BGU | MY PATH, Haim Doron, MD

At the same time, the IMA was gaining ground as a scientific union for in-service training, licensing of doctors, and so forth. Wages and working conditions of Clalit employees were handled by the union of Clalit doctors, while those of state employees were negotiated by the union of government physicians. For decades, wage issues of community doctors were negotiated directly between Clalit headquarters and doctors in the community. After Clalit doctors reached an agreement with Clalit, the agreement was applied to, and adopted by, the salaried physicians of the other sick funds. When there were struggles, it was the Labor Federation that had the final word between Clalit doctors and the sick fund. But the Federation had a serious conflict of interest: On one hand it represented the doctors, on the other hand Clalit. This situation led Clalit doctors to distance themselves from the Labor Federation and turn to their professional organization -- the IMA -- to represent them. Over time, the IMA came to be viewed as the definitive professional representative of Israel’s doctor community as government physicians followed suit. Over the years, I learned that combining a labor union that deals with wages and employment conditions and a scientific council that deals with specialization, as is the case with the IMA, is inappropriate. The IMA was no different from other unions in suffering from the torticollis (‘wry neck’) malady cited at the opening of this chapter -- everyone perpetually perking up their heads at an abnormal angle to check out the wage situation next-door. Thus, the Doctors Association couldn’t consummate a new agreement that raised the wages of one sector, without raising the wages of all physicians. This included department heads with private practices. In practice, this deepened the inequality in earning power of employees. The Strike Methodology It wasn’t wage demands that bothered me, but rather the methodology of the strike. It wasn’t a strike in the classical sense and structure. At the beginning, patients were treated after paying the doctor a 600 NIS fee for a hospital visit. Though there was supposed to be a fee paid to the doctors even at clinics, the clinic doctors did not identify with this idea. When they began charging per visit, the Ministry of Health turned to the labor courts, which ruled that doctors were forbidden from charging money at hospitals. When they couldn’t continue to charge at hospitals, they opened treatment service centers in hotels and similar places where they charged 600 NIS per visit. Parallel to this, a significant number of hospital doctors just walked out, i.e., they didn’t show up for work. The ramifications being clear, the Ministry of Health got no-strike restraining orders that considered doctors as essential workers forbidden to strike, and the doctors refused to honor them. In the middle of this tug-of-war, an agreement - ground rules for the strike -- was reached by Minister of Health Eliezer Shostak, and the Attorney General, Yitzhak Zamir. The principles were as follows: Hospitals could work at a third of normal capacity; all community clinics, without exception, would be closed; and the authority of hospital directors would be curtailed. I don’t know how any Minister of Health could sign such an agreement; but he did. I viewed this agreement as a calamity, and fought it tooth and nail. First of all, I saw the closure of clinics as totally irresponsible and a gross injustice from a medical standpoint. In 1983, things were not yet computerized, and the ramification of closing the clinic doors was locking-up all the medical records of patients. If prior to the strike, a person had an x-ray that showed a suspect finding, then with the clinic closed, there was no way to access the x-ray, or even to know what had

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