Many physicians and other healthcare professionals came on aliya over three decades ago when the former Soviet Union dissolved, and they were a blessing for Israel. But now, most of them are retiring, and the numbers of doctors and nurses who remain are inadequate for the country’s medical services.
The shortage of physicians is felt primarily in the geographic and socioeconomic periphery and in medical specialties such as anesthesiology, internal medicine, and pathology.
This is one of the conclusions of the Picture of the Nation 2022 report, just issued by the Taub Center for Social Policy Studies in Jerusalem, which presents some of the most important trends in the economy, labor market, health, and demography, welfare, and education. The booklet, written by the Taub Center’s president and expert in economics at Bar-Ilan University (BIU) in Ramat Gan, Prof. Avi Weiss, provides an up-to-date picture of the state of Israel in 2022.
Manpower in the medical professions is having difficulty keeping up with the population growth despite an increase in doctors due to the opening of new medical schools and the rise in the number of medical students studying abroad. Thousands of lives per year in Israel could potentially be saved by adopting medical practices that are successful in other countries, Weiss stressed.
Despite the increase in the number of physicians in Israel, their number is lower than the OECD average. Between 2000 and 2019, there was an increase of 26% in the number of physicians in Israel, thanks to the Soviet emigration. At the end of 2020, the number of physicians under the age of 67 stood at about 31,800, of which more than 8,300 were interns. The share of physicians per thousand population in Israel is lower than the OECD average – 3.3 versus 3.5.
Unfortunately, Israel leads the OECD countries in the share of medical graduates who studied abroad because all medical schools are public and subsidized by the government, which limits how many can be accepted for studies.
In the past few years, there has been a rise in immigrant physicians to Israel and Israeli physicians who have studied abroad. Alongside this, the number of medical students has doubled in the past decade due to the opening of new faculties of medicine at BIU in Safed in the Galilee and Ariel University in Samaria and the modification of additional hospitals to train physicians.
About half of the physicians in Israel are over the age of 55; this is also bad news. The population of physicians in Israel has the highest average age among the developed countries, and many physicians are approaching retirement age. About 49% are over the age of 55.
The share of working Israeli nurses is among the lowest in the OECD. There are five active nurses per 1,000 population, as opposed to an average of 9.5 in the OECD. From a geographic perspective, the shortage is felt primarily in the periphery, while from a professional perspective, it is felt in public health and even more so among school nurses. In addition, there is a trend of academization in the nursing profession, so the number of registered nurses is increasing while the number of practical nurses is declining. In 2020, the share of licensed nurses under the age of 67 was 6.3 per thousand population.
The number of physicians per capita in the Southern and Northern Districts is significantly lower than in the other districts. Between 2018 and 2020, the number of physicians per 1,000 in Tel Aviv was 5.8, as opposed to 3.0 and 2.5 in the Southern and Northern Districts, respectively. Between 2015 and 2017, the gap in the number of physicians widened between the Southern and Northern Districts and the rest of the country, apparently due to the gradual rollback of periphery grants.
Meanwhile, in the lower socioeconomic groups, the rates of COVID-19 vaccination that is open to all Israelis are particularly low, while the proportion vaccinated among this group tends to be higher in the case of traditional vaccinations such as those given to young children. Weiss suggested that there may be long-term implications in view of the virus’s physiological, mental, and socioeconomic effects.
There is a potential to prevent thousands of deaths if medical practices that have been successful in other countries can be successfully adopted in Israel. In Israel, there is a very high level of mortality due to diabetes, and it is among the poorest performing countries in the OECD in this regard. A reduction in mortality from diabetes to the median level among the 36 other countries in the ranking would prevent almost 3,400 deaths per year. This is higher than the number of deaths from the Coronavirus in 2020. In addition, thousands of deaths per year from other diseases could potentially also be prevented if medical practices that have succeeded in other countries can be successfully adopted in Israel, the author continued.
There were high mortality rates during the COVID-19 waves, but the overall mortality rate among COVID-19 patients was relatively low. In 2020, there was a high death rate among the elderly, while in 2021, there was actually an increase in mortality among the young. Last year, there was an increase in mortality among the young because they did not get fully vaccinated or wear face masks in indoor spaces, while the rate among the 75+ age group who protected themselves better fell to almost pre-pandemic levels.
The number of deaths in 2022 dropped relative to 2021. During the first two months of 2022, the number of deaths from COVID-19 was about 1,930, in contrast to about 2,400 during the same period in 2021. The rate of mortality from COVID-19 among confirmed patients in Israel was among the lowest in the world throughout the pandemic, evidence of the successful response by the Israeli healthcare system to the pandemic, Weiss continued.
As for having babies, there was an increase in fertility among Jewish women and a leveling off of the downward trend among Arab women — Early signs of the effect of the pandemic on rates of fertility in Israel show an increase in the fertility rate among Jewish women and the leveling of the downward trend among Arab women. The average number of children per woman in Israel is almost double that in the OECD. Future trends will show whether the coronavirus pandemic strengthened the trends in fertility in Israel over time or weakened them, wrote the Taub Center president.
Meanwhile, there has been a recovery in immigration to Israel, primarily from Ukraine and France. Some 26,000 immigrants arrived here in 2021, including the largest American immigrants since 1973. In the preceding year and in the shadow of the pandemic, there was a significant decrease in the number of immigrants, which was mainly due to the decline in aliya from Russia and Ukraine. The war between them is likely to lead to a renewal in the immigration from these two countries, Weiss predicted.
The sections dealing with macro-economics and the labor market describe events in 2021 showed a surprising recovery in the Israeli economy, though not in all areas; the increase in the debt-to-GDP ratio following many years of efforts to lower it to an optimal level; and an exceptionally large drop in private consumption and imports. The hi-tech sector managed to minimize the impact of the crisis and weather the storm, but this was not the case in some other sectors.