The Physician on a Board of Directors: Bane or Benefit?

With the accelerated development of innovative domains such as artificial intelligence, big data, and personalized healthcare, the continuing growth of health-tech and bio-tech industries is to be expected. Concurrently, the question of the extent and nature of physicians' involvement in these rapidly evolving industries arises, especially in management and leadership capacities such as directors or chief executive officers of such companies. Against this backdrop, the Israeli Medical Association recently launched a first-of-its-kind course designed to train senior physicians as directors in health-tech companies by providing them with vast relevant financial, legislative, and professional proficiencies. Due to their medical knowledge and clinical experience, physicians bring a substantial added value to these industries. However, considering the inherent tensions and potential conflicts between adhering to the logic of a profit-making, competitive market on one hand and maintaining the doctor's oath on the other, it is inevitable that dilemmas and difficulties will emerge. Much has been written about the roles and responsibilities of boards of directors, but to date, little has focused on the unique position of physicians who serve in these roles. This article aims to examine the ways in which conflicts or dualities of interest manifest themselves for physicians who assume roles as directors and whether effective remedial strategies are available, based on the authors' own experience in the initiation of the IMA physician-directors course.

In Service of the Society? Medical Associations as Agents of Social Change-Implications for Health Policy and Education in Israel.

This study aims to explore what medical associations in Israel do to promote public health, what values underpin their activities, and how their actions can be interpreted. For this purpose, an analysis of both individual and organizational levels was applied in an effort to yield a more nuanced understanding of the relationship between society and the medical profession. In-depth interviews with senior physicians were conducted, combined with a review of policy and public initiatives of medical associations between 2008 and 2018. The findings of this study reveal that medical associations engage in a range of social and policy initiatives designed to promote public health, but, at the same time, they tend to construct socially related health issues as medical problems in a manner that fits their sectorial agendas. This may reflect organized medicine's efforts to extend its dominance over society through the application of the biomedical model to social issues. It is necessary to integrate biosocial training with medical education to ensure that future physicians are equipped with the skills needed to implement social medicine.

Home Hospitalization Worldwide and in Israel.

BACKGROUND: Global trends, such as the population aging, the increase of chronic morbidity, soaring costs of healthcare services, and work overload in hospitals raise the need to find innovative solutions for providing quality medical services. One solution adopted by healthcare systems around the world is "home hospitalization," that is, providing an array of necessary health services in the patient's home, instead of in the hospital department. The aim of this focus article is to explore the spread of home hospitalization worldwide and examine the challenges and pathways for its adoption and implementation. Many countries, including the United States, Canada, the United Kingdom, and Australia, operate home-based hospitalization programs. In Israel, the service is in its infancy, but in view of the extreme workload and the high mortality rate from infections in acute care hospitals, home hospitalization has recently gained public interest and political support, which may encourage its further development.

[HOW MANY PHYSICIANS ARE ACTIVELY PRACTICING MEDICINE IN ISRAEL? ON THE DIFFERENCES BETWEEN VARIOUS METHODS OF MEASUREMENT].

INTRODUCTION: In 2018, Israel replaced the workforce surveys of the Central Bureau of Statistics with administrative data files, as the source of its reports to the OECD on the number of physicians practicing medicine and their percentage of the population. In the wake of the change, the scope of the medical workforce reported by Israel dropped by approximately 9%-15% in each one of the years from 2012-2015. Furthermore, while according to the previous measurement approach, Israeli figures were consistently equal to or higher than the yearly OECD averages, according to the new method these figures are lower than the averages of other OECD members. Essentially, according to the new data, the number of physicians practicing medicine in Israel straddles the minimum desirable amount recommended in the past by workforce planning committees in Israel. The new data are largely accordant with the feeling of distress and shortage in the medical workforce, which pervades the health system for many years, and simultaneously raise questions as to the reliability of official Israeli data as reported to the OECD - data upon which researchers, policy makers, the media and the public rely. Consequently, it is recommended to consistently improve the measurement and reporting to international organizations and to increase transparency regarding the measurement methods of various indicators in the health field.

Taking the measure of the profession: Physician associations in the measurement age.

Systematic measurement of healthcare services enables evaluation of health professionals' quality of work. Whereas policy makers find measurement a useful mechanism for quality improvement, a public choice perspective implies that physicians would resent such an initiative, which undermines their professional autonomy. In this article, we compare two healthcare systems of economically developed countries - Israel and the UK. Both systems share common features such as universal coverage, strong state intervention, and enthusiasm for New Public Management. In both countries, quality measurement was introduced in acute care hospitals at around the same time. However, while the UK succeeded in establishing a framework of surgical outcome measures during the 2000s, a similar initiative in Israel failed completely during the 1990s. We also refer to subsequent quality indicator efforts in Israel, in both community and hospital frameworks, that were more successful, but in a way that reinforces our central thesis. We contend that differences in reform outcomes stem from the medical profession's reaction to government's endeavors. This response, in turn, hinges on the professional organizations' relative institutional position vis-a-vis state authorities. This study constitutes a unique investigation of the medical profession's response to critical quality measurement reforms. Most importantly, it stresses the institutional position of medical associations as the primary factor in explaining cross-case variation in government's success in introducing quality measurement.

The Task Force for the Promotion of the Status of Women in Medicine in Israel.

BACKGROUND: In this article, we offer a brief summary of the report from the Task Force for the Promotion of the Status of Women in Medicine in Israel. The task force, formed by the Israel Medical Association in 2013, published a comprehensive report in May 2015 dedicated to the promotion of equal opportunities for female doctors in the Israeli healthcare system and in the academic world. The aim of this paper is to present the work of the task force and to highlight its main principles and recommendations against the backdrop of the gender revolution in the Israeli healthcare system and worldwide.

Perceived health status in a comparative perspective: Methodological limitations and policy implications for Israel.

BACKGROUND: The perceived health status indicator included in the OECD Health Statistics suffers from severe methodological limitations related to data collection. Furthermore, this indicator is also included in the OECD's Better Life Index, thus distorting the total health score of some OECD countries, among them Israel. The purpose of this paper is to explore the erroneous use of OECD health data in Israel and to warn of its implications. METHODS: Analysis of data from the OECD Health Database, Better Life Index and the Israeli Central Bureau of Statistics, review of media reports and governmental documents concerning health measures, conversations and correspondence held with officials in the relevant organizations. RESULTS: OECD's perceived health status outcomes for Israel are biased upwards, resulting also in an upward bias of the Israeli overall health grade in the Better Life Index. This is due to the methodological differences between the OECD's standard survey questionnaire and the Israeli one. Yet, erroneous comparisons constantly appear in governmental documents and media reports, presenting health status in Israel in an excessive positive light. CONCLUSIONS: Data from the OECD Health Statistics and the Better Life Index are reaching policy makers and the public in a manner that potentially distorts professional and political discourse on health. This may lead to a decrease in the resources allocated to health based on a flawed comparison. In the long run, and no less serious, the systematic imprecision may detract from the reliability of authority reports in the eyes of the public. Caution is essential in dealing with health indices and international comparisons. The OECD and relevant national agencies should invest greater efforts in the consolidation of definitions and methodologies.

Participation of National Medical Associations in quality improvement activities - International comparison and the Israeli case.

BACKGROUND: Many countries have devoted considerable efforts in an attempt to improve the performance of their health care systems. National Medical Associations (NMAs), along with other stakeholders, play a part in the promotion of such activities. The purpose of this paper is to explore the nature and level of participation of NMAs in activities of quality improvement in medicine, with a specific emphasis on Israel. METHODS: THE AUTHORS CONDUCTED A SURVEY AMONG NMAS AROUND THE WORLD INQUIRING AS TO THEIR INVOLVEMENT IN THREE CENTRAL ASPECTS OF QUALITY IMPROVEMENT: clinical guidelines, quality measurement and continuing medical education (CME). In addition, they conducted a review of the literature in order to gather more information and complete the data collected in the survey. The findings were processed and analyzed comparatively. RESULTS: Most of the NMAs surveyed participate in quality improvement activities at least to some extent. NMAs' main involvement is in the regulation of CME and they are involved to a much lesser extent in the preparation of clinical guidelines and in quality measurement. In Israel, the Israeli Medical Association (IMA) has a dominant role in both the preparation of clinical guidelines and the regulation of CME credits. DISCUSSION: It is possible that the expertise maintained by the profession, coupled with the organizational power of the NMA as a union, is viewed as beneficial for regulating educational activities in medicine such as CME. Conversely, the issuing of clinical guidelines is usually regarded as a typical scientific activity, and therefore often rests in the hands of professional medical societies. Quality measurement is regarded as a distinctive administrative tool and is usually found in the province of governments. Based on the typology that we introduced in our previous paper, we discovered that the extent of NMAs' involvement in quality improvement coincides with the mode of governance of the health care system. CONCLUSIONS: The nature and level of participation of NMAs in activities of quality improvement varies widely. Collaboration of NMAs in this field with other stakeholders is not uncommon, and may contribute to the further development of quality improvement in medicine.

Regulatory tasks of national medical associations - international comparison and the Israeli case.

BACKGROUND: In many countries, NMAs, along with other stakeholders, play a part in the regulation of physicians. The purpose of this paper is to compare and explain the level of involvement of NMAs in physician regulation in several developed countries, with a specific emphasis on Israel. METHODS: The authors conducted a review of the literature on physician regulation, focusing on licensing and registration, postgraduate training and physician disciplinary measures. Detailed country specific information was also obtained via the websites of relevant NMAs and regulatory bodies and correspondence with select NMAs.Five test cases were examined in detail: Germany, Israel, the Netherlands, the United Kingdom and the United States. The Israeli case will be discussed at greater length. RESULTS: Medical licensing usually lies in the hands of the government (on the national or state level). Specialist training, on the other hand, is often self-regulated and entrusted in the hands of the profession, frequently under the direct responsibility of the NMA, as in Israel, the Netherlands and Germany.In all the countries presented, other than Germany, the NMA is not involved in instituting disciplinary procedures in cases of alleged physician misconduct. DISCUSSION: The extent to which NMAs fulfill regulatory functions varies greatly from country to country. The relationship between government and the profession in the area of regulation often parallels the dominant mode of governance in the health care system as a whole. Specifically, the level of involvement of the Israeli Medical Association in medical regulation is a result of political, historical and ideological arrangements shaped vis-à-vis the government over the years. CONCLUSIONS: In Continental Europe, co-operation between the NMA and the government is more common than in the USA and the UK. The Israeli regulatory model emerged in a European-like fashion, closer to the Netherlands than to Germany.The Israeli case, as well as the others, demonstrates the importance of history and ideology in shaping contemporary regulatory models.

[Part-time residency training in Israel].

Full-time work has long been perceived as a cornerstone of medical residency, the consensus being that a resident must apply the bulk of his time and attention to his professional training. Demographic and cultural changes that have taken place over the last several years, specifically the rise in the number of female doctors and the importance of leisure time to the younger generation, have intensified the need to find new and innovative ways to deal with the plight of the resident population. One idea, already in effect in many Western countries, is the institution of part-time residency programs. The possibility of fulfilling residency requirements on a part-time basis is intended to assist medical residents in integrating their professional development with their personal and family life, without compromising the quality of their training. A number of research studies conducted over the last several years in countries that allow part-time residency, among them the United States, England and Switzerland, aimed to examine the quality of part-time training. The various studies evinced a high level of satisfaction from the program both by the residents themselves and their supervisors, and in many aspects those doing residency part-time received higher appraisals than their full-time colleagues. Some of the residents polled noted that they would have totally foregone the practice of medicine had there not been an option to complete residency part-time. In light of the experience throughout the world and the changing landscape in Israel, the Scientific Council of the Israeli Medical Association decided to examine the issue and its various aspects, and weighed all the considerations in favor and against part-time residency. Recently, the Scientific Council approved the launch of a pilot program to allow part-time residency in several fields that were carefully selected according to specific criteria. Once the Ministry of Health completes the LegisLation process, part-time residency will officially begin in Israel.