A month has passed since the medical residents launched their spontaneous protest that enlivened the drowsy talks between the Israel Medical Association and the Finance Ministry. It all began on July 19, when the residents were informed about the draft agreement between the sides and decided to protest the lack of binding conditions. With support from the tent protesters, the residents left their hospital stations, blocked traffic and threatened to go on a hunger strike.
Two weeks ago came a breakthrough in the negotiations, including acceptance of some of the residents' main demands - 1,000 more hospital positions for doctors and the reduction of duty shifts to six a month. The residents then ramped up their protest, submitting more than 1,000 resignation letters that threaten to undermine the public health system if they take effect on September 4.
In a letter last week, Finance Ministry wages director Ilan Levin detailed the concessions the residents have achieved as part of the talks. These include hundreds of new resident positions at hospitals, fewer monthly shifts and additional compensation beginning with the seventh shift each month, a significant pay raise, a five-day work week, overtime pay and an expansion of pension allocations.
But all this failed to bring calm. On the contrary, the residents continued their protest, announcing on Tuesday that their representative will walk out of the mediated talks between the IMA and Finance Ministry.
Yesterday saw attempts by hospital managements to prevent residents from resigning. In a meeting at Rambam Medical Center, management called on department heads to concentrate on preventing residents from implementing the planned mass resignation. We spoke with Dr. Ronen Bar-Yosef, 36, a specialist in pediatrics and a resident in pediatric pulmonary medicine at Rambam. He's also one of the hospital's representatives in the junior doctors' council that was set up during the protest.
Why did the residents decide this week to walk out of the talks with the treasury?
I'm not an official representative of the council, but I can say that the decision was based on the sense that the council was not an effective side in the negotiations. Our representative was not included in meaningful discussions, and when we asked to be a significant part of the mediation process, we were refused .... We're not interested in receiving a signed agreement that we can't respond to. We want to be part of the process so the interests of all sides are safeguarded.
Do the residents feel they have a sympathetic ear in the IMA or the Health Ministry?
In recent days there has not been sympathy. Not in the Health Ministry, as shown by the violent step by the ministry's director-general against us - which constitutes a threat - asking that the resignation letters be collected so he can use them selectively in the future. Nor at the IMA, whose heads repeatedly refuse to include us as a side in the negotiations.
Can you clarify the reasons for the resignation of the resident doctors?
There are certain binding conditions that have not changed; they've been specified in the press several times, and we haven't moved one centimeter. No binding condition of ours has been accepted. We think the addition of staff positions is spin because it is provided outside the cost of the agreement. This means the positions will have to be part of the budgetary framework of the hospitals themselves, and the hospitals don't have the budget to fund them. So these positions can't be used. In the previous agreement, 650 positions were promised, but that hasn't been implemented to this day. So this provision has no practical meaning in our opinion.
Another binding condition is reducing duty shifts to six, and in this case too the concession is problematic. Already in 2000 it was agreed that residents will not be on duty for more than six shifts, and that during a residency the number of shifts will be reduced to four .... Now they're stipulating a maximum of six shifts over the entire residency, which is in fact a worsening of working conditions compared to 2000 ....
Another binding condition is a raise in beginners' pay for residents to NIS 50 an hour, so doctors can enter the system and those who have studied for many years can provide for their families. Nurses who work alongside us are paid much higher hourly wages than we are. We appreciate their work and think we deserve to be paid at least as much as the staff members that work by our side; that's a respectable salary.
It's claimed that the managers of the major hospitals in the center of the country, who seek to introduce private health services, are behind the residents' demands. Is that true?
Speaking in the first person, that's not the case. Prof. Rafi Biar, the director of our hospital, has given us his full support. I don't think that's because of a desire for private health services, but because he's a doctor like every one of us and believes in the justice of our claims. I think his support is based on his complete identification with our struggle.
How long will the residents continue their struggle?
There's a very clear deadline - in 21 days the resignation letters will take effect. We at Rambam have so far submitted 131 letters of residents who have resigned, and over 100 letters of specialists, including department heads. When the time comes, we'll resign, and then the whole issue will be the Health Ministry's responsibility.
What else can the residents do to raise the public's awareness to their struggle?
We have lots of plans until the resignation takes effect, but that's part of the developments in accordance with what happens on the ground. Many things are planned. After all, our declared objective is not to resign, because the patients' interests are of paramount importance to us all along the way. But if there's no choice, we're determined to stand behind the step we've taken.
Yesterday the residents held a conference at Rambam. There were specialists who supported them and others who opposed them. In your opinion, does this struggle create a split in the health system?
From the very beginning, at Rambam the residents and specialists have been unified, our hospital has the largest number of specialist resignations and it is second nationally, after Sheba, in the number of resident resignations. Besides, Rambam has a huge number of senior doctors who have supported the residents' step in writing, adding their signatures. But the struggle may indeed cause a rift between residents and specialists at other hospitals. That's the Health Ministry's goal, and we're trying to prevent that and acting to continue operating as one body.
Do you think the residents' struggle is linked to the general social protest now happening around the country? Is it linked to the struggle over housing costs and the high cost of living?
If you look back, the doctors began their protest long before the social justice protest. Obviously they're part of the middle class and part of the public that's experiencing socioeconomic distress. In my opinion these two struggles are not dependent on each other, but they're being conducted in parallel. And both deserve to be listened to.
What do you personally plan to do after you resign?
Unfortunately, like any doctor in the public health system, I work in a number of positions. If and when the resignation takes effect, I will continue to work in my other positions at a health maintenance organization. And I hope the crisis ends as early as possible and we all go back to work. Although each resignation is entirely personal, we hope everyone resigns on the same day, and that everyone is returned to work that same day.
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