The amount allocated is less than the amount needed to drive the move – NIS 100 million, but the implementation of the outline is not only a problem of money, but mainly of a shortage of doctors. After all, there is no reason – if the intern finishes a shift, someone must replace him and now there is no such person. The fear is that the price of the damage will be borne by the residents of the periphery, where the implementation of the outline is supposed to begin, who are already suffering from a particularly severe shortage of doctors. Furthermore, Horowitz’s “Committee for the Implementation of an Outline of Shortening Interns’ Shifts”, headed by the Deputy Director General of the Ministry of Health, Dr. Sefi Mandelovich, collapsed when 14 of its 24 members refused to sign the final report – including representatives who were subordinate to Mandelovich In the end, Mendelovich himself – whose committee was designed to make a quarter of the circle – admitted in the report that there was a problem he was unable to solve, and that was the issue of the weekends. The problem is that an intern who will participate in the scheme will be forced to work every weekend or break the principle and still work a 24-hour shift. In the end, only three people wanted this outline: the head of a prescription organization that represents a tenth of the interns, Ray Beaton, Minister Horowitz, who was buried politically, and the director general of the Ministry of Health, Nachman Ash, who does not receive the support of the system.
However, there were some hints that the outliner had not said his last word and that shortening the shifts of the interns had become an important item on Lapid’s list of tasks for the 2022 elections. began to deal with it on a personal and daily level. She met with the heads of the editorial board and devoted quite a bit of time to it, but behind the scenes and without unnecessary publicity. A second sign was Minister Horowitz himself – a former journalist who is well acquainted with the dynamics of media and public relations, who began tweeting, promoting and above all “taking credit” “On the same agreement that was strongly opposed by the health care system and the treasury. Horowitz’s awakening after his defeat in his party hinted that something was happening below the surface and he would not be willing to give up the approaching photo-op.
1 Viewing the gallery
2. Last night Hapur fell – the Medical Organization (RAI) convened an urgent discussion on “Lapid’s unilateral steps” to shorten duty shifts in the outline of the competing organization Mersham. the hospitals, because the Prime Minister decided to promote the outline and implement it. He also informed that there were attempts on behalf of the organization to sit down with the Prime Minister and explain the problems in the outline and what is delaying its implementation, but Lapid refused. More precisely, Lapid gave them an ultimatum – if you want to meet me, come with a list of concessions and compromises you are willing to make in the context of the outline. Otherwise, we have nothing to meet. Bharri thought this was too much and preferred not to meet with anyone under ultimatums and preconditions, not even with a prime minister. Especially after Bharri believed that Shultz “played games” with them and withheld information from them – explained sources in the organization. Contact with Schultz has been cut off in recent days.
This morning it was already clear to the senior officials of the RA and also to the seniors of the hospital system, who are expected to bear the consequences of the current shortcut outline, that Lapid decided to go for it and now he is just trying to figure out how to do it. To the question of “Calcalist” whether Lapid is going to sign an agreement with the interns of Mersham To shorten shifts to 16 hours and to allocate NIS 66 million for this, his office began to quibble, they did not deny and officially said: “The Prime Minister is working to solve the crisis of interns and to make sure that the shortening of shifts as promised and signed will be realized. The time has come to put an end to this injustice.” However, Rabbi Zion Hagi chairman defined the move as “populist. An outline that cannot be implemented due to a lack of doctors, therefore this outline is doomed to failure and will ultimately cause great frustration among the interns.”
The more interesting reaction to these events came precisely from the Ministry of Finance – he was surprised. The senior officials who manage the event, including the budget department, knew nothing. However, the Minister of Finance and Lapid’s political partner, Avigdor Lieberman, knew the details. His response was different. Those around him explained that the 66 million shekels for the implementation of the outline are budgeted and “ready to be launched”, as long as there is legal approval for this due to the election period. Those around Lieberman said that as far as the Minister of Finance is concerned, “the money is on the table” and the problem is neither monetary nor “treasury”, but legal.
The response of the Ministry of Health was a little confused: “We welcome the Prime Minister’s decision. The decision allows us to continue preparing for the implementation of the model in order to bring about shorter shifts and a better health system,” wrote the director general of the ministry Prof. Nachman Ash. A few minutes later, a revised message arrived with credit to the Ministry of Health: “Under the direction of Prime Minister Lapid and with the cooperation of the Ministry of Health, the Director General of the Ministry of Health maintains continuous contact with all the parties involved, from government ministries to specialists and doctors – with the aim of finding a solution to the issue within a limited the elections”.
The ministry explained that “Ash congratulated based on news that was published and in retrospect turned out to be inaccurate”, when Ash refused the warm greeting to Lapid. Inside Lapid’s office they were frightened by the exposure and especially by the reactions to the decision he made. Unlike Esh, Lapid was taken seriously by the senior officials of the RA. Even today, the meetings and discussions continued with all the unions, the hospital managers and the internal organization of specialists. Populist. We wish to warn against rash decision-making resulting from a system of pressures and idle threats – a system that may once again produce promises in the air that cannot really be implemented. We are aware of the fact that the State of Israel is in an election period, by all means, and request that the sense of responsibility and common sense prevail over all other considerations whose honor is placed in their place,” reads a joint and sharp letter of all the heads of the medical unions and hospital managers, drafted at today’s meeting.
3. It is not clear what caused Lapid to enter this vortex. Horowitz may have convinced registrars and senior academics, such as Prof. Gabi Ben Nun from Ben Gurin University, who believe that we must immediately start implementing the outline, and correct it if necessary. In their view, all the threats and prophecies of wrath are idle and the only threat that exists is an intern who treats patients 24 hours a day.
Horowitz also sees this event as an opportunity to come back to life: after increasing the health care budget, if he is part of a photo op with a solution to the problem of interns, he may have enough credit to return in the next election, which, as we now see, may take place not long after the November 1 election. This event may be the ticket that guarantees him a “comeback”. In the end, Lapid wants only one thing: a photo op. He wants the credit for solving the interns issue. Even a semblance of a solution will suffice. In the end, the timing of Lapid’s move says it all: we need to produce a successful event ahead of the elections, so that the citizen will be convinced that Lapid has solved the problem of long shifts, and that there is no better Mish Atid who stands at the head of these tasks. All in all, it’s a recorded handshake with all the players saying “cease fire” into the microphones.
It’s not a lot, and for that we just need some compromises here and there: Lieberman has already promised the amount to get started, and now we just need a little goodwill from the hospital managers for a small pilot, and for the senior officials of the RA to swallow the frog, and for the prescription to come down a little from the tree – all in all They can make a victory lap to get stronger for the next round against the RA – the battle over a collective wage agreement for doctors.
4. The event initiated by Lapid raises many more questions than answers. The first question is whether this whole move is legal during the election eve period. The claim of illegality is weak. It is possible to overcome it and convince the Legal Adviser to the Government, Gali Beharev Miara, to support the move since it is a matter of human rights. After all, public health is just as important as the appointment of the Chief of Staff. Also, this is an issue that began deep within an elected and functioning government (end of 2021) and continues until now – there is a government decision on the matter and it is also budgeted. Furthermore, the Israeli government has never withdrawn from the outline, but there were These are the various courts that scheduled hearings upon hearings and rejections upon rejections after countless petitions. The difficulty in implementing the outline was always discussed and not its disqualification.
And once again we return to the question of applicability. The answer to this question has never changed. And this time, most of the system (hospital managers, the Treasury and the RA) believe that the outline is bad and not applicable. On the other hand, the Ministry of Health and the Registry believe that this outline is the order of the day and a solution to most of the system’s ills. It is certain that the task of recruiting 70-100 doctors within a few weeks and placing them in the relevant departments seems like quite a challenge.
Is there any way to compromise? Here the answer is positive. In fact, the Ministry of Finance and the RA have already agreed on a compromise, which was rejected outright by the Ministry of Health and the Registry: instead of 24-hour shifts, there will be 20-hour shifts, including two hours of rest during the shifts inside the hospital, without affecting wages, without extending the shifts, and even with an increase Salary for those who will not enter the pilot in the early stages. This is a compromise that was proposed within a functioning and elected government, and it can be canceled in the next government. There is probably no other solution.
The question now, after the move has been revealed, is whether Lapid will indeed go all the way after the uproar he caused or whether he will package the move he has been carefully planning for several weeks as an “election spin”, immediately put it in the freezer and close the event with the classic explanation: “I tried”.