Although the Israeli Medical Association struck an agreement with the Finance Ministry in August, hundreds of medical residents remained dissatisfied with their work conditions and submitted letters of resignation. The residents in the center of the country opposed the nine year agreement signed by the IMA and the Treasury. They demanded higher compensation, an improvement in working conditions and to have the agreement reduced from nine to four years. They also requested that a monitoring committee be set up to track the implementation of the agreement.
The courts deemed the residents’ submission of resignations as an unauthorised collective labour action and affirmed that the IMA continues to represent all the country's doctors, including the residents.
Following the court ruling, more than 700 residents submitted new letters of resignation on a more individual basis. These resignation letters were also rebuffed by the courts. The National Labor Court persuaded both the residents and the Treasury, together with the IMA, to continue negotiating under court auspices. However, following weeks of court mediated negotiations, no agreement was reached.
The Finance Ministry suggested allocating funds for solving problems that may arise in the coming years and employing specialists in full-time hospital positions. They also proposed improving employment terms, such as including a weekly day of rest, providing doctors with transportation to hospitals and ensuring they are not placed on more than six on-call shifts a month. Still, no agreement was reached.
At the end of October, Supreme Court Justice Hanan Melcer, sitting as the High Court of Justice, stated that he would give the residents two weeks to find a solution to their labor dispute with the Treasury.
On the 14th November, nearly 250 medical residents did not show up for work. The move came as the court ordered talks with the Treasury failed to make any progress. The residents had kept the move quiet to avoid the High Court issuing an injunction. The hospital residents were joined in the protest by a few dozen medical specialists.
A further 200+ medical interns failed to show up to work in hospitals on the 15th November, in a show of support for the medical residents. Over 100 senior doctors from public hospitals also announced their intention to resign in solidarity with the residents. Forty doctors would resign from Rambam Medical Center in Haifa, forty from Sorosky Medical Center in Tel Aviv and a further 20 from Sheba Medical Center at Tel Hashomer, in addition to other hospitals. Most of the resigning doctors are affiliated with a newly formed group, the Association of Hospital Doctors, which ostensibly was set up to compete with the Israeli Medical Association. The doctors oppose the nine-year agreement and especially its requirement that they punch time clocks.
The resignations came as approximately 250 medical residents did not show up for work for the second consecutive day, leaving public hospitals in the center of the country understaffed. Work at hospitals in the periphery continued as usual.
The Health Ministry warned that the residents were acting “in contempt of court” and instructed hospital directors to tell their residents that if they did not coordinate their absences with management, they would be violating hospital rules and the ruling of the National Labor Court, which had instructed them to return to work.
After a week of absenteeism, hundreds of medical residents returned to work at hospitals throughout the country. The negotiations between the government and the residents had come to a standstill and the High Court appointed Prof. Moti Mironi, president of the Chamber of Israeli Mediators, and retired Supreme Court Justice Itzhak Zamir, to mediate the negotiations over the subsequent two weeks.
The negotiations were held at the Israeli Medical Association offices.The Treasury stated in advance that it would not break the nine-year accord that was signed with the IMA at the end of August, but that it could make adjustments in order to satisfy the residents.After long discussions exploring solutions to the issues raised by the residents, a supplementary agreement was signed on the morning of December 8th, which would improve working conditions for doctors, with an emphasis on community residents and young specialists, without taking away from the provisions of the collective agreement signed on the 25th August.
In the days preceding the signing of the agreement, specialist physicians in the various hospitals voted on the details of the agreement, and their willingness to withdraw the resignations submitted if this agreement takes effect. An overwhelming majority were in favour of the draft agreement.
Below is a summary of supplementary agreement reached:
Grants for specialist doctors - the doctors will receive a bonus of 20,000 NIS after the first stage of their training, and another bonus of 40,000 NIS after the second stage.
Weekly rest day - Residents will be entitled to an extra day of restafter weekend duty, in addition to the day of rest they already receive after every duty shift. Their weekly day of rest shall be considered an ordinary working day, and not be deducted from their salary or vacation days.
Monitoring Committee - A monitoring committee will be setup in hospitals, which will include representatives of the hospital administration and representatives of the IMA within the hospital, as well as representatives of the residents. The committee will enforce the maximum number of duty shifts of six a month and ensure that the weekly day of rest is also received.
Compensation for seventh or more duty shifts - A doctor who works more than 6 duty shifts a month will receive special compensation (in order to provide a negative incentive, employers who assign specialists to more than six duty shifts a month will be fined.)
Work on Fridays - Specialists will also be paid for working more than 13 Fridays in a year. On the 14th Friday they work, they will begin to receive extra reimbursement.
Specialist interns – Specialist interns in highly-specialist departments may receive compensation for duty at the rate of 120% of a full duty tariff.
As part of the compromise, the wage agreement and its implementation will be reexamined after four years, in 2015, and if the parties fail to reach an understanding they will turn to arbitration.
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