Israel to trim med student internships in bid to tackle ‘dire’ shortage of doctors

Decision to halve length of medical internships and restructure them will boost number of practicing physicians and lead to better-trained doctors, Health Ministry says

Nathan Jeffay is The Times of Israel's health and science correspondent

Illustrative: Doctors perform cardiac catheterizations at Hadassah Ein Karem Hospital, in Jerusalem, on January 20, 2020. (Hadas Parush/Flash90)
Illustrative: Doctors perform cardiac catheterizations at Hadassah Ein Karem Hospital, in Jerusalem, on January 20, 2020. (Hadas Parush/Flash90)

The government will speed up the process for medical school graduates to start practicing medicine, in a move that is expected to ease the national shortage of physicians.

Currently, Israel requires all medical students to intern under the close supervision of another doctor before being okayed to practice.

Unlike in the United States, where internships take place as part of a medical student’s residency — during which the new doctors become increasingly independent — in Israel, students must first complete an internship before being placed as a resident, limiting the contribution they can make in the hospital.

Health Minister Aryeh Deri has announced that Israel will move toward the American system, and new doctors will be able to start residency after just six months as interns.

As residents, they can work far more independently and take more of the hospital’s workload, while training in their chosen specialty, such as pediatrics, surgery, or obstetrics and gynecology.

Medical schools and hospitals have applauded the decision.

The move will improve staffing and make a big difference to a health system that is “currently facing a dire shortage of doctors,” Prof. Chaim Putterman, acting dean at Bar Ilan University’s Azrieli Faculty of Medicine, told The Times of Israel.

He added that the details of the plan, which will increase the variety and intensity of hospital experiences during both internship and the residency, will result in doctors with deeper knowledge.

“There has been much discussion over the last few years in the Israeli health system on how to maximize the educational benefit of the internship, and align it more with the US system,” said Putterman. “In this new plan by the Health Ministry, physicians will have the opportunity for a more focused training experience as interns, while shortening the time it takes to bring trained physicians into the medical workforce.”

Prof. Chaim Putterman, acting dean at Bar Ilan University’s Azrieli Faculty of Medicine. (Courtesy of Bar Ilan University)

Israel has been facing a shortage of physicians for years, especially in outlying areas of the country. The confluence of a growing population of elderly in need of care and a wave of doctors from Israel’s baby boom retiring has intensified the problem. So is a shortage of places in Israeli medical schools, which prompts many Israelis to study abroad.

Prof. Nadav Davidovitch, chair of the Department of Health Systems Management at Ben Gurion University’s medical school, said the reform represents an important step in a system that needs reform.

“There is a great need to restructure medical education, including internship and including all the residencies,” he told The Times of Israel. “The changes make lots of sense and will get doctors working in their specialisms quicker, which is important in light of the shortage of physicians.”

According to an outline released by the ministry, the new program will involve a six-month “core” period, which includes time in internal medicine, general surgery, pediatrics and elsewhere — and which includes work at different times of the day and night.

After each period, the hospital department where they serve will assess competency and only let them progress if they pass.

The start of the residency will be restructured. Instead of the current norm, which lets new doctors immerse themselves in a particular specialty for just a month or two before choosing one to focus on, they will have more time to decide. They will spend six months working in one or two specialties, a move that is intended to produce doctors who have made considered choices about their specialty and who are passionate about their area.

Prof. Nachman Ash, director-general of the Health Ministry, billed the decision as “a fundamental change for all medical students and the entire health system.”

“In the long term, we will get better quality doctors who will integrate quickly, smoothly and professionally in the health institutions, and make the whole system easier,” he added.

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