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The fight for a new medical school in Israel

The Council for Higher Education is due to publish revised conditions for setting up a medical school, behind which is a clash between Reichman University and the existing schools.

In the coming weeks, a committee set up by the Council for Higher Education in Israel is due to publish updated conditions for opening a medical school. The decision to invest now in revising the conditions comes against the background of the intention of Reichman University, the only private tertiary education institution in Israel with the status of a university, to open a medical school. Most of the existing medical schools oppose the idea.

The chairperson of the Council for Higher Education, Minister of Education Yoav Kish, actually supports the move, which puts the whole discussion onto the political plane, since there are fierce differences of opinion between Kish and the council members on other matters as well.

All agree: There’s a severe shortage of doctors

The starting point for the fight over the founding of a new medical school is in fact something everyone agrees on: Israel’s shortage of doctors will worsen in the coming years. Israel has some 30,000 doctors, 3.29 per thousand people, which compares with an average of 3.49 in the developed countries.

About 60% of Israeli medical students study overseas, and more than half of those study at institutions whose graduates will shortly be disqualified from obtaining a medical practitioner’s license in Israel, under the reforms spearheaded by Professor Shaul Yatziv, director of medical licensing in the Ministry of Health. If we add to that the fact that many doctors are shortly due to retire, Israel’s rate of population growth, and the effects of the war, we reach 2.9 doctors per thousand. The aim now is to mint 2,000 new doctors annually. That is not enough, but it’s the state’s target, and even that number is ambitious.

Prof. Ronni Gamzu, CEO of the Tel Aviv Sourasky Medical Center (Ichilov Hospital), who is formulating a plan on behalf of the Ministry of Health for expanding the number of doctors, is due to release it shortly.

"The Council for Higher Education is not meeting the targets," says Prof. Arnon Afek, dean designate of the Reichman University medical school. "This year, 1,030 students began medical courses. There were supposed to be 1,154." Reichman University wants to train eighty students when the medical school opens, and 120 at full capacity. This is not a huge number, but the university says that every addition helps.

No biology faculty

Reichman University was readying to launch its medical school in the fall of 2024, but, the more time that goes by, the more the coming academic year seems lost, and the fate of the whole enterprise is uncertain.

Afek emerged upset and angry after the previous meeting of the Council for Higher Education, when the application for setting up the medical school was first discussed. "I have never been treated so shamefully," he told "Globes". "They dismissed me. It didn’t matter what we said, they didn’t listen at all, and responded contemptuously. Representatives of all the universities and of the Student’s Union were present. Only the students’ representatives voted in our favor. Unless we finish dealing with the matter within a month or two, we won’t be able to take in a cohort of students, and then a simulation center will stand empty, empty classrooms, faculty with nothing to do, and eighty students will fly abroad to study, for no reason."

The lack of a biology faculty was the official reason for turning down Reichman University’s study program, but all sides agree that the threshold conditions were not completely clear. Do there really have to be biology studies at a four-year medical school whose students come after completing a first degree at another institution, as Reichman University plans? This will be examined by the special committee for setting threshold conditions, headed by Prof. Jonathan Halevy, co-CEO of the Shaare Zedek Medical Center.

"This is an outdated approach," says Afek. "At the university we have bioethics, synthetic biology, big data. Is biology the only basis for medicine?" The innovative simulation center at Reichman University, he says, is more important than laboratories when it comes to medical studies.

"It may be that it will be decided that any institution that teaches for a second degree can offer a four-year medical course, and then, theoretically, there could be a flood of applications," says a source close to the committee. "It may be that it will be decided that this can only be a university, and then Reichman will be the only institution able to join. Either way, whatever is determined will affect medical studies for years ahead."

The same source says that Reichman University could also set up a biology faculty if the threshold conditions require it, but that that would take it at least another two years, and they would have to recruit many good researchers from overseas, build laboratories, and invest capital.

The red rag to the system: A private institution

Besides the official reason for the disqualification, it would appear that the fact that Reichman University is a private institution is a red rag to the system. The universities fear that private medical studies will worsen the shortage of doctors in the periphery of the country. Those who work in the periphery are usually those who grew up there. Will a medical student who can afford to pay tuition fees of NIS 90,000 a year come to a settlement in the periphery afterwards? Reichman University has put together a grants program designed to encourage this, but the other universities don’t believe it will help.

The universities also fear that a private medical school will be able to pay higher salaries to lecturers, at their expense. Reichman University claims to have solutions, based on employing pensioners and lecturers who have not yet been taken on by the existing schools.

The main dispute is over practical teaching hours at the hospitals, known as clinical fields, which are the bottleneck of the system, because of the workload on doctors. Reichman University is proud of its plan to create clinical fields in the community, in collaboration with the health funds, but the medical schools say that if the number of clinical fields can be expanded, they will be happy to expand their faculties, and there is no need for new ones.

"I’ve seen what bringing private medicine into the public health system does. It changed it completely. What we really need is a structural change," Prof. Gamzu told "Globes", revealing parts of the new plan that he is formulating.

Gamzu proposes reducing the number of clinical weeks required to obtain a medical degree, and giving new incentives so that doctors will be freed up for teaching. As far as he is concerned, the solution lies in changing the balance of forces between the deans of the medical faculties and the hospitals. "Today, the hospitals work with several medical faculties, and I propose that each hospital should work mainly with one dean, so that he will be able to put more pressure on the hospitals to provide teaching hours.

"This could be anchored in regulations, stipulating, for example, that every bed is tied to such and such hours of teaching. That way, 20-25% more clinical fields could be added, bringing us very close to the target."

According to a source close to the committee, the areas of the country where clinical fields could be added are Tel Aviv and Haifa. The rest are saturated. "Within two years, Haifa will probably open a medical school, and, together with expansion of the existing schools, it will be possible to reach 1,600 students," he says.

Gali Weinreb