Only 250 oncologists currently treat cancer patients in Israel, whose numbers and life expectancy have grown over the last decade. These doctors, including oncology clinicians and radiologists, divide their time between clinics, hospital day wards and wards for prolonged stays. Their work load is enormous, and the Israeli Oncologists Union estimates that hospitals lack 180 positions for additional oncologists in order to meet the growing demand.
Some wards are located in new buildings that were financed by donors, but looks can mislead. The number of oncology positions hasn’t been updated for years, while treating cancer has been greatly transformed, making great strides. It is characterized by new medications and treatments that were previously unavailable, with higher survival rates. Longer life expectancy has increased the numbers of new cases.
“Coping with cancer is one of the major tasks we face in the next decade,” says the director of the Rambam Health Care campus, Prof. Rafi Beyar. “The previous decade saw a 44 percent increase in the number of patients with only a 12 percent rise in the number of oncology positions. We now lack 40 physicians, as well as additional staff such as radiation technicians – an area that has grown dramatically. The duration of treatment has been extended by a year, reaching 4.7 years on average. The number of hospitalization days in oncology wards has grown by 20%, to 9,700. Despite this, personnel and infrastructure have remained static.”
Visits to clinics have also increased, with intolerable stress on the entire oncology infrastructure, expressed as a shortage of beds and manpower.
These problems are common to all the major hospitals that have an oncology center. The Oncologists Union warned of shortages several years ago, stating that 150 additional oncologists were needed in 2012, with the number probably rising to 200 by now. Standards were last set in 1995, with one doctor assigned to five hospital beds. 1,700 clinic visits were allocated to each doctor (who had no lecturing duties). One radiologist was assigned 200 simulations a year. These numbers are now totally unrealistic, with much higher burdens on all staff members.
The Oncologists Union’s director, Prof. Wilmosh Marmerstein from the Soroka Medical Center, says that “the cancer field is rapidly changing. Survival rates are higher but things are more complex. There are many more options and tests, so that appointments take longer, requiring more explanations and information. There is a more personal connection with patients, with more mental stress on doctors.”
Dr. Ido Wolf, the head of Ichilov Hospital’s oncology department, adds that the field has been turned on its head in recent years. “Patients receive second, third and fourth lines of treatment, which are increasingly complex. They survive longer with more and different types of complications than before. There is a rise in the overall number of patients. The clinics are also overburdened, with doctors seeing 15-20 patients a day. This is unrealistic, since longer sessions with patients are essential. The shortage is nationwide, even though this is the number one cause of death. The entire burden now rests on only 250 doctors,” he says.
Dr. Raanan Berger, the head of Sheba Medical Center’s Oncology Institute, says that “the increasing burden stems not only from larger numbers of patients and improvements in survivability, but from the increased complexity of treatment. With mixes of medications there is also more bureaucracy involved, adding to the stress. Patients are better equipped with knowledge and often won’t accept a verdict that no more can be done.”
The Ministry of Health commented in response: “The ministry attaches great importance to finding solutions for oncology patients. The director general, together with leading hospitals, is preparing a plan to strengthen the system, with the addition of more beds and oncology positions. A new radiology center is planned in Safed. Deputy Minister Litzman has instructed the ministry’s director general to find ways of increasing the number of PET and MRI machines in order to shorten waiting times and enhance diagnosis. New cancer centers have opened in recent years in major hospitals, geared at providing comprehensive treatment for cancer patients. Patients enjoy subsidized benefits, with one third of the ministry’s budget devoted to new anti-cancer drugs. Radiation clinics are also being upgraded.”