The head of a state-backed think tank tasked with finding ways to get Israel to train more doctors condemned the Government’s recent decision to close three medical schools hosting foreign students to accommodate more local citizensand argues that the controversial and costly measure is unnecessary.
Earlier this month, the Council on Higher Education announced that it was closing the American medical programs at the Tel-Aviv Universitythe Ben Gurion University and the Technion to replace the 130 foreign students studying there with Israelis, given the growing shortage of doctors in the country.
But on Wednesday, the teacher Rafael Beyarwho led the council’s own committee to investigate ways to increase the number of Israeli medical students, told The Times of Israel that there were other ways to reach the goal.
“[El comité] presented a detailed plan on how to accept an additional 400 medical students for four-year programs. There was no need to close foreign programs to accept those 400 [estudiantes] additions,” said Beyar, who also recently wrote a letter to the council criticizing the decision to close the programs.
The State of Israel already has a shortage of doctorsespecially in the most remote areas of the country, and the situation is expected to get much worse in the coming years in light of the aging of the Israeli population, which requires more medical attention, as well as a wave of doctors who will retire.
Most doctors in Israel are forced to study abroad due to the critical lack of available places in Israeli medical schools.
One of the main obstacles is the expansion of so-called “clinical spaces”, places in hospitals and laboratories where medical students gain practical experience.
American programs allow foreigners to study in Israel but receive American degrees and do residencies in the United States. They have long been seen as a boon to the Israeli medical system, bringing in large amounts of tuition money – foreign students pay more than 10 times as much as Israelis – as well as increasing Israel’s academic reputation internationally. internationally and create an informal network of doctors in the United States with close ties to Israel.
Beyar, former director of Haifa’s Rambam Medical Center and former dean of the Technion’s Faculty of Medicine, stressed that the letter to the council represented his personal opinion and not that of the committee.
Although he confirmed that he had sent the letter to the council, he refrained from providing a copy of it, saying that the full contents were “intended for the council and professional officers”.
A council spokeswoman said she was not immediately aware of the letter but dismissed Beyar’s opposition. She highlighted the magnitude of the problem facing the Israeli healthcare system and the existing obstacles that make it difficult to radically increase the number of medical students.
“It is easy to throw figures like 400 additional places, but there are practical considerations”, said the spokeswoman. “Whenever a decision is made, there are going to be people who disagree with it.”
A 2017 report by the State Comptroller on Israeli medical schools also found that the shortage could be addressed in other ways, but that a lack of proper communication between the council and the Health Ministry prevented this.
“There are other relatively simple solutions to adding clinical spaces in hospitals that have not been considered, but the lack of a comprehensive and systemic way of thinking prevents them from being added,” the comptroller wrote.
Beyar is not the only top medical official to oppose the decision to close US programs.
The teacher Arnon Afekacting director of the Sheba Medical Center and former director general of the Ministry of Health, lashed out at the move, calling it “unnecessary and miserable.”
“Yes, Israel needs to train its own doctors, and the current situation, where only 40% of doctors are licensed in Israel and most study abroad, is unreasonable and unconscionable,” he told The Times of Israel. .
“But I don’t see any reason to shut down the American programs,” said Afek, who previously headed the American program at Tel Aviv University.
“My heart really hurts,” he said. “It is so difficult to build something and so easy to destroy it.”
Afek, who has been researching and writing about Israel’s doctor shortage for more than a decade for academic journals, said Israel needs to add about 800 new medical students each year to overcome the looming shortage. He argued that the goal is feasible, but only if the government allocates the necessary funds to address the issue.
“Claims about the lack of clinical spaces make no sense. They make no sense. They haven’t even asked us, the directors of the hospitals, about the issue“, said. “I tell them there is absolutely, positively, no problem doing this. Don’t get me wrong, it would require an investment of resources, but it’s like any investment, it’s an investment in the country. It is an investment in our ability to treat our grandparents, our children.”
Afek primarily advocates the opening of new medical schools in Israel. He is currently leading efforts to create one at the Reichman University in Herzliya, formerly known as the Interdisciplinary Center.
The spokesperson for the Higher Education Council insisted that there was no other option than the closure of American programs to increase the number of Israeli medical students starting in the fall of 2023since all the alternatives were either too expensive or too complicated to implement.
Asked how the government then planned to add the hundreds of new places needed to tackle the shortage, the spokesman said the issue was still being looked into.
“This next academic year, we increased the number of places by 70. The following year, [al cerrar los programas estadounidenses] we added another 130. I don’t know what will happen next year. They are working on it,” she said.
Afek also wondered why the council didn’t at least first try some kind of stopgap measure to entice students from American programs entitled to citizenship to stay in Israel after graduation and thus increase the number of doctors in Israel. Israel.
In fact, although a not insignificant number of former students return to Israel – including this reporter’s brother-in-law – the vast majority settle in the United States.
However, the decision to return to the United States is usually an economic one. Saddled with several hundred thousand dollars of student debt, even graduates who plan to eventually move to Israel first seek more lucrative careers in the United States, where doctors’ salaries are much higher than in Israel.
The government plans to compensate universities that are forced to forego higher tuition fees that they could charge foreign students.. But Afek said the funds could have been offered to students in the US program in exchange for an obligation to practice medicine in Israel for a certain number of years.
“Why not offer debt relief instead? Many of them want to stay in Israel,” Afek exclaimed.
The council spokesman rejected this solution as unreasonable, believing that not enough foreign students would accept the offer.
Why make a committee?
Afek also fumed over the fact that the council’s decision, taken in conjunction with the health and education ministries, was not in line with the Beyar committee’s recommendations.
“Why do you make a committee if you are going to do what you want anyway?” he asked. “They didn’t consult anyone, they didn’t ask anyone, they just went ahead and did it”.
The council spokeswoman said she could not comment on why the committee’s recommendations were not followed and referred The Times of Israel to the Education Ministry.
Education Minister Yifat Shasha-Biton did not respond at the time of publication.
Afek, who served as director general of the Ministry of Health from 2014 to 2015, described the closure of US programs in favor of Israeli students as not just a “band-aid on a gunshot wound” but as having a considerable cost.
“This is a drop in the ocean that will only cause damage: to Israel’s image, to the reputation of Israeli universities, to the connection with the diaspora, and to our ability to send doctors to train abroad,” he said.
The US programs, the oldest of which has been in operation for 46 years, have graduated thousands of physicians over the years.many of whom now work in America’s best hospitals and clinics.
“Those graduates get key positions in American hospitals,” Afek said.
According to Afek, these connections now make it easier for Israel to send its own doctors to do fellowships at these centers to improve their professional skills and thus raise the level of health care in Israel.
“So we want to send our doctors to the United States, but we refuse to train American doctors here in Israel?” he said.
Afek raised alarm bells that shutting down the programs would harm Israel’s ties with American Jewry. Although the programs are open to participants of any faith, being in Israel most of the students are Jewish.
However, the measure has been backed by the Minister of Diaspora Affairs, Nachman Shai.
The closures “will increase the number of places available to Israeli citizens in medical schools, rather than giving them the option to study abroad and perhaps not return home,” he told The Times of Israel.
Afek rejected Shai’s view, arguing that foreign and Israeli students need not compete; keeping American programs open and allowing more Israeli students to study medicine are not mutually exclusive.