BGU | MY PATH, Haim Doron, MD

When I was appointed to run the medical branch of Clalit in 1976, the Minister of Finance was Yehoshua Rabinowitz, and during his tenure there was a doctor's strike. Rabinowitz appointed me the chair of the committee mandated to reach a new wage agreement. During the negotiations, I succeeded in inserting into the agreement concepts whose ramifications were a rise in doctor’s earning power while at the same time being concepts that enabled one to better organize work in hospitals. These concepts remain valid to this day. Changes in Opportunities for Private Practice Over the years there were various developments in private medicine verses public medicine. At times, the doctors proposed permitting part-time work. But, in my opinion, there is no way one can operate a public hospital on a high level on the basis of part-time physicians. Moreover, one needs to keep in mind that the doctors didn’t propose this in order to engage in a second part-time salaried position in another medical role. Rather, they wanted to engage in the identical field, only in private practice. Had this proposal been accepted, it would have led to erosion, mixing of private medicine with public medicine. 148 In the governmental system as well as in Clalit, even prior to my tenure as director-general of the sick fund, and a little, but only a little, during my period at the helm, surrender to this concept was a gradual matter. We allowed department heads to engage in a 95 percent salaried position and the rest of the time to engage in private medicine. During my tenure I narrowed this arrangement and permitted only a handful of department heads to do so, to prevent losing key staff. I made one major attempt to raise the percentage of salaried positions in the public system, in return for abolishing the right to a private practice, i.e., in exchange for raising the individual’s earning power. 149 I began this kind of agreement with doctors in the Negev, but within days, the Ministry of Finance vetoed it, just as it had previously vetoed the sesión I had introduced both to fully utilize expensive hospital equipment and to have the bonus effect of raising staff wages from overtime in afternoon hours. 150 In my view, the beginning of incursion of private medicine was the decision passed by one of the Israel Medical Association’s committees decades ago. The decision was that it is none of the health system’s business what a doctor does after hours. After a physician fulfilled their duties as a full- time salaried physician in a public clinic, they were free to engage in private practice. It led to a huge gap in earning capacity between various doctors, even for senior physicians and department heads who enjoyed high status in the public system and academic privileges, and so on. This was the first break in the dam that opened the floodgates to blending public and private medicine. 151 Constant demands to enhance earning capacities, benchmarked against others in totally different lines of work, has a negative impact that is counterproductive to the objective to improve service quality. As Israeli society has become more materialistic, the grave phenomenon of “under-the-table medicine” or “black market medicine” (refu’a schorah) has developed: There is no difference whether this occurs through a direct cash payment pocketed by the physician, or in the form 148 The term Doron uses in all his discussions of “mixing” or “blending” public medicine with private medicine refers to the prohibition of wearing garments that are a mixture (sha’atnez) of wool and linen (Leviticus 19:19). This is not merely about trying to mix technically incompatible elements, such as ‘mixing oil and water’. Sha’atnez signals a breach of conduct that connotes adulteration of something pure. 149 The German Commission to Strengthen the Public Health System in Israel (2015) headed by Minister of Health Yael German includes the following recommendation: “Private medical services (Sharap) will not be allowed to expand to public hospitals -The hospitalization system will be funded from public sources.” https://www.health.gov.il/English/News_and_Events/Spokespersons_Messages/Pages/5062014_1.aspx 150 For more on this see chapters 5 & 7. 151 As for the effect on relations in the workplace, there is a particularly Israeli malady best diagnosed as a form of torticollis (‘wry neck’) -- everyone perpetually perking up their heads at an abnormal angle to check out the lay of the land. Each person is surveying another, then demanding for themselves the other individual’s wages: The social worker is looking at the teacher, the teacher at the doctor, the doctor at the judge, and so forth. It’s a hard malady to cure. The objective of work contracts is that in addition to benefits gained by the recipient, special occupational perks are also thought to enhance the service the employee renders.

89