1. One should not be overly excited by the attempt of the “Prescription” organization – which unites less than a quarter of interns in Israel – to sabotage the press conference organized yesterday by the Israel Medical Association (Hari) against the outline of shortening shifts promoted by Health Minister Nitzan Horowitz. Students who came to the scene and shouted, but still one thing is clear: as April 1 approaches, the tone will increase and the confrontations between the parties who support the outline and the opponents will only intensify.
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Brief reminder: In April, the temporary order that allows interns to work more than 24 hours in a row will expire. By this time something must happen, otherwise the interns will break the law. Yesterday, Clalit Health Services Director General Ruth Ralbag asked Prime Minister Naftali Bennett to intervene, as in the current situation they will have to decide between harming the public service and violating the law.
As of this writing there is no consensus between the parties – and the gaps are huge. On one side of the barricade stand the Minister of Health alongside a prescription organization and on the other side the Ministry of Finance together with the Medical Association who strongly oppose Horowitz’s outline and offer an alternative model. But neither Horowitz nor Prescription are even willing to hear about the same alternative model. In terms of balance of power one does not have to be a great expert to understand who is the strong side here and who is the weak one, but it is much more difficult to determine who is “David” and who is “Goliath” in this story.
Just last week, the Mendelovich Committee – the Committee for the Implementation of the Outline for Shortening Internships of Interns headed by Deputy Director General of the Ministry of Health, Dr. Sefi Mendelovich – crashed and crumbled when out of 24 members of the same committee, less than half (10 members) agreed to sign the report. Final H. Half of the opponents are Ministry of Health officials under Horowitz.
Moreover, instead of one report, we received three because both the Ministry of Finance and the Ministry of Health issued parallel documents at the same time as the Ministry of Health presented its report. Became a dead letter.
2. “We will not agree to forced wage cuts, coercive pensions, internships and family life of interns – and all this for a political and populist outline,” Omri Cohen, secretary of the Internship Forum in Hari, said yesterday. This outline is not applicable and will not happen – not a single intern has been recruited. On April 1, nothing will happen. Horowitz’s outline is an outline of the detached. It hurts internships, it hurts salaries and it harms the public health system, especially in the periphery. ”
Health Ministry Director General Nachman Ash did not remain obligated and in a conversation with Calcalist responded: “What is this not applicable? Is the current format of 24-26 hour shifts a force majeure? Obviously it is applicable. There is no such thing as inapplicable. The question is how much do you think it’s important to do and how much are you willing to put in to make it happen. Now, there are more interests here that it will not happen than that it will – and that is currently the problem. “So it’s true that it should come at the expense of other things, that resources should be invested in it, and that the IRA and the Ministry of Finance should prioritize it over other things – and also the Ministry of Health.”
He said, “If it is decided that it needs to be done, and I am with it completely complete, then one has to make an effort for that to happen. Then it will be feasible. It is the most feasible model there is. Hari presented this model in the great work they did that took them a year and a half. But we need to invest and make an effort. “Ash concluded with a clear signal that the Ministry of Health has no intention of compromising.
3. “According to the special report published by the Ministry of Finance last week, the main problem with the outline is the number of doctors. Not devices but flesh and blood doctors: there are simply not enough doctors in the country. In the coming years a whole generation of doctors from the former Soviet Union will retire Stable reform “which means disqualifying a significant proportion of medical schools abroad. Israel has a Western record in the number of physicians trained outside its borders (about half). From 2026 onwards, if nothing dramatic happens, the number of doctors will start to drop completely, not just in relation to the size of the population.
Most of those who will no longer be recognized as working doctors in the periphery: more than half of the interns at Ziv, Barzilai, Laniado, Poria, Wolfson, Nahariya and the Holy Family hospitals in Nazareth are medical graduates from unapproved countries. Already now the hospitals in the periphery are peaks in the rate of unmanned standards. The numbers herald disaster.
In the meantime, there is another phenomenon that is not being talked about: most – or all – of the interns were assigned to work in the inpatient setting at the expense of the community (HMOs). This is the reason why last week the Ministry of Finance sent a press release that caused a complete shock: In support of shortening shifts, the Ministry of Finance will budget the shortfall at NIS 66 million. The responses quoted HMO CEOs as welcoming.
The announcement raised two questions of principle: Since when does the Ministry of Finance support the outline and what is the connection to the HMOs’ CEOs?
In the coming years, a reform will come into force, which means disqualifying a significant number of medical schools abroad. Starting in 2026, the number of doctors will begin to decline.
How does it work today? HMOs interview internship candidates to recruit them as community physicians. If they are accepted, the fund funds the internship. But since there is no internship in the community but only in hospitals, the intern goes to the hospital for a period of 3-4 years, and at the end of the internship, instead of staying in the hospital, he returns to the fund.
The big concern in the Treasury is that following the outline of the shortcut, the interns will not return to the community and remain in the inpatient setting. Therefore, the Treasury has added money (above the health basket budget) for the funds to recruit and ensure a respectable amount of community doctors. Shortening shifts cannot come at the expense of harming preventative medicine and community medicine.