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Published: 20 Tishrei 5770, כ' תשרי תש"ע, October 8, 2009
Link to original article
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'We did it of our free will'
Ronny Linder-Ganz
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Paige (Pnina) Applebaum-Farkas, a dermatologist with a thriving clinic in New Jersey, had realized the American dream. She built up her practice herself, had thousands of loyal patients, raised five children and was living a life of luxury. And yet, a month or so ago, Farkas "reversed" the dream of many Israeli physicians. She gave up her gold mine and moved her family to Israel, directly to the town of Efrat in the West Bank.
"I had a very large clinic," she relates. "It was hard to close it down. Professionally, I'm heading for the unknown. I have to go back to square one and prove myself all over again. But it's worth the effort, I have no doubt. In the history of our people, Jews left because they were forced to, so we're fortunate we could do it of our own free will."
David Zlotnick of Montreal, a specialist in family and emergency medicine, earns much less than he did back in Canada, despite holding down two jobs. What's more, the 32-year-old physician expects to be drafted into the Israel Defense Forces sometime soon for 18 months.
Zlotnick: "It's a year since I made aliyah, so by law they could call me up any day now. I have a family and a baby on the way, so it's not easy, but I took that into account when I moved here. Israel is my new home, so why should I be any different from Israelis who've served in the army?"
Many Jewish physicians who have immigrated here in recent years through the Nefesh B'Nefesh organization say they have no complaints and no hard feelings to vent. Not that there is a shortage of things to grumble about: an Israeli income that's significantly lower than what they earned "back home"; the long period of adjustment required to rebuild their professional lives and familiarize themselves with the local medical system; and the fact that the IDF, which suffers a serious lack of doctors, is anxious to get its hands on them.
Shortly before Rosh Hashanah, we brought together four new-immigrant physicians - Applebaum-Farkas, Zlotnick, Odelia Amit and Eric Scheier - to ask what influenced them to pack up and move to a sweltering Levantine country. And how life is, now that they're here. Amit, 26, finished her medical degree and hopes to specialize in cardiology, and Scheier, 34, is a pediatrician.
Israelis are accustomed to moaning about the difficulties here, and local doctors have made it a specialty. Yet you abandoned comfortable lives and successful careers. Why?
Scheier: "Because of the children. We always wanted to raise our children in Israel, but if you wait too long, you don't do it in the end. When our oldest daughter was 12, we knew that it was a critical point."
Zlotnick: "I always wanted to make aliyah after my studies. I wanted to bring my skills as a doctor to Israel and do medicine here."
Amit: "I was happy in England, but I never lived life fully because I never felt it was my home. That's a hard thing to feel. I'll need to serve in the army as well, and I want to do it because my children will be in the army, too."
Applebaum-Farkas: "The reasons were completely religious. The children are growing up - our oldest son is 15 - and it was clear the time had come. True, it was hard, but it's already getting easier, because they have been made very welcome by the school and the kids here."
What are the main problems you have faced?
Scheier: "Since we made aliyah a year ago, we have been in an ongoing state of transition, of letting go of the luxuries of life. We became a one-car family - unthinkable in America. Also, professionally, it hasn't been easy. Sometimes, trying to communicate with a patient in my very imperfect Hebrew, it sounds as if I don't really know what I'm doing. One time a patient asked me for Adex [a local brand name for the analgesic ibuprofen], and I had to look it up.
"Situations like that wound your pride and take the wind out of your sails. In general, there are many professional differences between the U.S. and Israel, like dosages, and medications that have not been certified by the FDA. It wrenches you out of your comfort zone."
How did your family and colleagues react when they heard of your plans to move to Israel?
Zlotnick: "Most of my colleagues thought I was crazy. Since they didn't share my values, they couldn't understand the move, and it was hard for me to explain it to them."
Applebaum-Farkas: "My Jewish colleagues actually were envious, but they didn't have the courage to make aliyah. Many people recognize that there is a different lifestyle here, that Israelis work hard, but also know how to enjoy life. In America they don't know how to enjoy things. They wouldn't take off work to go to a bris [circumcision ceremony] or to see a game their kid is playing in."
Salaries under the knife
Doctors' salaries in Israel are significantly lower than in the United States, where the health system is for the most part private, but also lower than in Britain and Canada, which have public health systems.
David Zlotnick admits that moving to Israel meant that he now earns "about one-third of what I did in Canada." Says Amit, who has now experienced the problems local specialists face: "My work hours are the same as they were in Britain, but I'm earning 40 percent of what I earned there." In the private sector, according to Scheier, "A pediatrician doesn't do too badly. My aim is to earn two-thirds of what I earned in the U.S., but it will take twice as many hours."
How does one deal with the sharp decline in income?
Applebaum-Farkas: "I'm still looking at different work opportunities here, but I've discovered that in private practice one can make more than I thought. In any case, I am committed to go back to the States for short periods over the next few months. I have thousands of patients there. Economically, that will give us a bit of breathing space."
This "summit meeting" with doctors who worked in the most advanced medical systems in the world provided a good opportunity to hear their opinions of Israel's health system.
"Primary treatment in hospitals, and accessibility to them, is far better in Israel than in the United States," says Scheier. "You can come to a hospital, get treatment and be out in half an hour. That doesn't happen in America. You come to an emergency room and you have to wait two hours for a doctor."
"The method of treatment here is completely different," Amit notes. "A patient spends more time in emergency, before getting to a ward, than he would in Britain, apparently because there are far more sub-specialties here. In Britain I look into the patient's eyes. Here they call in a neurologist. It's unnecessary for so many doctors to be involved in one simple treatment because, for the most part, an emergency medicine doctor has the skills to do it alone."
Zlotnick believes there are no emergency room specialists in Israel, but both he and Scheier agree that it's easier in general to get to see a doctor here than in either the United States or Canada. "In the States, I call the family doctor, make an appointment for the next week, and even if I have insurance, I have to break out a savings plan to pay the deductible," he says.
Zlotnick adds that the situation is even worse in Canada, where "there is such a severe shortage of doctors that half the population doesn't have its own family physician or pediatrician. They're forced to go to a hospital emergency room for every problem. Even if it's urgent, it can take a few days until they see a doctor, and a few months for a specialist." In Israel, he notes, "we couldn't believe it. We called the kupah [HMO] and got an appointment to see a doctor the next day."
In some ways, Israel "scores higher" than Britain's national health system, says Amit: "In the U.K., if someone has suspected pneumonia, he'll get an X-ray and that's it. In Israel they don't stop there, and they'll prescribe far more expensive tests, like a CT scan."
And how are the patients here?
Scheier: "People here shout, and there's no respect for privacy."
Zlotnick: "I like the informality in Israel. Patients call the doctor 'bro' or 'my dear' - until they begin yelling."
Applebaum-Farkas: "There is a feeling of camaraderie. Okay, so you shout and get angry, but the next moment you quiet down, and in the end you leave with a smile on your face. In America, people simply storm out of the clinic in a rage."
What do you think of your colleagues, Israeli doctors?
Amit: "The doctors here are great, very knowledgeable and willing to help professionally. True, they're not always patient, but they're warm and open. That reminds me why I made aliyah."
Applebaum-Farkas: "American doctors have more clinical experience because they see more patients, but the average Israeli doctor is smarter because he has to be really good just to get into medical school. I think the problem with Israeli doctors is that after a time they learn to live with the system, and don't try to fix it. They don't believe they can change anything, and that's a pity."
Scheier: "It's amazing how doctors here don't distance themselves from their patients. In the States, the doctor comes to his clinic in a Porsche and wearing an Italian suit. Here doctors give patients their phone number and come to work in jeans and sandals. It makes them a lot more accessible and with a more human touch. For me it's great to work with colleagues like that."
'A vision and a role'
Nahum S. Goldberg, a radiologist, became a full professor two years ago, at age 42, at Harvard Medical School. After a decade at the Beth Israel Deaconess Medical Center, he has earned a reputation as a leading researcher in the field of noninvasive treatments involving imaging. Goldberg moved to Israel just one month ago with his wife and five children, and joined Hadassah University Hospital in Ein Karem, Jerusalem. The hospital quickly began to appreciate his potential, and he is in the process of creating a new center for developing noninvasive imaging therapies for cancer.
"I was a Zionist from a very young age, and I always knew that my home was in Israel, and my goal was to do something important here," says Goldberg. I have a vision and a role: to bring the most advanced methods to Israel, and to create at Hadassah one of the best centers in the world for treatment and new imaging techniques ... Now I want a new challenge, to build something in Israel for the people of Israel, not just for myself."
In January 2008, the Nefesh B'Nefesh organization, in cooperation with the ministries of health and of immigrant absorption, announced that new-immigrant doctors from North America and Britain under 45 years of age would receive a special package of benefits and grants, beyond the usual entitlements bestowed upon new Israelis. The purpose was to somewhat soften the impact of the economic decline that faces newcomers on their arrival. Every new-immigrant physician receives an initial grant of $25,000, and an additional salary of up to $1,500 per month for the first two years of his or her stay in Israel. The benefits amount to a total of $60,000 for every doctor.
For its part, the Immigrant Absorption Ministry is financing the employment of doctors in the health system to the tune of NIS 500,000 (each) over three years. It also covers the cost of the preparatory courses for the Ministry of Health licensing exam. The doctors, in return, commit themselves to work in Israel for at least nine months of the year.
"These doctors have a serious problem," explains Daniella Slasky, who heads the employment department of Nefesh B'Nefesh. "The cost of medical school in the U.S. can reach $200,000. Young doctors find themselves with big loans they need to repay. It's hard to do that on a small Israeli salary." Hence the financial incentives.
Slasky emphasizes that the benefits accrue only to doctors over age 45, whose financial situation merits them. "In some cases, even our grant is not enough. We were recently contacted by a young doctor who very much wanted to move to Israel, but he still owed $220,000 in loans from his medical studies. He will apparently need to wait a few years, work in the U.S. and pay back at least part of his loan, and only then make aliyah."
Once in Israel, the doctor still has a demanding course to follow: a waiting period of several weeks for a work permit, Hebrew classes to learn medical terminology in Hebrew, supervision for several months by a senior physician and army service. The current campaign has been successful thus far. Some 60 doctors have moved to Israel in the last two years from Anglo countries, joining the 90 or so who have made aliyah through Nefesh B'Nefesh since 2002. |
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