’t work as doctors.
The Health Ministry and the Israel Medical Association did not provide figures on the rate of doctors who complete six years of study but don’t continue to do internships. The Council for Higher Education has not provided figures on the dropout rates of students during the study program.