The shortage of physicians is a significant challenge in providing adequate medical service in Israel’s geographic periphery. To relieve that shortage, financial grants have been given over the last decade to physicians choosing to complete their residency training in hospitals in the country’s periphery. In 2015, the Myers-JDC-Brookdale institute, together with the Ministry of Health and the Israel Medical Association, conducted a study of the effects of these grants on the residents’ choice of workplace (center or periphery) and medical specialization. The study indicated an increase in the number of residency trainings begun in peripheral hospitals, probably due to a combination of several factors, including the grants. However, analysis of the characteristics of resident physicians in the periphery suggested that most would have chosen to complete their residency in the periphery even without the grants. Moreover, the proportion of those who had studied medicine in Israel among the residents in the periphery did not increase with the grants. In the current study, the research team re-interviewed the same residents, now young board-certified specialists, to assess the effects of the grants provided on their choices (several years later) regarding the region and institution in which they work and map out their career path in the transition from resident to board-certified specialist.
- Map the employment characteristics and work patterns of physicians in the transition from resident to board-certified specialist.
- Identify the factors affecting the choice of work region (center or periphery) and workplace at the end of their residency.
- Examine which variables affect the choice of working in the periphery, and the degree to which grant recipients have remained in the periphery after completing their residency training there.
Survey of 534 young physicians during the year after completing their residency training. The survey was conducted online or over the phone, according to respondent preference. The data were collected in four cycles from January 2019 to October 2020. The response rate was 65% (346 respondents).
Physicians in Israel’s geographic periphery and center receive job offers and special conditions of similar variety and rates, and their work patterns following their residency stage are similar. Professional challenge and development and family-career balance were the considerations ranked highest in selecting a workplace. Variables related to having a background in the periphery – parents living in the periphery, internship and mainly residency in the periphery – are the strongest predictors of employment in the periphery as young specialists. However, the percentage of young physicians who remained employed in the type of region (center v. periphery) where they completed their residency was lower among physicians who had completed their residency in the periphery.
The research findings support the notion that efforts should be made to attract physicians to the periphery at the residency stage to increase the likelihood that they would remain to work in these areas as specialists as well. However, as found in an earlier study, the financial grants attracted to the periphery only a small number of residents who would otherwise have chosen to specialize in central Israel. Accordingly, despite the tendency of physicians to remain in the geographical area of their residency, the number of specialists remaining in the periphery is limited and insufficient.
We recommend allocating resources to creating a cadre of high-quality physicians from among Israel’s peripheral population. We recommend giving dedicated incentives to outstanding students, to encourage them to choose to complete their residency and work in the periphery. Emphasis should be placed on providing opportunities for combining research and/or teaching and on creating a supportive environment for young families as job retention measures.