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Medical students prefer not to intern in Israel's periphery

אוקטובר 16, 2007. Haaretz: Yuval Azoulay
Medical school students consider Tel Aviv's Ichilov Hospital to be the most desirable location for internships during their seventh year of study, a Health Ministry report has discovered.

Beilinson Hospital in Petah Tikva and Kfar Sava's Meir Hospital were also close to the top of the list, while hospitals in Afula, Nahariya and Ashkelon came in last, out of 19 state hospitals.

In the past, students used to "swap" internships at the more sought-after hospitals for money, but the Health Ministry says it has put a stop to this practice.

The report says that last year some 139 medical school students asked for internships at Ichilov and 123 requested Beilinson. "The best hospitals are always in the center [of the country]," says Miki Cinori, 28, of Tel Aviv University, who is interning at Ichilov. "Working in the South or North is like working overseas.

"As a future doctor, I won't find the services Ichilov offers at other hospitals. As a new doctor, I want to be exposed to the maximum amount of knowledge, instruments and advanced technologies. Most of my friends prefer to do their internships at one of the hospitals in the center. Ichilov is good for both patients and doctors, as far as the conditions and work environment are concerned."

The smaller hospitals farther away from the Tel Aviv area are desperate for interns. "It's a problem for the entire periphery," says Dr. Shimon Scharf, director of Ashkelon's Barzilai Medical Center. "There is a shortage of doctors, and here it's most acute. Interns could do a hell of a job here."

He's furious, but not surprised by the report's findings. "The fact that they're releasing these figures now is like adding insult to injury," says Scharf. "The state doesn't distribute personnel in a logical manner. The hospitals in the periphery are harmed, and now they're rushing to advertise it. It gives periphery hospitals a negative image, as though they are less popular, and therefore not as good."

Dr. Michael Dor, executive head of the Health Ministry's medical administration, says many students consider their chances of finding work following their internships, and whether it will likely be a well-paid position, before choosing a hospital at which to intern. "They look at the prospects of private practice after their hospital work," says Dor. "If a doctor works in a hospital and doesn't make a lot of money, he will want to complement his [hospital salary] with private work. In the periphery, there is not a lot of that, so they would prefer to come to the center from the beginning."

A medical official in the South illustrates the situation for the outlying hospitals. "We hardly have the money to buy medical equipment, and we can't even consider building a new building in the next few years [like better-funded hospitals can]," says the official. "We can't tempt medical students to do their internships here, although we want to. Meanwhile, central region hospitals have various funds full of money and give interns perks and benefits, such as pay increments, grants, rent assistance, etc. We're not attractive."

Scharf suggests changing the system. "The internship is considered a study year, and the students can be forced or told where to go, then given some incentive or scholarship," he says. "I interned at Sheba [Medical Center in Tel Hashomer], and when they asked me to go to Wolfson [Medical Center in Holon], I didn't hesitate, because of my love for medicine. It all begins and ends with leadership."

The students are allotted internships in a lottery supervised by the Health Ministry. The most desirable places ¬ the hospitals in the Tel Aviv area ¬ are given out first in the raffle.

In some cases, students have "sold" their internships at a more desirable popular hospital to those whose names did not come up in the lottery. "Students charged as much as NIS 50,000 to swap an internship," says a Health Ministry official. "Students who got a place in a popular hospital could sell it to another who found a place in a peripheral one. We put a stop to this practice."
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