Tuesday 30 August 2011

Learning Lessons From the Doctors' Strike

After 158 long days of strikes by Israel's doctors, a deal has finally been reached with the treasury over their pay and working conditions. An agreement was signed between representatives of the doctors' labour union and government officials on Thursday which changes dramatically the humiliation that doctors in the public sector have been subject to in the past. The agreement is retroactive to 2010 when the last agreement ran out, and will govern pay scales for a nine-year period.

It is shameful that it took five months of strikes by the doctors to finally convince the treasury to agree to the new deal. Under its terms, hospital doctors will receive an average pay increase of 49%. Doctors working in the periphery of the country, and doctors working in specialities which suffer an acute shortage of personnel, will receive a substantially higher increase. These increases give an indication of how far behind market rates, doctors pay scales have fallen over the past few years. In return for the better salary levels, doctors have agreed to clock in and out of their shifts. A further 1,000 positions have also been added by the government to reduce the shortage of manpower that has been plaguing Israeli hospitals. Overall, this agreement is set to change the face of Israeli medicine and medical treatment in the country over the next few years.

The Israeli medical health system is one of the best that I have come across. One does not find the phenomenon here like in the USA and other countries around the world, that people who are at an economic disadvantage are unable to receive medical treatment. In Israel, all citizens have the right to have access to basic medical treatment which is of a high standard. One does also not experience the issue which the UK's National Health System suffers from of lengthy waiting lists for treatments to be carried out. In Israel, even though it may require some patience, treatments are usually available within a reasonable period of time. Now that pay scales have been rectified, it will ensure that those delivering this service will be remunerated accordingly. It will also mean that high quality individuals will be attracted to the medical field, and will be incentivised to practice their art in Israel as opposed to seeking more lucrative opportunities abroad.

For me, the main lessons to be learned from the new deal are the ones arising from the process that it took until the time that it was agreed. One can learn many things from the behaviour of the doctors in this process, as well as the way in which government officials acted. One of the toughest lessons that new immigrants to Israel are forced to learn, frequently via the most difficult route, is that there is no such thing as automatic entitlement in this country. Even if you have a caste-iron agreement in place which says that you are entitled to a certain increase in salary or other entitlement, you will not receive this unless you are prepared to go in and demand what you are entitled to. Whereas in other countries, companies usually have a date upon which salaries are reviewed and pay increases are awarded (or not as the case may be), this type of behaviour is not typical for Israel. Companies will award pay increases to those who shout the loudest, and may completely overlook those who are not willing to make a big noise. The doctors' strike was one of necessity. It should be clear that, without the industrial action and public relations exercise that went with it, the doctors would not have achieved a small fraction of what they deservedly achieved.

The way that the action was taken, is of equal importance. Emergency services were never interrupted. Instead, the doctors professionally separated the cases into those whose treatment was essential, and those whose treatment could be delayed. Any treatment that was essential went forward without consideration of the industrial action. Doctors administering chemotherapy and psychiatric treatment did not interrupt their regular work day in the interests of taking best care of their patients. The strike was immediately lifted ten days ago in the area of the terror attacks in the south until such time as all casualties from these attacks had been taken proper care of. Although there is now a substantial backlog of non-emergency treatments that have been delayed, the doctors have somehow managed their medical responsibilities under their Hippocratic Oath, while also succeeding in placing the required pressure on those who only understand the language of industrial action.

The behaviour of the government officials in this sorry story have less sympathy and respect from me. To begin with, the demands of the doctors were completely ignored. Even when the industrial action was initiated, the treasury refused to give sufficient consideration to the effects of below-market pay rates to the country's medical professionals. It eventually took a hunger strike on the part of the chairman of the Israel Medical Association, and a complete walkout of all medical residents from their hospitals until the proper attention was given to this important issue. When the agreement was finally signed last week, the treasury officials did their best to keep the signing low-key and behind doors.

It is true that the government has an obligation to keep its spending under control, especially at the current time when inflation threatens to increase. With huge security obligations, Israel's government spending is always tough to keep under control. This should not, and cannot serve as an excuse for not allocating the correct public money to build the future of this young country. Education, medical services, infrastructure and many other services cannot be ignored due to the military and security requirements. It does mean, however, that public officials have extra responsibility to ensure that each Shekel of tax money goes as far as it possibly can. In this, unfortunately, our country fails miserably. The amount of waste, corruption and unnecessary spending of money that is evident is a huge disappointment to the citizens of Israel. Why should the defense minister feel justified to request a new Audi A8 at a cost to the taxpayer of 2 million Shekels, when his current A6 is more than adequate. The state comptroller's reports are regularly critical of unnecessary wastage of tax money. Such lack of consideration to where the money really needs to go, should not be tolerated.

I feel that citizens of the State of Israel owe a deep debt of gratitude to our medical professionals. For many years, they have provided a high quality service in line with the most recent developments in technology and treatment, while being paid far less than their real value. When the moment came to bring this situation to a head, they did so in the most respectful way possible, while still insisting upon the maintenance of their own rights and dignity. If some of our government officials and elected politicians behaved in this way, Israel would be in a much better overall state.


avraham sapir said...

you have failed to mention the 1000 doctors resigning tomorrow. this will cause israel to become another banana republic. all the best of our meds will emigrate elsewhere where their talents will be appreciated and paid for, thanks to netanyahu for leading us into the abyss

Anthony Reich said...

You are correct to say that I did not mention the fact that many residents tried to resign as of today. In fact, the update to this story is that the labour court prevented their bulk resignations from going into effect. Many, however, have put in their own personal resignations. They are resigning due to the fact that they believe that the agreement between the government and the Israel Medical Association does not address the issues confronting young resident doctors.

Although I don't believe that this fact turns Israel into a banana republic, it is clearly an unfortunate situation. It is true that many of them intend to get their speciality qualification abroad, something that the government should be actively working to avoid almost at any price.