A report card on the physician work force: Israeli health care market—Past experience and future prospects

Is there a doctor in the house? Availability of Israeli physicians to the workforce

BACKGROUND

Israeli policymakers have expressed serious concerns about being able to meet the growing demand for physician services. For this reason, the Israel Ministry of Health (MoH) undertook studies based on 2008 and then 2012 data to obtain an accurate assessment of the size, specialty mix, demographic and geographic composition of the physician workforce. This paper highlights the findings from these studies about the number and percentage of licensed physicians in Israel who were not available, were only partially available, or were about to leave the Israeli healthcare workforce.

METHODS

The two studies cross-linked administrative files of the entire physician population in Israel. The two sources were the MoH registry of licensed physicians, which contains demographic, medical education and specialty information, and the Israel Tax Authority income file on employment data. A third source, used only for the study of 2008 data, was the CBS Population Census Data 2008 which was based on a large representative sample of the population (14%), along with the updated Population Registry, which provided data on physicians whose occupation was in medical care as well as the number of work-hours. By linking the files we could also assess the population of licensed Israeli physicians living abroad.

RESULTS

Only 74% of licensed physicians of all ages in 2012 were active in the Israeli workforce. Of physicians under the age of 70, 87% were living and working in Israel. Female physicians tended to retire from the workforce earlier than males and were more likely to work fewer hours during their working years. The rate of physicians who worked longer hours declined in both genders as age rose. About 10% of licensees had been living abroad for at least a year and the majority of these were older. Approximately 7% of licensed physicians, ages 30-44, were abroad and most are presumed to be doing additional clinical training or gaining research experience. In some specialty fields young physicians were not replacing retirees at a compensatory rate; anesthesiologists, a specialty in short supply in Israel were more likely to be living abroad than other specialists.

CONCLUSIONS

Assessment of the medical workforce pool and personnel planning require not just the number of licensed physicians but also information about the employment mix of license holders and their level of professional activity in Israel. For planning future workforce needs, it is important to keep in mind that the average female vs. male physician has lower clinical productivity due to shorter hours and earlier retirement and that a group of young physicians will predictably be abroad at any point in time; however major "brain drain" is not evident. Furthermore, extrapolating from the findings in the current studies, we believe that a potential shortage of physicians within Israel can be mitigated by better administrative support of physicians, use of physician extenders, and careful attention to improving physician satisfaction in certain specialties.

Medical education in Israel 2016: five medical schools in a period of transition

Abstract

We reviewed the existing programs for basic medical education (BME) in Israel as well as their output, since they are in a phase of reassessment and transition. The transition has been informed, in part, by evaluation in 2014 by an International Review Committee (IRC). The review is followed by an analysis of its implications as well as the emergent roadmap for the future.

The review documents a trend of modernizing, humanizing, and professionalizing Israeli medical education in general, and BME in particular, independently in each of the medical schools. Suggested improvements include an increased emphasis on interactive learner-centered rather than frontal teaching formats, clinical simulation, interprofessional training, and establishment of a national medical training forum for faculty development. In addition, collaboration should be enhanced between medical educators and health care providers, and among the medical schools themselves.

The five schools admitted about 730 Israeli students in 2015, doubling admissions from 2000. In 2014, the number of new licenses, including those awarded to Israeli international medical graduates (IMGs), surpassed for the first time in more than a decade the estimated need for 1100 new physicians annually. About 60 % of the licenses awarded in 2015 were to IMGs.

Conclusions

Israeli BME is undergoing continuous positive changes, was supplied with a roadmap for even further improvement by the IRC, and has doubled its output of graduates. The numbers of both Israeli graduates and IMGs are higher than estimated previously and may address the historically projected physician shortage. However, it is not clear whether the majority of newly licensed physicians, who were trained abroad, have benefited from similar recent improvements in medical education similar to those benefiting graduates of the Israeli medical schools, nor is it certain that they will benefit from the further improvements that have recently been recommended for the Israeli medical schools.

Inspired by the IRC report, this overview of programs and the updated physician manpower data, we hope the synergy between all stakeholders is enhanced to address the combined medical education quality enhancement and output challenge.

Physician density planning in a public healthcare system: Complexities, threats and opportunities-The case of the Israeli healthcare system

Human-resource planning in healthcare is one of the most significant challenges that healthcare systems worldwide face. Among all healthcare professions, the planning of physician supply is the most complex of all due to physicians' lengthy training and many specialties. Forecasts showing a disturbing downward trend in the ratio of physicians to population in Israel prompted the Israeli Government in 2010 to establish a committee mandated to predict demand for physicians and recommend steps to adjust supply to it. The committee analyzed numerous variables that affect physician supply and demand and recommended measures that in greater part were implemented. The article discusses the methodology of the committee, its recommendations, and their implementation such as a 52% increase in the number of first-year medical students between 2010 and 2012. Its analysis of the current situation shows that the implementation of the recommendations successfully stemmed the decrease in physician density and attained the committee's other long-term objectives: physician density of 2.9 per 1000 of population and an increase (32.5%) in the number of physicians who began training in targeted specialties.

Thinking about giving up clinical practice? A gender-stratified approach to understanding junior doctors' choices

PURPOSE

This study examined the association between workplace factors and thinking about leaving clinical care by junior doctors (i.e., doctors in postgraduate training) in Germany, and used a gender-stratified approach to address the so-called feminization of medicine.

METHOD

In this cross-sectional questionnaire study, 1,494 German junior doctors working in patient care in Bavaria in 2006-2007 were sent a questionnaire about considering leaving patient care (outcome variable). Logistic regression analyses were used to calculate the predictive influence of workplace factors on the outcome variable (adjusted odds ratio [aOR], 95% confidence interval [95% CI]).

RESULTS

Of the 637 responding junior doctors, altogether 52% (men 49.3%, women 54.2%) had thought about leaving clinical practice. Support of colleagues and superiors (men aOR 2.70, 95% CI 1.20-6.04; women aOR 3.46, 95% CI 1.67-7.17), performance feedback (women aOR 1.88, 95% CI 1.23-3.14), the availability of postgraduate training possibilities (men aOR 4.74, 95% CI 1.53-14.69), overtime (women aOR 1.82, 95% CI 1.02-3.25), weekend duty (men aOR: 3.58, 95% CI 1.86-6.88), and the medical specialty were found to be significant predictors for thinking about leaving clinical practice for both men and women.

CONCLUSIONS

Workplace factors predict the wish for leaving clinical care for junior doctors. Male and female junior doctors seem to have different priorities in the workplace, which should be addressed in order to retain them in patient care.

Understanding adolescent and young adult use of family physician services: a cross-sectional analysis of the Canadian Community Health Survey

Background

Primary health care is known to have positive effects on population health and may reduce at-risk behavior and health problems in adolescence. Yet little is known about the factors that are associated with adolescent and young adult utilization of family physician services. It is critical to determine the factors associated with utilization to inform effective primary health care policy. We address this gap in the primary health care literature by examining three issues concerning adolescent and young adult family physician use: inequity; the unique developmental stage of adolescence; and the distinction between utilization (users versus non-users) and intensity (high users versus low users).

Methods

We conducted nested logistic regressions for two outcomes: utilization and intensity of family physician services for early adolescence, middle adolescence, and young adulthood using the 2005 Canadian Community Health Survey.

Results

Chronic conditions were associated with utilization in early and middle adolescence and intensity in all age groups. Respondents from Quebec had lower odds of utilization. Those without a regular medical doctor had much lower odds of being users. The factors associated with use in early and middle adolescence were in keeping with parental involvement while the factors in young adulthood show the emerging independence of this group.

Conclusions

We highlight key messages not known previously for adolescent and young adult use of family physician services. There is inequity concerning regional variation and for those who do not have a regular medical doctor. There is variation in factors associated with family physician services across the three age groups of adolescence. Health care and health care policies aimed at younger adolescents must consider that parents are still the primary decision-maker while older adolescents are more autonomous. There is variation in the factors associated with the two outcomes of utilization and intensity of services. Factors associated with utilization must be understood when considering the equitability of access to primary health care while factors associated with intensity must be understood when considering appropriate use of resources. The understanding gained from this study can inform health care policy that is responsive to the critical developmental stage of adolescence and young adulthood.