Is there a doctor in the house? Availability of Israeli physicians to the workforce

BackgroundPreventative health services are a pediatric health care cornerstone, which strives to promote health and prevent illness and injury. In Israel, Maternal Child Health Clinics (MCHC) provide these well child services for ages 0–6 years. MCHC care includes physician visits; however, the physician’s role is not well defined. The study purpose was to provide a basis for setting policies that determine the role of physicians in the provision of MCHC services. To get broad input we included MCHC stakeholders - parents, MCHC physicians, non-MCHC physicians and MCHC nurses, specifically to obtain insights regarding the MCHC physician role and to characterize the stakeholder demographics, service utilization, and practice patterns.MethodsProfessional groups completed self-administered written questionnaires (n = 398). Parents were interviewed during MCHC visits using a structured questionnaire (n = 1052). All provided demographic data, service characteristics and agreement with ten potential MCHC physician roles - Physical Examination, Abnormal Health Condition Detection, Developmental Screening, Anticipatory Guidance, Parent-Child Interaction Counseling, MCHC Staff Advice, Children-at-Risk Detection, Growth Surveillance, Vaccination Counseling, and Inter-physician Communication.ResultsThe study findings seem to indicate a true shortage of MCHC physicians. The median age of MCHC physicians was significantly higher than both non-MCHC physicians and MCHC nurses. There was agreement among stakeholders regarding some roles (Physical Examination, Developmental Screening and Detection of Abnormal Health Conditions) but not others. Most parents reported having at least one MCHC physician encounter. Parents who did not visit the physician were younger and had fewer children.ConclusionsStakeholders view MCHC physicians as integral to MCHC care. Roles traditionally regarded as part of primary prevention were less likely to be attributed to physicians than screening roles considered secondary prevention.Updating and standardization of the MCHC physician role is needed along with a national strategy to recruit and train MCHC physicians.to ensure optimal pediatric preventive health care in Israel.

Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The role of the physician in Israel’s maternal child health clinics: surveys of professional and parental perceptions

Stein‐Zamir

Shoob

Zimmerman

2017

“…By adding PAs, Israel has joined a global trend of creating new healthcare roles and positions as a response to various medical workforce problems, including shortages in primary care, rural areas, and other settings [1]. Israel has also been dealing with similar problems such as a shortage of health professionals, especially in the periphery, and shortages in some specialties more than others (geriatrics, anesthesiology, intensive care, surgery, and pediatric subspecialties) [2–4]. These problems have forced the Israeli government to plan ahead and find creative ways to avoid or circumvent shortages.…”

Section: Introductionmentioning

confidence: 99%

Integration of the first physician assistants into Israeli emergency departments – the physician assistants’ perspective

Maoz-Breuer

Berkowitz

Nissanholtz-Gannot

2019

Background A new role of Physician Assistant (PA) was introduced into Emergency Departments (ED) in Israel in 2016, as part of a larger effort to improve the quality of service in the EDs. When the new role was introduced, there was a fair amount of uncertainty about whether it would succeed, in light of ambivalence on the part of many ED nurses, and lack of clarity among ED directors about the necessity of a PA role, and about the extent to which PAs would be allowed to take on professionally meaningful tasks. The first class to train PAs was run by the Ministry Of Health between May 2016 and August 2017, with 34 PA trainees participating. 17 out of 24 EDs across Israel partook in the integration of the new PAs. This study assessed how this initial phase of integration is proceeding, from the perspective of the PA trainees themselves. Methods New PA trainees were surveyed at the beginning and end of their training. Likert scale responses were collected (using a scale of 1 to 6). Respondents were asked about difficulties in their previous profession, their motives for choosing the PA profession and their expectations for the new position. The follow-up survey included additional questions about their clinical activities. Descriptive and correlational statistics were performed. Results In the first survey, PA trainees reported that their main difficulties as paramedics were lack of options for professional advancement and burnout. New PA trainees had initially very high expectations for professional challenge, professional status upgrade, personal fulfillment, career prospects and an increase in wages (average mean score 5.7). In the follow-up survey there was a large drop in all of their ratings (average mean score 3.8). In the second survey, PA trainees reported spending the majority of their time evaluating, diagnosing and managing patients as opposed to preforming clinical procedures, such as inserting an IV, administrating medicine or applying casts. Despite their decreased expectations, they still felt that they were intellectually stimulated (5.3 average), given high levels of responsibility (4.8 average), and making significant contributions to the healthcare team and patients (average score of 5.5). All of the above were correlated with overall satisfaction. The main difficulties they reported were related to limited authority and further career advancement. Conclusions The new Israeli PA role has officially been launched in emergency medicine. The first group of PA trainees report a positive, productive integration, and overall satisfaction levels with their new career are high. However, the PA trainees reported having experienced some difficulties along the way, and there was a large decrease in their overall expectations from the new position during their first year on the job. Since the subject of limited authority was found to be a substantial difficulty for the new PA tr...

“…In a recent IJHPR article, Horowitz and colleagues report on analyses from 2008 and 2012 of the Israeli physician in workforce. [ 1 ] By linking national administrative files, the authors were able not only to assess the total “potential” physician workforce by tracking licensed physicians by specialty, they were also able to offer perspectives on the “effective” supply of physicians available, with a particular focus on physician productivity and physicians residing abroad.…”

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confidence: 99%

Workforce planning—going beyond the count

Sandy

2017

Every country struggles with how best to meet the demand for health care services with the available resources. This commentary offers a perspective on the Israeli physician workforce and the analyses of Horowitz et al., which found age and gender differences in physician productivity and career longevity, differences across specialties, and a sizeable fraction of licensed Israeli physicians living abroad. Workforce planning can be subject to data collection and statistical uncertainties, but even more important are the assumptions and forecasts related to demand for services and organizational arrangements for care delivery. Readers should be cautious in analyzing productivity just by counting hours or years worked, and comparisons across countries may not account for differences in the nature of physician work. The question of whether Israel has enough physicians for the future has to go “beyond the count” to looking at the roles of other health professionals, the use of new technologies and new team configurations, and the overall efficiency and effectiveness of health care delivery systems such as hospitals, ambulatory care clinics, and community-based care.