Medical Specialties in Crisis: An Exploratory Study

For years, the health system has been aware of the crisis affecting several medical specialties. The Amorai Commission, which reviewed the issue, concluded that it was unable to investigate it thoroughly due to lack of data and appropriate tools and recommended further examination. This study aimed to identify criteria and measures for determining that a medical specialty is in crisis, to ascertain the extent of the crisis, to examine its causes, and to identify possible solutions; this was done by means of a case study of general surgery and internal medicine.

For the purposes of the study, we conducted a qualitative analysis of testimonies submitted to the Amorai Commission and of interviews with key personnel in the health system, hospital directors, and heads of general surgical and internal medicine wards. We also conducted a secondary analysis of data from a national survey of specialists and analyzed national data files relating to supply and demand for medical specialties. Our research also included consultations with heads of medical societies and associations abroad.

The study identified the following five indicators of a medical specialty in crisis, on the basis of which we examined whether general surgery and internal medicine really are in crisis and, if so, to what extent:

  • A shortage of “good” residents (those whom the department heads consider most suitable) – as reflected in a decline in pass rates in Stage 1 exams; the quality of earlier training (according to the country where they graduated medical school); and gender (increased percentage of women)
  • Difficulty filling vacant positions
  • Not enough physicians for the quantity of clinical work and, consequently, an increasingly heavy workload
  • A sense of insufficient remuneration and limited opportunities to supplement income within the hospital
  • Impaired quality of working life – overload, lack of job satisfaction, and a sense of burnout

The study examined and elucidated an issue that had not previously been thoroughly investigated in Israel. The findings offer a basis for establishing indicators for specialties in crisis, for methodically identifying the main factors responsible for the crisis, for clarifying the extent of the crisis, and even identifying possible ways of solving it. Although the present study focuses on two specialties, it could constitute the basis for a broader study of additional medical specialties.

Key findings from the study have already been used in manpower policy development; both the Israel Medical Association (IMA) and the Ministry of Finance have made use of the data in their efforts to negotiate a new collective agreement for physicians.

Citations in the professional and academic literature

Rosen, B., Waitzberg, R., & Merkur, S. (2015). Israel: Health system review.

Rosen, B., Waitzberg, R., & Merkur, S. (2015). Health systems in transition. Health17(6).

Kogan, K., Panizel, R., & Perlman, Y. (2018). Part-time practice in healthcare: Impact on operational versus medical performance. Health marketing quarterly35(2), 85-99.