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Chapter 2 - Physicians’ Strikes in Israel, 1976-2000

The first physicians’ strike took place in 1976 and continued for 58 days. Within the framework of the sanctions, outpatient clinics that operate at hospitals were closed, only urgent surgery was carried out and patients were not discharged from hospital. As the strike progressed, the hospital physicians intensified their struggle. In this context, the physicians sent letters of resignation and took steps to set up a private company for the supply of medical manpower services. A day before the resignations came into effect, the physicians reached an agreement with the Ministry of Finance.

The main issues that were on the agenda in 1976 were:

·       The burden of duty rosters and payment for this.

·       Payments to physicians for being on-call.

·       Giving physicians time off after being on-duty.

·       Full implementation of the previous agreement between the physicians and employers, which was signed in 1973.

·       Formulating a salary system that would not require interdependence of various industries in the economy.

·       Establishing a study fund for physicians.

·       Opposition to any attempt to reduce numbers of physicians.

The achievements of the 1976 strike included:

·       An additional 2.5% to the combined salary.

·       A change in the promotion system and a shortening of the periods that a physician was required to wait before promotions.

·       A revision of fixed supplements to salary.

·       A revision of the salary supplement for work in a hospital according to rank.

·       A revision in the payment mechanism for being on-duty and on-call.

·       Determining a ceiling for being on-duty.

The second physicians’ strike took place in 1983 and continued for 117 days. During the strike, the physicians left the hospitals, sent letters of resignation, and as a part of a local initiative even began a hunger strike. Moreover, the Medical Federation established during that strike a private company (SHARET) that organized independent medical centers for providing medical treatment.

The main demands raised by the Israeli Medical Association in 1983 included:

·       Additional positions for physicians.

·       A solution to the hospitalization crisis.

·       A doubling of the combined salary (salary calculated according to seniority).

·       A restriction upon a physician’s permitted work hours to 36 hours per week and a prohibition against working more than 16 hours continuously.

·       Compensation for the erosion of physicians’ salaries.

·       A comparison between the salary of medical interns and the average salary in the economy.

The achievements of the 1983 strike included:

·       Determining a payment mechanism for overtime and for allocating being on-call within the department and the hospitals.

·       Payment of a supplement to the physician for work in a hospital.

·       Payment of a supplement to an intern in an amount of 10% of the salary.

·       Adopting the salary scale that applies to legal workers so that the total value of the salary supplements for the years 1982-1984 was approximately 60%. In practice, a salary supplement of 22% was given, in view of the high inflation in that period (approximately 300%), which eroded the supplement.

The third physicians’ strike took place in 1994 and lasted only one day. The memorandum of understanding was signed shortly before the election for the General Federation that was due to take place in that year, apparently out of a desire to avoid a work stoppage in the hospitals and clinics of the Clalit Medical Fund before the election. The main issue on the agenda in 1994 was the increase of salary for physicians, in which the amount of the basic salary was increased at the expense of supplements and other salary components.

The achievements of the 1994 strike included:

·       The inclusion of salary supplements that were paid by virtue of the previous employment agreements, which were given in the past in a differential manner, with new salary tables that increased the salary basis for the purpose of pension payments and social benefits.

·       Addition of promotion grades for physicians and beginning new promotion tracks for senior physicians.

·       Payment of a salary supplement for output.

·       Payment of a salary supplement for physicians in the internal departments.

·       Payment of a salary supplement for consulting work.

·       Determining a payment rate for being on-call and on-duty in emergency rooms.

·       Giving holidays to physicians for being on-duty and examinations, with a possibility of using the balance also for further study.

·       Establishing a system for further medical studies provided by the Scientific Council and in cooperation with the medical schools.

·       Regulating a mechanism for professional advancement and recognizing a physician as a top specialist.

The longest physicians strike until the present time took place in 2000 and continued for 217 days. Within the framework of the struggle, the physicians declared general strikes, disruptions and various sanctions. The main issues that arose during the strike were a demand to maintain the real value of the salary, an improvement in the general earnings of physicians and introducing a remuneration mechanism for further study and absences. At the end of fruitless negotiations with the Ministry of Finance, the parties agreed to arbitrate.

The achievements of the 2000 strike included:

·       Obtaining a 13.2% salary increase for physicians.

·       Increasing the fixed salary portion of physicians’ total earnings (from 35% to approximately 50%) so that the physicians’ net salary increased.

·       An extension of the pension coverage for physicians.

·       A determination of entitlement to study vacation before examinations.

·       Establishing a public commission to examine the state of public medicine and the status of physicians.