As Israel’s medical system experiences shortages of doctors, nurses, beds and medical equipment, a growing number physicians immigrating from North America could help fill the gap.
The most recent plane of new immigrants, which touched down early Wednesday morning, included 27 medical professionals out of a total of 239 new Israelis. The incoming physicians and nurses are an asset to Israel’s medical system, but they face challenges acclimating to a foreign health care system and take a significant pay cut by making the move.
“Ultimately, I don’t know how this will play out,” said Abby Lazar, 31, a pediatrician from Philadelphia on board the flight. “But it’s a nice thing to be able to not only live in Israel but also contribute to society there, especially to an area where there is need.”
The flight was one of several flown each year by the immigrant group Nefesh B’Nefesh in cooperation with the Ministry of Immigrant Absorption, the Jewish Agency, KKL, Tzofim-Garin Tzabar and JNF-USA. Founded in 2002 by Rabbi Yehoshua Fass and American businessman Tony Gelbart, Nefesh B’Nefesh aims to encourage Western immigration to Israel by easing the process for American, Canadian and British Jews. According to Nefesh B’Nefesh, it has so far brought 57,000 immigrants to Israel.
The latest group of immigrants included 11 physicians, two nurses, five psychologists and nine paramedical professionals.
Nefesh B’Nefesh is making efforts to attract physicians to Israel, and is working with the Health Ministry, hospitals and health care clinics to streamline the physicians’ accreditation process and match them with employers.
“They are desperate for good professionals, and American professionals are considered to be among the top,” said Ronen Fuxman, Nefesh B’Nefesh’s liaison for medical licensing. The 11 immigrant doctors on board Wednesday’s flight is likely the largest number ever on a single flight to Israel, Fuxman said.
The medical professionals are moving into an overburdened system in Israel that is likely to face steeper challenges in the years ahead. A report released last month by the Health Ministry (Hebrew link) comparing health care in Israel to the rest of the OECD found that Israel employs fewer doctors and nurses per capita than other developed countries, with 3.1 doctors per 1,000 residents, compared to the OECD average of 3.3. Israel is close to the bottom of the OECD when it comes to employing nurses, with only five nurses per 1,000 people, far below the OECD average of 9.3. Israel also ranks near the bottom of the OECD in its per capita ratio of medical students, MRI machines, CT scanners and available hospital beds.
Israel scores above average in longevity, suicide rate, fertility rate and rate of infant deaths, according to the survey.
A 2017 study found that only 74% of licensed physicians were active in the workforce. The researchers cited burnout and poor conditions as contributing factors, and suggested that high-performing Israeli students are increasingly being drawn to more lucrative and less demanding careers in high-tech and engineering.
The shortage will likely become more severe in the coming years, as thousands of doctors from the former Soviet Union who immigrated to Israel in the 1990s retire from the workforce.
The IDF also struggles to provide adequate health care for its soldiers. Immigrant doctors are subject to the draft until a much later age than other immigrants, which can be problematic for physicians with families who may need to serve far from home and make less money in the military. The IDF has clashed with Nefesh B’Nefesh and other immigrant groups over physicians’ draft cutoff age. Currently, male doctors and dentists are drafted until age 34, and female doctors and dentists without children are drafted until the age of 29.
Fortunately for Israel, the number of physicians immigrating is slowly growing, Fuxman said, with about 60 doctors arriving in Israel this year through Nefesh B’Nefesh. The doctors, and immigrants as a whole, are also relocating at a younger age, meaning they will be active in the Israeli system for a longer time.
In his role at Nefesh B’Nefesh, Fuxman coordinates yearly events in the US for medical professionals. The events, which started five years ago, now draw representatives from the Health Ministry, hospitals and medical clinics. In addition to physicians, the events serve nurses, speech therapists, dentists, social workers and psychologists. Participants can come to the events with their documents to begin their accreditation process with the ministry’s licensing division and begin interviewing for jobs.
Health providers in Israel are increasingly interested in immigrant doctors, said Fuxman, who has held his current position as liaison for three years. They now come to him with specific positions they need filled, and he can then search for matches with people considering moving to Israel.
Almost all of the physicians on board the flight had licenses waiting for them in Israel already, Fuxman said. The process used to take six to eight months, meaning immigrants had to visit Israel to apply for a license ahead of time, or else were not able to work for months after arriving.
The biggest obstacle for employers and immigrant physicians now is language. Some providers, including Ichilov Hospital and Clalit Health Services, which runs a network of hospitals and primary care clinics throughout Israel, have set up programs to help new doctors improve their Hebrew, including classes for immigrants and a buddy system where new immigrants are paired with more experienced immigrants on staff.
“My Hebrew’s pretty good but it’s not excellent, so I think I’m going to be working on my language skills and cultural differences and differences in the medical system while transitioning my family to a new place. I think it’s going to be a big learning curve,” Lazar said.
Lazar, who is immigrating with her husband and three children, has contacts and a personal background in Israel already, like many of the other physicians who are making the move. She spent the summer after her residency in Israel, and shadowed Israeli doctors to get a feel for the medical system. She also has friends and relatives who practice in Israel.
Yona Saperstein, 29, a family physician from Brooklyn on the flight, also spent time in the Israeli medical system before making the decision to move to the country with his wife, Lilach, an audiologist, and their three children. Yona participated in a program at Shaare Zedek medical center in Jerusalem during medical school.
“Seeing that I could live as a Jew and a doctor in Israel, it became more of a reality,” Yona said. “Doing more research I found that there is not only room for it but a need for family physicians in Israel.”
The Sapersteins, who are moving to the suburbs of Haifa, got their accreditation and began the interviewing process at a recent Nefesh B’Nefesh event. Their main motivation for moving is providing a Jewish education and atmosphere for their children. Their medical expertise was also a factor in the decision.
“The fact that there’s a shortage shows that Israel is growing. There are so many young people and old people. Those are great things. Everything that we’re doing, we’re trying to contribute to help with that,” said Lilach, 27, whose parents are Israeli.
Chaim Arias, another physician on Wednesday’s flight, is not daunted by the deficits in Israel’s health care system either. The 35-year-old pediatrician is moving to Beersheba with his four children from Las Vegas, having attended medical school at the Technion, in Haifa. He has experience managing a heavy workload already, he said.
“As a physician I feel like there’s a big need, especially for pediatricians,” Arias said. “Vegas is also an underserved population. There are too many people for the amount of doctors. In Vegas I would see 40 patients a day anyway.”
The main drawback for Arias and others, he said, is financial. Working in a public health care system means the doctors will make far less money than they would in the US.
“Salary-wise there’s not much we can do. Salaries in Israel are still lower than America,” Fuxman said. “Professionally, it’s kind of a demotion. The salary, and also the Israeli medical system, is still a little lower than the American one,” in terms of quality of care and facilities, he said.
Some doctors opt to commute to the US for a couple of months a year to supplement their salaries, he said. Employers who need them are willing to let them go to make up for their lost income.
The Sapersteins note they will save money on education since they won’t need to send their children to expensive yeshivas in New York City.
“It’s a very different life. Once we get out of the mentality of comparing I think that’s going to be the key. It’s a different economy, it’s a different culture, different necessities,” Lilach said.
Lazar acknowledges her family will need to adjust their lifestyle to make up for the lost income, but sees the benefits of a public health care system after working for two years at the Children’s Hospital of Philadelphia. She recalls a boy she treated who had leukemia. His family did not have insurance and delayed bringing him to the hospital when he started to regress.
“Sure enough his leukemia had returned and it’s an awful thought that a mother wouldn’t bring her kid to the hospital because she couldn’t pay for it,” Lazar said. “I didn’t go into pediatrics for the money.”
Luke Tress, along with other members of the press, was flown to New York and back to Israel by Nefesh B’Nefesh.