Israeli Medical Association rails against Shas's medical title changes

The Knesset Health Committee headed by Shas MK Uriel Busso wants to change the name of physicians' assistant (ozer la’rofeh in Hebrew) to physicians’ associate (amit rofeh). This, according to dozens of medical societies in the Israel Medical Association (IMA) who petitioned against the change, gives the misleading impression that the person is almost a physician. 

“The physician assistant (PA) should be assistant, to help doctors to work under their strict supervision,” Prof. Yuval Yaron, senior gynecologist, geneticist and director of the prenatal Diagnosis Institute at Tel Aviv Sourasky Medical Center, told The Jerusalem Post in an interview on Thursday.

Busso announced the change one day after physicians held a two-hour warning strike at hospitals across the country to protest the Knesset’s repeal of the Reasonableness Standard, which some doctors saw as  severely limiting their professional decision-making and medicine-practicing powers.

“It was vindictive, childish, misleading, shameful and has many implications on how medicine will be practiced,” Yaron said. “Over the years, there have been discussions among the IMA, the Health Ministry and others on Pas, of whom there are many in the US and elsewhere. The IMA was not opposed in principle, but what tasks they can perform must be supervised and clearly defined.

“In the US, the American Association of Physician Assistants wanted to change its name to ‘The American Association of Physician Associates,’ to give the professionals more prestige. The association did not get its wish, because no such legislation was passed by Congress to make it possible,” he said.

But in Hebrew, rofeh amit puts PAs on par with physicians – like ‘associate professors’ who are almost full professors – and not assistants to physicians, Yaron stressed.

When the IMA and its societies protested, Busso said, “Don’t worry! It will be OK.” Health Minister Moshe Arbel, also a Shas MK, promised that the IMA would “not be kept out of the picture.”

Ultra-Orthodox (haredi) groups have been trying for over a year to get recognition for non-academics, especially haredi women, by the authorities as physiotherapists, occupational therapists and speech therapists after only a course or two and not after graduating from an academic institution. Now, says the IMA, they are trying to do the same for PAs.

“Doctors won’t suffer from such changes. It will be patients – the poor, haredim and those living in the periphery – will get second-class treatment,” Yaron declared.

Prof. Hagai Levine, chairman of Israel Public Health Physicians which was a signatory of the petition, said that Kohelet Forum is pushing for the cancellation of the IMA’s Scientific Council, which is its scientific arm. It is responsible, under the Physicians Ordinance, for the planning and supervision of the physician specialization system in Israel and for continuing education programs in medicine.

Among its responsibilities are:  

• Setting medical specialization policy with the aim of maintaining the high level of medicine in Israel,
• Overseeing the specialization system of about 5,000 medical residents.
• Approving medical specialist certification in 56 medical fields,
• Initiating changes in specialization programs in existing medical fields,
• Determining new medical fields requiring specialization,
• Accrediting fellowship professional training programs as higher specialization programs,
• Accrediting and overseeing professional training and continuing studies programs for IMA members,
• Accrediting and overseeing hospital, clinic, unit and all other medical settings offering medical specializations,
• Conducting Stage A and Stage B specialization examinations and specialization final examinations in higher specializations, and
• Encouraging scientific and research activities within the IMA and in Israeli medical institutions.

Kohelet proposed that the Scientific Council has “conflicts of interest in its activities that harm the public good, the good of the public health system, and sometimes also the good of the doctors themselves. To resolve these conflicts, structural changes must be applied, with the Scientific Council taken out of the hands of the IMA and turned into a statutory organization that will deal with medical training in Israel. The IMA should be left as a representative workers’ organization only.”

Levine concluded that such changes would give politicians superpowers in the medical field and is a major reason why the IMA officially opposes the government’s judicial overhaul – and for the feeling among many physicians, specialists and medical students that they have no alternative but to relocate abroad.