Zionist Medicine – The Brick Wall

At a recent medical conference in Israel, a distinguished vascular surgeon from the UK lectured on a topic unrelated to diseased arteries. In fact, he was extolling the virtues of opening an ice cream stand in Piccadilly Square. Lest we think he was just drumming up medical business with vessel-clogging pistachio and cream, he assured us that he’d hung up his surgical gloves for good. 

He explained that a child with ice cream in hand is grateful, and the child’s smile is immensely gratifying. Just a few months ago, the surgeon informed us, he was dealing with angry litigious patients and refusenik insurance companies. So you see, he assured us, there is no hope in medicine. But there is reason for optimism; the post-medicine future can be sweet and delicious.

This overarching sense of professional pessimism is all too common among Anglo physicians in Israel. And it is distinct from the reality (and pervasive black humor) of Israeli life in constant crisis mode. In fact, despite near-constant war and the pressures of life in Israel, Israelis are among the happiest on the planet. Not so for Anglo physicians in Israel. 

It turns out that Israelis are happy because of especially strong family and social relationships, as well as a sense of belonging. These factors apply to Anglo physicians as well, and one may add a sense of mission even beyond that of non-Israelis in ‘helping’ professions. After all, it is a unique privilege to be able to care for our ‘extended family’ in Israel, those whose histories and destinies are so tied to our own.

So why the overall sense of defeatism among Anglo physicians? I don’t think it is the invariably lower salaries. Few physicians make aliyah expecting to earn more than they did or could in their home country. And besides, there is little correlation between wealth and happiness. It is also not for lack of positive professional impact. A talented Anglo physician in Israel is likely to be providing a service otherwise unavailable or at least not available at the same level. That same physician living in Teaneck and working in Manhattan is more easily replaceable.  

I believe many Anglo physicians hit a brick wall in Israel. I do not mean the following as G-d forbid, an indictment or moral judgement, only an observation. 

Some do not attempt to scale the wall at all. Navigating the bureaucracy, beginning again at the base of the totem pole after climbing high in a previous life. The daunting prospect of an entirely new set of professional norms in a new language. These are the physicians who come at retirement age, when financially secure. Or those that live in Israel while working in-person or remotely outside of Israel. Some may commute for a week or two per month and diagnostic radiologists may tele-commute for US practices from their homes in Israel.

Then there are those physicians who become resigned to downgrade their professional activities in Israel. These are primarily the specialists who compromise on their sub-specialty or forgo their specialty altogether. A gastroenterologist, for example, may forgo his highly specialized endoscopic ultrasound skills to become a general GI doc in a health fund, or may give up on GI altogether in order to work as a general practitioner. 

Hospital salaries for internists and many specialists are so low, and working conditions so unfavorable, that many choose to practice exclusively in outpatient clinics. Hospitals suffer for lack of talent where patients are most complex and need it most. And the physicians are denied the professional challenge and satisfaction of complex inpatient care, academics and teaching. 

What a loss! For both the individual physician and the Israeli health ecosystem. 

There are real and entrenched challenges without quick fixes. Hospitals are notorious hornet’s nests of personal politics, self-preservation, and fierce competition. Archaic regulation means much specialized care can only be performed in hospitals. This does not benefit over-crowded hospitals, it does not benefit patients who must deal with deep-rooted hospital bureaucracy, inaccessibility and poor customer service. And it certainly does not benefit physicians who are then beholden to the entrenched inefficiencies and dysfunction of public hospitals.

There is also an especially powerful network of medical advisors, whose recommendations for individual physicians carry enormous weight in patient choices. This is especially true in regions with a high ultra-Orthodox population. While a valuable service to patients, the criteria for physicians making the A-list are nebulous and opaque. The system is beneficial to a small number of physicians, but effectively excludes well-deserving others from advancing their careers.

So, can Anglo physicians penetrate or at least form a crack in the brick wall? I believe the answer is yes. More on this soon…