AROUND THE GLOBE – Journal de l’Israel Medical Association (IMA), août 2013
Attracting young physicians to the periphery in Israel – 5th Jerusalem International Conference on Health Policy
This year’s Jerusalem International Conference on Health Policy centered on the theme of health policy in times of austerity. The conference aimed to confront the following key challenges: patterns of health care under austerity; institutional governance strategies; sustaining quality and performance; and financial and economic strategies.
Leading experts in management and governance, health economics, health policy and regulation, population health, and quality and performance measurement addressed the participants during the conference plenary sessions. In addition, thematic sessions delved more deeply into these tough, but fascinating issues.
Dana Fishbain, Manager of the Israeli Medical Association Scientific Council, represented the IMA at the conference and presented a joint study conducted by the IMA and Myers-JDC-Brookdale Institute on attracting young physicians to work in the Israeli periphery.
In Israel there are significant health disparities between the peripheral and central areas. There is a geographical maldistribution of specialists and difficulties in attracting young physicians to train in remote hospitals. This has led to many unfilled residency positions in distressed specialties and in the periphery. The 2011 physicians’ collective agreement signed by the IMA aimed to address this issue. As part of the 2011 collective agreement incentives were offered to residents working in the periphery.
The study questioned whether and how the distribution of new residencies has changed in the wake of the new incentives.
The incentives included:
- An immediate 10% addition to the monthly salaries of residents working in the periphery, increasing to 25% by 2013. Specialists receive an immediate increase of 8%, growing to 17% by 2013.
- One-time payments to all residents who start a residency training program in the periphery:
- 500,000 NIS in the distressed specialties,
- 300,000 NIS in other specialties.
- Incentives for residents in distressed specialties in all districts
The study found that the percentage of new residents starting their training in the periphery increased in the North – from 7% in 2010 to 12% in 2011 and 11% in 2012 and in the South – from 8% in 2010 and 2011 to 12% in 2012. The total number of new medical residents significantly increased in 2011, and moderately increased in 2012 compared to 2010. Dana explained that these increased numbers may be mainly attributed to an increasing number of licenses issued in 2011 compared to 2010 (900 vs. 726). They may also be partially attributed to candidates “sitting on the fence” to whom the agreement gave new motivation to start a residency.
Dana concluded that these findings are encouraging news for health policy authorities; however such impressive increases may be shortly eroded if not properly maintained. The mechanism of financial incentives seems to be an effective tool for influencing the distribution of new medical residents in Israel. Nevertheless, it remains to be seen whether those physicians who trained as residents in the periphery will continue there as specialists. A long-term desired effect of the incentives would be for a high percentage of those periphery-trained residents to permanently base their life and work in the periphery.
Finally Dana explained that the IMA is planning to carry out a survey of young physicians to explore to what extent the increase in the number of residents choosing to go to the periphery was due to the change in incentives. A further longitudinal study over the next 7 to 10 years will be needed in order to measure the long-term effect. In Israel there are significant health disparities between the peripheral and central areas.
The conference aimed to confront the following key challenges: patterns of health care under austerity; institutional governance strategies; sustaining quality and performance; and financial and economic strategies.
Mots-clefs : Médecins