Noblesse Oblige

In negotiations about doctors' conditions, the key is in the hands of the senior physicians, who must make concessions; this is a noble profession, and noblesse oblige.


The medical profession is a noble one. When young men and women decide to study medicine, they do so out of a sense of mission and self-sacrifice. They want to cure sick people. They are trying to save lives.

It's also an interesting, wide-ranging profession whose services are in demand around the globe. All these considerations explain why doctors feel they aren't getting what they deserve.

So they have launched a battle. But since they are intelligent people, they haven't left anything to chance. Their campaign was meticulously planned.

The first stage began four months ago; this was the stage of influencing public opinion. During this stage, doctors spoke about the "collapsing health system," and about residents who, they claimed, earn less than cleaning women, even though their average wage comes to NIS 18,000 a month (for six shifts a week ).

The second stage began two months ago. This was the stage of limited work sanctions, a war of attrition. During this stage, they would temporarily halt services first in one place, and then in another. The third stage is set to begin on July 1, when they will launch a strike that will virtually shut down the country's hospitals.

The problem is that while the doctors talk about residents' low salaries for public consumption, the residents aren't even represented at the negotiating table. They aren't taking part in the talks, and not a single demand is designed to improve their wages. The whole effort has one goal: to improve the salaries of specialists and senior physicians.

Why? Because Israel Medical Association chairman Dr. Leonid Eidelman's power base consists of senior physicians and heads of hospital departments. These leading medical professionals occupy the top leadership spots in the medical union. Should Eidelman not obtain significant material gains for them, he will not keep his post at the IMA. The residents can wait.

The IMA prefers to conceal information about the real wages earned by senior physicians and specialists. The association does not talk about its members' moonlighting. But about a third of IMA members work in the afternoons in special hospital frameworks that offer extra income. Another third have private practices, or jobs in private hospitals or institutes, or work as community consultants, or as independent physicians in health maintenance organizations.

These are special privileges not enjoyed by any other public-sector employees. An engineer employed by the National Infrastructure Ministry cannot do "after-hours" consulting on private-sector engineering projects. A lawyer in the State Prosecutor's Office cannot write private contracts in the evenings. But a doctor can see patients for consultation in private clinics, in exchange for hefty payments, and then make sure these patients have their operations in public hospitals.

There are indeed problems in the health system. Therefore, it is right to increase the number of medical school graduates; that will reduce the shortage of doctors. Doctors who move to the periphery should be compensated generously. Financial incentives should also be given to doctors who choose to specialize in fields where there is a shortage of physicians.

Steps should also be taken to improve working conditions for residents. The length of their shifts should be reduced, as should the number of shifts they do each week. And incentives should be given to senior physicians to agree to do regular hospital shifts. As things stand today, a person can be admitted to a hospital in the afternoon and be treated by a resident who completed his or her training the day before without a senior physician anywhere in sight.

The Finance Ministry has gone a long way toward meeting the doctors' demands. It is prepared to sign an eight-year agreement awarding doctors a 20 percent raise, plus an additional 8 percent if they agree to punch a time clock and switch to a five-day work week.

But it isn't offering the same raise to all doctors: The treasury wants the bulk of the money to go toward solving the problems of the residents, the periphery and understaffed medical professions. The doctors, in contrast, want most of the money to go to specialists and senior physicians. On this issue, the Finance Ministry is right.

Now, with mediation from the courts, the sides are set to begin two weeks of intensive negotiations. This represents an opportunity to forge a just agreement. But the key is in the hands of the senior physicians, who must make concessions. After all, this is a noble profession, and noblesse oblige.