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Monday, February 11, 2008

Just one more reason to kick myself for not going to medical school

There's an old joke about a physician who passes away and finds himself standing at the end of a long line of people.  He asks the person in front of him what everyone is waiting for and is told that everyone is on line to find out if they will be judged worthy to enter 'Olam Habah' (the world to come). 

After waiting for what seemed like hours without the line having moved even an inch, the doctor walks up to the front of the line and explains to the gate-keeper that he was a doctor and that he shouldn't have to wait in line.  After all, based on all the lives he'd saved and all the charity he'd given it was a shoe-in that he'd be admitted.  So why not let him go in right away?

The heavenly functionary apologized for the wait but explained that everybody had to stand judgment and nobody was given head-of-the-line privileges no matter what their role had been on earth.  The doc wasn't happy with the answer, but he had no choice but to go back to the end of the long line and wait his turn.

However, a few moments later he was surprised to see a man in a white lab coat and wearing a stethoscope draped casually around his neck walk right to the front of the line, wave to the attendant and walk right into paradise.

This was too much to take, so he stormed back to the front of the line and in a loud voice began demanding an explanation:  "Hey, I just saw you let that doctor in without having to wait in line. I thought you said nobody had head-of-line privileges here!"

The gate-keeper put his finger to his lips and said, "Shhh, I didn't mislead you.  That was G-d... he just thinks he's a doctor".

I've shared this joke today for a couple of reasons.  First and foremost is that I just discovered yet another reason to kick myself for not going to medical school.

You see, Nefesh B'Nefesh has recently announced their latest initiative: Helping Israel solve its doctor shortage.  They are doing this by offering very attractive incentives (I've heard the number $60,000 tossed around) to doctors who make aliyah.

I've mentioned on several occasions how indebted Zahava and I are to Nefesh B'Nefesh for their advice and assistance before, during and after our aliyah.   While we would have certainly moved to Israel with or without their help, they helped streamline the process, and most importantly, helped us differentiate the important issues from the small stuff that olim usually waste time and energy worrying about.

Well, Nefesh B'Nefesh hasn't been sitting on their laurels since helping us with our aliyah back in 2003.  In fact every year  since, they've continued to set the bar ever higher by bringing record numbers of immigrants from Canada and the US to live - and stay! - in Israel. 

This doctor incentive program isn't some improbable 'Northern Exposure' scenario where NBN is waving money in front of newly minted (i.e. broke) docs in hopes they will spend a couple of years in Israel before heading back to nip and tuck aging matrons in Beverley Hills.   Let's face it, there isn't much you can offer someone - doctor or otherwise - in the way of incentives that will make them voluntarily want to move long term to a place they have no desire to be.

However, if someone already has in the back of their mind that it might be nice to live in Israel... but with student loans and various professional fees hanging over their head, they are finding it difficult to figure out how to extricate themselves from the present long enough to even think about the future... well, then Nefesh B'Nefesh's new program might be just the ticket.

Add to this the fact that - today's joke not withstanding - doctors moving from North America to Israel take a huge hit in both the pocketbook and prestige.   This is another reason for Nefesh B'Nefesh to be involved in the whole aliyah process with doctors, since the re-entry and absorption process can sometimes be a little more bumpy for physicians than for many other professions.   And it is exactly NBN's well-known holistic approach to aliyah that has resulted in their retention rate (% of people who remain in Israel long-term) remaining so high!

In addition to the assistance NBN is offering to doctors, they are obviously still going full steam ahead with new and existing programs designed to help potential olim from all walks of life begin to shift their aliyah from the daydreaming to planning stage. 

They are constantly visiting large Jewish communities throughout North America to run live seminars on a wide range of general topics related to aliyah.  But they have also recently started reaching out to potential olim who may be outside major metropolitan areas by running Webinars (web-based seminars) on very specific topics, in a format that will allow anyone with an Internet connection - regardless of their physical location - to participate and learn.  You can find out more about NBN Webinars here.

And of course, for those who want to simply get the ball rolling, the first step is to get your hands on a Nefesh B' Nefesh application.  As luck would have it, You can find one right here.

And remember, whether you're a doctor or a just needle-fearing layman like myself... Israel has one important advantage over life in Canada or the US; Nobody here bothers to wait on lines!

Questions?

Don't thank me... I'm a giver!

Posted by David Bogner on February 11, 2008 | Permalink

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Hey, Trep,

Where I come from the punch line to that joke has always been:

"No, that's G-d. He just thinks he's Woody Hayes."

Posted by: dfb1968 | Feb 11, 2008 12:38:38 PM

As for people coming and staying, they are coming. Whether they will stay is still not known--the program is only around 5 years old.

What I have heard (emphasis on "heard"--it may or may not be accurate) is that NBN does not necessarily provide a realistic picture of the job/economic situation here. Speaking for myself, the fact that I did my homework and knew what to expect when I got off the plane (tough job search and low-paying internship and many years until I hit a reasonable salary) was a huge assistance during the first year or so.

I suppose some of the long-term results will have to do with how many of the NBN'ers manage to escape from IDT. :P

The doctor approach is interesting. Do we really have a shortage? I thought we have one of the highest patient/doctor ratios in the world? (Sincere question--I honestly am surprised).

Gila

Posted by: Gila | Feb 11, 2008 1:25:35 PM

... and your cut is...????!!!

Posted by: Val | Feb 11, 2008 1:58:05 PM

Doctors here get paid a ridiculously low salary. Some (many?) get paid less than computer people and work several jobs to make it. I know Americans have loans and fees and that doctors there don't make what they once did, but their earning potential is still so much greater there. I don't think that many people will take NBN up on their offer. (I'm assuming this incentive is only for those who will actually work in Israel, many doctors do live here and commute).

Posted by: Baila | Feb 11, 2008 2:19:37 PM

What's a line?

Posted by: Dudu (aka Benji) | Feb 11, 2008 2:20:28 PM

HI.

I actually just sent in the application.
to any of those considering, here are a few details.

- David is right, 60,000$, thats is split up as an initial grant upon making aliya (25,000) then a certain amount per month over 2 years depending on if you work in a clinic or hospital.

- need to be 45 years or younger

- It is needs based, so there is no guarantee of receiving the incentive

- need to commit to working in Israel 9 months a year. Many Doctors who make aliyah don't work in Israel and go back to America to work.

- must return the money if you leave Israel within 3 years of receiving it.

any other questions, please free to ask......

It is wonderful idea... will it change the mind of people who don't have Aliyah on their radar, likely not. But to those of us with
medical school loans a or those contemplating, its a big help.

Posted by: David | Feb 11, 2008 2:41:04 PM

dfb1968... And then you punch a cameraman, right? ;-)

Gila... True they have only been in business for a little over five years, but their retention numbers for that period are (again, from what I've read) much higher than for comparable periods of aliyah under the sachnut. And as to downplaying the economic situation, I;d have to disagree. A NBN rep we spoke with before we made aliyah actually made Zahava cry with his very bleak outlook on the employment/financial outlook. He has since become a neighbor and has no idea he had this affect on my wife... but the fact remains, they were very straight with us about the financial horizon. As far as docs are concerned, I don't know if there is a severe shortage (since that would, at least in theory drive up salaries), but I have heard there is a shortage of western-trained doctors. I know this sounds terribly biased, but aside from a few premier Soviet-era medical facilities, the rest of the FSU was not known for turning out high quality physicians. There is a reason why the very wealthy people in the FSU still go to the west for serious treatment. I'll leave it to the many docs who frequent this site to say more about the actual situation here in Israel.

Val... For the sake of full disclosure allow me to say the following: Although NBN is an advertiser on this site, I do not benefit from any of the additional traffic I might send their way. You see, Webads is run by someone I know but since I have relatively high traffic I agreed to a flat fee structure with him rather than potentially breaking the bank with a pay-per-view or pay-per-click formula. So no, my cut is exactly $0 (other than the satisfaction of being able to do something nice for an organization that helped me immensely).

Baila... Like I said. I don't think the idea was to entice doctors to come who weren't considering it already. The idea was to help remove a small stumbling block from before docs who would love to be here already but need to pay off their debts.

Dudu (aka Benji)... It's one of those large groups of people you are likely to see pushing and shoving to get towards any destination in Israel.

David... Thanks. I was actually thinking of you when I made the 'Northern Exposure' reference. :-)


Posted by: treppenwitz | Feb 11, 2008 2:46:19 PM

Now if only Israel had a lawyer shortage as well, so I wouldn't have to get this $130,000 in law school loans paid off here before I could consider aliyah.

Posted by: Michael | Feb 11, 2008 4:44:35 PM

Hmm. When I first heard about this program a while back, I initially thought it was a great idea. Now, I'm not so sure.

I feel like NBN may have missed the mark on this one. True, Israel is definitely lacking in some professions (whether this applies to doctors or not is up in the air), and could use some more citizens trained in various areas. Whether this solution is best solved by a costly incentive program for aliyah is another issue altogether.

$60k isn't chump change just to bring a single doctor to Israel. Would it really be better to do so rather than bring, say, 30 other people to Israel? Or what about just putting the money to improving Israeli infrastructure for olim, benefitting far more people?

Aside from a 'is the money worth it' perspective, there's the secondary issue that I don't think that aliyah is the way to solve this problem. There are certain specialties in which Israel is sorely lacking the needed expertise to develop a good skill base... but medicine is not one of them. They have some great doctors and medical researchers, they just don't have enough of them. Thus, the real solution is not to entice people to make aliyah (needed if there is no base to work from in Israel), but rather to increase the number of Israelis who go into medicine. I'm told that there are plans in the works to increase the number of medical schools, which should help. It also would be useful to improve their salaries and benefits (though of course this will most likely take place at a governmental level). There are plenty of talented Israelis who can go into medicine; we don't need to drop $60k on people to make aliyah.

Not to say that they aren't welcome, and NBN shouldn't make every effort to encourage and help people make aliyah. Rather, I think this is a misallocation of resources and a silly way to solve what is actually a long-term, complex issue with the Israeli health system.

Something that might even be better is to ease the logistics side of things. IIRC, doctors who make aliyah are required to enter IDF service until a fairly old age (early 30s?) - perhaps this requirement can be adjusted to recognize the difficult realities of IDF service after years of costly schooling when the olim are (presumably) beginning on their families. What about the residency requirements? Can doctors who complete a residency in the US 'port' their experience to Israel, or must they begin a residency anew?

Point is, $60k is nice, but it's a drop in the bucket beside the other looming logistical issues facing a medical oleh/olah. These could be eased through tweaking of regulations, at far lower cost... and the underlying problem must be solved through policy changes on the Israeli side, not on pushing aliyah.

Posted by: matlabfreak | Feb 11, 2008 5:29:12 PM

I heard the $60,000 is because NbN got a donor who specifically allocated the money for doctors. But I don't know if that is true or not.

Posted by: JoeSettler | Feb 11, 2008 6:03:50 PM

... and your cut is...????!!!

I said the same thing to my son's mohel. For some reason his mother didn't appreciate it. ;)

Posted by: Jack | Feb 11, 2008 6:07:23 PM

I really don't get this. I'm not a doctor but I took an $80,000 a year cut in salary when I moved to Israel. So, what? If NbN offered me $80 grand to move to Israel, I'd yawn. Now, if they offered me $80 a YEAR for the rest of my life..now we are talking.
My point is, $60,000 over 3 years compared to a life time of doctor's earnings in the US is pocket change. I seriously can't imagine it will make any difference. I would say give it to Israeli doctors to keep them from leaving..or, at least postpone their leaving.

Posted by: Naomi | Feb 11, 2008 8:55:54 PM

Weren't there also problems with Olim who got their degrees from Yeshiva based institutions, such as Einstein, and Israel not certifying them? I thought I remember hearing something about Lawyers in Israel, so it woudln't only apply to one's undergraduate degree?

Posted by: Jaime | Feb 11, 2008 10:08:42 PM

Good grief. Where to start?

Not enough doctors? Wow. How would free people handle such a problem? How is it possible that there is a shortage of doctors when doctors make so little? A shortage should drive their salaries up. Oh, their salaries are set by the government, you say? Could that be the cause of the problem? That doesn't seem like something that $60K is likely to smooth over. Here's a one-time check in exchange for which you can move somewhere where politicians, not your customers, decide your salary. Baaaad deal.

The money would go farther in attracting foreign doctors if it was donated to a political party who would introduce some capitalism in the economy and decide that defending its citizens from Israel's enemies was a really really important role for government, maybe more important than setting salaries. The problem is, I'm not sure either Israel or the US has such a party...

PS: Are they giving you a check to compensate you for the fact that your grandkids will be Israeli?!? ;-)

Posted by: Doctor Bean | Feb 12, 2008 2:02:52 AM

Oh, poop. I'm sleep deprived and cranky. On any other day that PS would have gotten caught in my "be nice" filter. Is it too late to apologize and retract it?

The rest of it I stand by though.

Posted by: Doctor Bean | Feb 12, 2008 3:03:18 AM

45!

Time's a-runnin' out!

Posted by: psychotoddler | Feb 12, 2008 5:21:26 AM

mounting sense of incredulity as I read he comments.
Someone (Naomi I think) took a pay cut of 80kD to maake aliyah? Darnit I MAKE that much once every, say,3 and a half YEARS! and I'm not considered so unfortunate here, where minimum wage is 900 USD monthly (and some people don't make that. (Here, is Israel by the way).

And people commute to the States? Hello, global warning? Hello, no oil reserves? (and we know who controls what there is). I ride a motor scooter to work (and some days bicycle, that's screwing the Iranians).

And who says that America = Good? The health-care there leaves a lot to ask for. Better that we keep the British/European model in that as well as other things (no to GMO!)

Posted by: asher | Feb 12, 2008 1:57:34 PM

of course I meant global WARMING

Posted by: asher | Feb 12, 2008 2:09:19 PM

I would like to point out that if someone makes say $50k-$60k per half or 3/4 of a year, and commutes between America and Israel to do it, they are probably putting a lot of that money into the Israeli economy.
Just a guess though.
(Numbers figured from not quite halving the salary asher mentioned -- you know since they didn't lose it all.)

Posted by: Channah | Feb 12, 2008 4:39:25 PM

Better that we keep the British/European model in that as well as other things (no to GMO!)

The healthcare system here in the US is flawed, but it is not nearly as bad as some people try to make it out to be. Just ask Doc Bean.

Posted by: Jack | Feb 12, 2008 6:38:17 PM

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