At the end of 2020, there were 32,000 physicians in Israel, an increase over the previous year. This figure included 8,300 residents. However, the supply of medical personnel relative to population size is actually declining, due to the rapid growth of the population coupled with physician ageing and retirement, and there is also an evident shortage in certain medical specialties. Physicians report excessive workloads, tend to work in more than one framework, and combine work in the public and private healthcare systems.
Physician and nursing staff numbers declining relative to population growth: The past decade has witnessed a steep rise in the number of new physicians per year, but despite a 26% numerical increase, there are fewer physicians per thousand people, due to the rapid rate of Israeli population growth. Moreover, Israel’s share of medical school graduates is among the OECD’s lowest, and Israel has the highest percentage of graduates of foreign medical schools. There are disparities in the quality of training between medical schools in Israel and in other countries, for instance in medical licensing exam pass rates. In an attempt to address these gaps, the Ministry of Health has shortened the list of foreign medical schools recognized in Israel. With regard to nursing staff, the numbers are again lower than in the OECD, with a gradual increase in the ratio of registered nurses (about 5.7 per 1,000 population) and a decrease in the ratio of practical nurses, with 0.7 practical nurses per thousand people in 2020.
When we look at physicians by gender and age, we find that Israel has one of the highest shares of older physicians among developed nations – half of the country’s doctors are aged 55 and over. During the coming decade, a third of the Israel’s veteran physicians are expected to retire. The share of women physicians has been trending upward, and this has an impact in a number of areas. Female physicians tend to work fewer hours than their male counterparts, such that the overall supply of physician work hours will decrease. There are also implications for choice of specialty. In addition, with the overall increase in the share of women physicians, it is expected that their representation in managerial positions will also increase.
Healthcare infrastructure disparities between districts and population groups: The hospital bed to population ratios in northern and southern Israel are the lowest of all the country’s districts, and there are disparities in terms of geriatric rehabilitation and general rehabilitation beds, as well as in the distribution of infrastructures and medical personnel. The Tel Aviv District’s physician to population ratio is the highest – twice as high as that of the Northern District. There are also medical specialties that are insufficiently accessible in the periphery, forcing patients to travel long distances. It appears, however, that in specialties with relatively low levels of demand, healthcare service decentralization would be infeasible, both medically and economically, and that it would be better to invest greater resources in fewer major centers than in wider service distribution while at the same time investing in transportation development, dedicated transportation for patients, and the development of community-based primary medical services.
Another way to improve access to healthcare services is to create new roles for non-physician health personnel such as practice nurses authorized to diagnose patients and prescribe medications, pharmacists authorized to prescribe prescription drugs, and a new profession that has emerged in recent years – the physician’s assistant, who provides preventive/diagnostic services and treatment under physician supervision. The continued development of this profession may be expected to significantly ease the shortage of medical personnel.
The poor are less immunized against Covid-19: Rates of immunization against Covid-19 rise along with socioeconomic status for all age ranges over 20. Vaccination gaps are evident in the lower socioeconomic clusters, not just in terms of delaying the third dose but also in refusing it altogether. That is, Israel’s socioeconomic disparities are also manifesting in the pandemic’s impact on the population at large, and their impact may be expected to persist, given the disease’s long-term physical, mental, and socioeconomic effects.