The Migration of Physicians: The Israeli Experience

1
The Migration of Physicians The Israeli
Experience

• Malke Borow, J.D.
• Israeli Medical Association
• March 2007

2
Physician Migration-The Situation in Israel

• Beginning in 1989, large influx of immigrants
  from the former Soviet Union.
• Absorption of approximately 1 million immigrants
  (about 1/6 of the population)
• Israel is a country of immigrants and greatly
  supports immigration.

3
Israeli Immigration 1989-2000

• 535,000 families 1,042,720 immigrants
• Continents of largest immigrant groups
• North America 26,330 (2.5)
• Western Europe 35,100 (3.4)
• Africa 48850 (4.7)
• Former Soviet Union 885,850 (85)
• 50,000 physicians, pharmacists and nurses

4
Physician Migration to Israel

• Average aid provided by government for absorption
  of immigration NIS 62,800 (13,950 USD)
• Additional aid for physicians included
  vocational Hebrew studies, licensing procedures
  (preparatory course, licensing exam) and
  employment (for purposes of specialization).

5
Immigrant physician employment-forecast and
reality

• Between 1989-1995, approx. 12,870 physicians
  immigrated to Israel.
• Assumed that approximately 2500 immigrant doctors
  could be absorbed.
• In part, this figure reflected the general growth
  in population due to immigration wave.

6
Physician Immigration to Israel from FSU

•  
• Based on the self-declared occupation of the new
  immigrants. The number of physicians is estimated
  to be 90 of the total, or 12,870
•  Sources Israel Central Bureau of Statistics and
  Ministry of Immigrant Absorption . Taken from
  Shuval and Bernstein, 1997. Immigrant
  Physicians, p. 50.

7
Licensing and specialization

• 1988 licensing exam
• Preparatory courses-several languages
• Specialization more difficult to obtain
• Highlighted differences between Israeli and FSU
  systems

8
System-wide response

• Inter-ministry committee
• Ministry of Health/Immigration Retraining
  courses, funded residency programs, preparatory
  courses, employment assistance
• Hospitals observation and residency
• IMA advocacy and representation
• Parliamentary and Judicial systems
• Immigrants associations

9
Professional Acclimation

• Pre-employment
• Entry into profession
• Initial employment
• Professional establishment/advancement

10
Physician Migration-Employment (1989-1992)

• 4800 immigrant doctors (71) received licenses to
  practice medicine
• 85 of these were gainfully employed, 85 of them
  as doctors (i.e., 72 of those who received
  licenses were employed as doctors)

11
Physician Migration-Employment (1989-1992)

• 66 were salaried doctors, of these
• 60 general physicians
• 30 residents
• 10 specialists.
• Most likely to receive license and find work
  men, under age 55, some fluency in Hebrew

12
Recognition of credentials (1989-1992)

• 73 of licensed physicians applied to IMA
  Scientific Council for recognition of their
  specialty.
• 9 were granted full recognition
• 5 were required to pass practical examination

13
Recognition of credentials (1989-1992)

• Remainder were required to retrain partially or
  fully.
• New criteria for recognition, aimed exclusively
  at Soviet physicians, instituted in 1992 and 1994.

14
Updated figures (1989-1998)

• Approx. 20,000 immigrants from former Soviet
  Union declared themselves as doctors.
• 13,000 applied for license to practice medicine
  8000 received.
• 5000 of these applied for specialty
  certification 1500 certified by 2000.

15
Updated figures (1998)

• 70 of licensed doctors working as physicians.
• 22 employed as specialists
• 37 employed as residents
• 41 employed as general practitioners
• 37 of immigrants not working as physicians
• 21 working in other fields entirely
• 16 not working at all

16
Integration into employment market

• Job stability (93 still working in 1998)
• Better working conditions
• Career advancement
• Still underrepresented in senior management,
  administration, academia

17
Potential explanations for successful large scale
absorption

• Decrease in working hours
• Non-conventional employment arrangements
• Private settings
• Cheaper workers
• Geographic dispersal
• Less attractive specialization fields
• Exchange of nurses for doctors
• Laws and policy

18
Effect on salaries

• 1989-1995 63.8 increase in number of physicians
  employed in Israel.
• Wages of physicians rose
• 65 for senior doctors
• 50 for majority of doctors

19
Effect on salaries

• Explanations
• IMA battle for increased wages and employment.
• Government efforts to integrate
  physicians-financing from temporary and special
  budgets
• Most initial employment was at lower end, because
  of retraining and re-licensing lag.
• Bias of wage agreements in favor of veteran
  physicians.

20
Major obstacles

• Social
• Lack of fluency in Hebrew (also professional
  issue)
• Family absorption difficulties
• Professional
• Education and training in USSR not comparable to
  that of Israel and the West-need to
  re-license/retrain
• Loss of status

21
Obstacles, cont.

• Legal
• Legal issues connected with recognition of
  credentials
• Financial
• Potential drop in standard of living
• Need to compromise on position taken
• Lower income/ job stability than native Israelis

22
Conclusions

• Immigration wave in early 1990s doubled number
  of countrys physicians.
• Many were absorbed without major repercussions to
  health system.
• Some left profession, retrained or changed
  direction within the profession.

23
Conclusions

• Individual doctor felt professional, sociological
  and economic repercussions
• Downgrade in status (and/or salary)
• Identity issues
• Need to retrain

24
Conclusions

• System wide view
• Extensive system wide mobilization
• Participation of profession and immigrant groups,
  non-formal support systems
• Quick organization and implementation of
  strategies to absorb immigrant physicians
• National policy regarding immigration and
  absorption of professionals.

25
Conclusions

• Slight positive effect on salaries
• No major impact noted on availability and
  accessibility of services.
• No studies re impact on quality of medical care