It is impossible to discuss the appeal of the medical field without mentioning physician emigration. International emigration of highly educated workers – "brain drain", is an increasing phenomenon, which is particularly evident among service providers and academics. The globalization of the services sector in recent years contributes to the surge in doctor emigration.

The reasons for abandoning the medical profession and doctors’ emigration vary from one place to another, but some are identical worldwide: quality of life, burnout, poor conditions in the country of origin, attraction to another profession, and the erosion of medical autonomy. Although physician emigration is more typical of less developed countries, we find doctors emigrating from relatively well-established countries such as Israel and Britain.

For example, a research study conducted in Britain found that of 1047 doctors who expressed readiness to emigrate and practice medicine abroad, 41% cited the working conditions in Britain as a consideration for emigrating. Of those who contemplated leaving the profession altogether (279 doctors), 75% cited working conditions as the reason, 23% mentioned quality of life, and only 9% expressed a positive desire to engage in some other field.¹

This research illustrates clearly that the desire to work abroad is more prevalent than the desire to leave the profession, and that working conditions are a key factor in the decision to abandon the field, and to a lesser degree – to emigrate.² For the most part, the reasons for emigration and the abandonment of the field of medicine do not stem from doctors’ negative sentiments towards the profession itself, but from the conditions inherent in its practice.

Therefore, it would be reasonable to assume that a change in government policy could increase the number of doctors who choose to remain in the field and practice in their native country.

A study that examined the rates of emigration from Israel between 1995 and 2002 according to education, employment, income, marital status and the duration of years spent in Israel, found that among those with an academic education there is a higher incidence of emigration from Israel than among less educated groups regardless of how the groups’ data is segmented, and that there is a relatively high incidence of emigration among doctors (4.8%).³ As mentioned previously, according to the research done by Van Dyke and Associates, there is a higher percentage of emigration among doctors: 6.5% of the surveyed doctors are currently living abroad. There is no data regarding this population except that they live abroad for extensive periods, primarily for purposes of work, study or internship.⁴

The results of a survey recently conducted by the Association of Israel Anesthesiologists in light of the persistent shortage of anesthesiologists in Israel, and the tendency of new doctors to avoid specializing in this field, indicate the alarming proportions of the phenomenon:⁵ of 310 specialists and interns in anesthesiology, 62 doctors (20%) have emigrated in the past decade. These medical personnel emigrated primarily to the US and Canada, and as far as is known, they were absorbed by their field of specialty abroad. Another eight doctors have reported their plans to emigrate in the near future. Although this example is taken from a specific medical specialty, it can serve as a concrete illustration of the precarious state of the future of medicine in Israel.

The phenomenon of physicians leaving medicine for other professions, the work overload, the burnout, and the diminished appeal of the medical profession, all adversely impact on the medical system as a whole, but the public healthcare system suffers the most. The private sector, which is continuously growing, offers doctors new employment opportunities. New private hospitals (such as the Assuta Hospital in Tel Aviv and in other cities) open, and plans are formulated by general healthcare services and insurance companies to open institutions of this kind. The insufficient remuneration and excessive workload which doctors face in the public healthcare system, increase the incentive for doctors who choose to stay in the profession to move over to the private medicine sector. This trend causes senior and prominent physicians to leave the public sector and undermines the principle of equity on which the Israeli public health system is based.

¹ PJ. Moss et al., "Reasons for considering leaving UK medicine: questionnaire study of junior doctors' comments", British Medical Journal 2004; 329 (7477): 1263.

² bid.

³ A Gold and A Moav, Brain Drain in Israel, The Shalem Center – The Social Economic Institute, May 2006

⁴ Van Dyke, ibid, 311.

⁵ The letter of Prof. Pearl, Chairman of the Association of Israel Anesthesiologists, on harsh data concerning emigration of anesthesiologists.