Experts find it hard to determine the main cause for physicians’ leaving the field of medicine and the high rates of emigration among Israeli physicians; it appears that the reasons are wide and varied. These include difficult working conditions, lack of support for young doctors, unsatisfactory remuneration, and inability to realize the medical ideal due to budgetary and regulatory constraints of the system and the employers. Studies conducted in Israel and abroad found a direct relationship between these causes and the following phenomena:
- Burnout, pressure and stress
- Physical and mental fatigue
- Contemplation of early retirement (based on foreign research studies)
- Abandonment of the field of medicine in favor of other careers
- Physician emigration
A 2002 study conducted in the US found several predominant parameters affecting the sense of dissatisfaction at work among family practitioners:1
Personal and professional factors – about one tenth of the physicians under 35 were found to be dissatisfied, compared to about a quarter of doctors aged 55-64; clinic owners reported higher dissatisfaction than employees; male physicians were somewhat more inclined than females to be dissatisfied.
Organizational factors affecting the physician-patient relationships – according to the study, difficulty in providing optimal care for patients and the doctors’ inability to make independent decisions, contribute greatly to the sense of dissatisfaction.
A study that examined stress, burnout and dissatisfaction among Dutch specialist physicians found that such doctors suffered a significant increase in stress-related sicknesses. Similar to the findings of the American study, personal, professional and organizational factors were found to cause feelings of dissatisfaction, burnout, stress, and even mental exhaustion.2
A similar Australian study conducted among physicians and residents in emergency medicine, found that 71.8% of the doctors suffered from varying levels of burnout and exhaustion, and 48.7% were found to be suffering from mild to severe lack of personal satisfaction.
The study found that dissatisfaction at work, long work hours, multiple shifts and doctors’ status as residents, directly impact on the prevalence of these phenomena among the respondents. The study also found high probability that doctors experiencing burnout would consider retirement within 10 years. Intervention is therefore required in order to improve these doctors’ personal, professional and organizational welfare.3
A comprehensive study examining these phenomena among physicians was also conducted in Israel. A 1994–2001 study conducted by the National Institute for Occupational and Environmental Health followed the state of hundreds of family doctors, pediatricians and other physicians. The data from 2001 shows that 60% of general practitioners, 39% of pediatricians and 72% of clinic directors suffered high levels of burnout, with burnout levels rising significantly throughout the years of the study. Burnout levels were higher among family doctors than among pediatricians, while clinic directors suffered especially high levels of burnout.4
Excerpted from the study conducted by the National Institute for Occupational and Environmental Health:
Average Levels of Burnout and Depersonalization5
Evidently, over the years there has been an increase in burnout and depersonalization levels also among family doctors and pediatricians.6
Not surprisingly, burnout is closely linked to insufficient remuneration. In fact, the average hourly rate earned by doctors in Israel in 2011 is only NIS 40 per hour (approx. $ 11.00). In some areas, doctors earn even less, at NIS 34.6 per hour (approx. $ 9.80) on average. Worst of all is the residents’ pay averaging only NIS 29.5 per hour (approx. $ 8.50).7
An area-specific doctor is a doctor that is not a specialist, who engages in a particular specialty.*
The level and structure of the wages paid to doctors is therefore a primary negative incentive to doctors’ remaining in the public healthcare system long term. This is especially true when it comes to the future generation of medical practitioners – the residents, who earn less than NIS 30 ($ 9.00) per hour despite many years of study, long hours of work at the hospitals, and tremendous investment of physical, emotional and intellectual energies in patient care.
The studies' findings presented above correspond with the findings of the Van Dyke and Associates' study (2011), which indicates a low level of satisfaction with the physical conditions of the work environment, the level of income, and the lack of balance between work and personal life (“external factors”) among medical practitioners. In contrast, the level of satisfaction derived from the nature and essence of the profession itself (“internal factors”) is relatively high. Researchers claim that doctors who remain in the field continue to be frustrated by the external occupation factors. If this frustration remains a regular part of the medical profession, it may adversely affect the physician’s work and its quality.8
1 J. DeVoe et al.,“Does career dissatisfaction affect the ability of family physicians to deliver high-quality patient care?”, Journal of Family Practice 2002; 51(3): 223-228.
2 M. Visser et al., "Stress, Satisfaction and Burnout among Dutch medical specialists”, Canadian Medical Association Journal 2003; 168(3): 271-275.
3 L. Goh, PA Cameron and P. Mark, “Burnout in emergency physicians and trainees in Australia”, Emergency Medicine 1999; 11(4): 250-257.
4 T. Kushnir, C. Levhar and AH. Cohen, “Are burnout levels increasing? The experience of Israeli primary care physicians“, Israel Medical Association Journal 2004; 6 (8): 451-455.
5 Depersonalization – a condition in which a person feels as if he underwent a strange change, or that his/her head is separated from the body. In a light form, this is a common sensation among healthy people under strain. Severe forms of depersonalization appear in situations of extreme anxiety, depression, schizophrenia, and in some forms of epilepsy. http://www.infomed.co.il/definition-1013/# [30 March 2011]
6 See a detailed description of the results and calculation method in the article of A Kushnir, “Are burnout levels increasing?"
7 IMA internet site http://www.ima.org.il/WageNew/Default.aspx]08 May 2011]
8 Van Dyke, ibid, 313.