Attracting Medical Residents to the Periphery and to Medical Specialties in Crisis following the 2011 Collective Agreement

In 2011, a collective agreement was signed between representatives of the physicians and the main employers of physicians. The agreement established financial incentives that were intended to address two problems: the shortage of physicians in the periphery and the shortage of physicians in the “specialties in crisis.” The incentives included one-time grants and an increase in salary for residents who chose residencies in hospitals in the periphery and/or in specialties in crisis. In addition, it was decided to increase the number of approved positions for physicians in hospitals, particularly those in the periphery.

The current study was intended to examine the impact of these incentives and to examine other factors and considerations affecting the choice of place of work and medical specialty. A related goal was to provide information to help policymakers decide about the future of the incentives and other ways to encourage physicians to undertake residencies in the periphery and in specialties in crisis.

The study was conducted in partnership with the Israel Medical Association (IMA) and the Ministry of Health and was based on two main sources of information:

  • An administrative data file from the Scientific Council of the IMA that includes information about all new residencies in Israel from 2005-2014.
  • A national survey conducted at MJB in 2015 of a national sample of residents who began their residencies in 2013-2014.

Using the administrative data, the study examined trends over time in new residencies, by geographic areas and specialty, with an emphasis on changes since 2011. The survey examined the considerations that influenced the residents when they chose their specialty and the hospital where they would do their residency, the perceived influence of the incentives, the residents’ plans as to where they would work after their residency, and related issues. The analysis took account of the background characteristics of the residents including the country where they had studied medicine and where their parents live.

The study findings have been presented at various forums – conferences, hospitals, the IMA, the Israel Association of Family Physicians and the Ministry of Health. The study has already stimulated in-depth discussion as to the future of the incentives, other strategies to influence the decisions of young physicians, and the current needs of the health system. These findings are timely, as discussions over a new agreement between the physicians and their employers will commence in the coming years.

Citations in the professional and academic literature

Avidan, A., Weissman, C., Elchalal, U., Tandeter, H., & Zisk-Rony, R. Y. (2018). Medical specialty selection criteria of Israeli medical students early in their clinical experience: subgroups. Israel journal of health policy research7(1), 20.

Weissman, C., Zisk-Rony, R. Y., Avidan, A., Elchalal, U., & Tandeter, H. (2018). Challenges to the Israeli healthcare system: attracting medical students to primary care and to the periphery. Israel journal of health policy research7(1), 28.

Ashkenazi, Y., Gordon, M., & Rosen, B. (2019). Using financial incentives to attract medical residents to the periphery: The Israeli experience. Health Policy123(1), 80-86.

Ida, Y., Talit, G., & Levy, S. (2019). Restrictions on the Employment of Migrant Workers in the Israeli Domestic Care Sector: Do They Really Work?. Journal of International Migration and Integration, 1-17.