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Intern leader laments 'no real dialog' with Health Ministry

Health Ministry chief: Medical interns’ 26-hour shifts to be shortened gradually

After 2,500 quit, Nachman Ash says he understands the doctors-in-training had greater hopes from negotiations but says not all fixes can be implemented immediately

Medical interns demonstrate for better work conditions outside the Health Ministry in Tel Aviv, October 7, 2021. (Miriam Alster/Flash90)
Medical interns demonstrate for better work conditions outside the Health Ministry in Tel Aviv, October 7, 2021. (Miriam Alster/Flash90)

After more than 2,500 medical interns quit en masse on Thursday in protest of the 26-hour shifts they are forced to work, Health Minister Director-General Nachman Ash said moves to shorten their hours will take several years to implement.

“The plan is the start of an important and significant path,” Ash told the Kan public broadcaster, vowing to implement a proposal to eventually shorten the workday to 18-hour shifts.

“It will take a few years so that we do not fail in this path. Unfortunately, the interns still do not accept that. I understand there were greater expectations, and believe that we will sit down later and reach agreements,” he added.

The 2,590 doctors-in-training signed off on resignation papers that were delivered Thursday to the Tel Aviv District Health office by Dr. Ray Bitton, head of the Mirsham organization of medical interns.

“To my regret, we have gathered here for a very sad day that has befallen Israel in which we are painfully forced to take a drastic step and present the resignation letters of more than 2,500 interns,” Bitton said outside the office.

The resignations came a day after the interns rejected a government proposal to gradually reduce shifts to 18 hours by 2026, but only in 10 hospitals in outlying areas.

“I ask the interns to understand that this is the beginning of a very important path, and it is important to do it responsibly. If we make it wider, there are things we can not implement,” Ash told Kan, implying the move would still be limited.

Health Minister Director-General Nachman Ash attends a press conference about the coronavirus, in Jerusalem on August 29, 2021. (Olivier Fitoussi/Flash90)

“We have examined things in depth. We are determined to implement the shortening of shifts for everyone, but responsibly and gradually. As soon as possible,” he added.

Bitton on Friday accused the Health Ministry of not conducting “real dialogue” with the medical interns’ group.

“There is no layout, but a plan for 2022 and then vague promises for five years without a budget promise, so every year we will have to fight again. If we want real change we need a serious and orderly proposal,” Bitton told Kan.

Dr. Ray Bitton, head of the Mirsham organization of medical interns, January 21, 2021 (Screen grab/Globes)

The government had promised that after the pilot program in the 10 outlying hospitals, the plan would expand to all hospitals later, but only if the necessary budget could be found and if a committee set up to examine the issue finds there has been no deterioration in the level of medical care.

Thursday’s resignations would only go into effect in two weeks, according to Hebrew-language media reports, but it was unclear if they are revocable after that.

The letter, addressed to Health Minister Nitzan Horowitz, said they were not motivated by personal interest and that it should be a national priority that those who arrive at hospitals get treated by doctors “who are not exhausted, tired, unfocused and without empathy due to inhuman conditions.”

The interns wrote that it has become clear to them that they have been “abandoned” and accused Horowitz of failing to adhere to his assurances of a reduction in hours for all interns.

Health Minister Nitzan Horowitz speaks during a press conference in Jerusalem on August 29, 2021. (Olivier Fitoussi/Flash90)

Horowitz on Thursday insisted that the government proposal was “a historic change, a revolution.” He said the issue of intern shifts was “a difficult, complex matter. There are many opinions, interests, many budgetary limitations, and mostly a manpower shortage after decades of neglect.”

The minister asserted that most reactions he’d gotten from interns and doctors had been positive, though he admitted some were disappointed and wanted a more dramatic change. “I too would want to make [a change] in one stroke throughout the country, but it’s not possible, as there simply aren’t enough doctors to fill in the missing shifts,” he said.

“Our plan isn’t perfect, but it is the start of a historic change.”

Medical interns demonstrate for better work conditions in Tel Aviv on October 4, 2021.(Tomer Neuberg/Flash90)

Up until 2000, interns had been working 36-hour shifts, and sometimes even more. That year, an agreement was signed to reduce the shifts down to 26 hours, with a two-hour break, according to The Marker business daily.

In 2012, following appeals to reduce the hours again, the government adjusted the irregular work permit to limit interns to two shifts a week, and for them to not work more than 71.5 hours in a week, according to the business news site.

Despite the new regulations, most hospitals have not implemented them.

According to a 2016 poll published on the business news site, 72 percent of interns worked more than 26 hours in a row at least once a month, 42% didn’t sleep during their shift, and 27% worked more than 71.5 hours a week.

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