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The truth about Sharap

Don't blame Hadassah's fiscal hole on Israeli doctors just trying to make an honest living
Workers from Hadassah Ein Kerem hospital protesting outside the Prime Minister's Office in Jerusalem over its funding crisis, on Sunday, February 9, 2014. (Photo credit: Yonatan Sindel/Flash90)
Workers from Hadassah Ein Kerem hospital protesting outside the Prime Minister's Office in Jerusalem over its funding crisis, on Sunday, February 9, 2014. (Photo credit: Yonatan Sindel/Flash90)

Two weeks ago, I was working in my clinic at Hadassah Hospital, taking care of Jews, Arabs, Eritreans, or anyone else who needed my help. Although I was overburdened (as usual) with an impossibly long list of patients, although I barely had time to go to the bathroom, and never had time for lunch, I was professionally and personally satisfied that I was making a difference in people’s lives.

Then came the strike. For two weeks, doctors have been targeted and blamed for the colossal mismanagement of the Hadassah Medical Organization. The fact that we are health care providers and have nothing whatsoever to do with management of the hospital seems not to matter.

Do we blame pilots and flight attendants for the high costs of air travel? Did we demonize bank tellers for the failure of financial institutions during the recent financial crisis? Do we blame the cows for the high cost of dairy products?

Health Minister Yael German was quoted yesterday as saying that “the private medical services at Hadassah pass on only 14% of revenues to the hospital, whereas “85% or more” goes to the doctors. That’s wrong.

At best, she is unknowingly disseminating false information. At worst, it reflects a deliberate attempt to further the agenda of the government, which wants to take over the hospital and all of its assets, dismantling and forever destroying our institution.

Hadassah is unique. It is a place where people can receive specialized consultative care and the highest levels of treatment in every possible field of medicine. It is a place that puts an emphasis on cutting edge research, state of the art facilities, and quality medical education.

Hundreds of doctors work for Hadassah. More than a million people are treated annually in over 120 outpatient clinics in more than 70 departments and specialized units. Not an easy task, particularly when many of these patients come to us with problems that no one else can solve.

Most of these patients are treated within the framework of the grossly overwhelmed public system, which is why you have to wait months for an appointment.

But there is another option, called Sharap. The purpose of the Sharap (private medical) service is to enable interested patients to personally select the senior physician who will treat them. The selected physician is a member of Hadassah’s senior staff, is a specialist in their particular field, and plays an important role in training other doctors. In the case of surgery, the selected physician will personally perform the surgical procedure, rather than delegate to physicians in training.

As a Hadassah physician, I earn a basic salary just like any other Israeli doctor. Most of my time is spent treating patients in the public system, but I can also see patients through Sharap in the afternoon hours.

When a patient pays 1,200 shekels for a Sharap consultation, I can dedicate more time to them, because I am in control of the schedule. I assume a personal responsibility to guide them through their surgical experience before, during and after the procedure.

Why do so many people pay this Sharap fee? First of all, many get reimbursed by their HMO. Second of all, it is easier and faster to get an appointment through the private system.

But what happens to the money? It depends who you ask. About 29% goes directly to Hadassah. 15% is supposed to go into a fund for the physician to help pay for medically related expenses such as conferences. (I say supposed to, because the money in these funds has disappeared, having been appropriated by management in order to deal with the financial crisis). Of the remaining 56%, 50-60% goes to the government in the form of taxes, and the doctor at the end of the day ends up with a grand total of approximately 24% of the original amount. Once again, I am not an accountant, and I’m sure that this data can be manipulated to support different points of view, but from my perspective at the end of the food chain, this is what I see.

What happens if you need surgery?

Once again, Hadassah gets approximately 29%. The doctor ends up with about 24%. But in addition, the hospital receives payment from the HMO for the use of its facility. This is revenue that would otherwise go to a private hospital or another institution somewhere else in the country.

I’m a doctor, not a businessman. I know very little about finances, and even less about public relations. Maybe that is why doctors do such a bad job of trying to explain their situation and defend themselves against the perception that all they care about is money.

The public seems to have no problem with the fact that other professionals earn money. In fact, the culture of the pursuit of money is a universally encouraged and promoted phenomenon. It’s okay if a 20-year-old who happens to work for a high-tech start-up gets a million dollars when the company goes public, but it’s a crime if a doctor tries to earn a living after investing 10 to 15 years of his life in preparation for a career of service?

Doctors work night and day, at the expense of their health and their personal lives, and deserve every penny that they earn.

At the end of the day, Sharap is an incredibly valuable service. It is good for the hospital, good for patients, and good for the doctors at Hadassah who would otherwise have to work elsewhere in order to earn the salary that they deserve. The recovery process that awaits us at Hadassah will be long and difficult, but it will be impossible without the benefits of Sharap.

The author is a senior surgeon at Hadassah Hospital and prefers to remain anonymous.