Hundreds of medical interns held a protest in Tel Aviv last Saturday demanding an expansion to the planned shortening of interns’ shifts announced by the Ministries of Health and Economy last week. The protest was led by Mirsham (Hebrew for “prescription,”) an organization that seeks to improve the working conditions of interns. After marching through Tel Aviv and intermittently blocking traffic, the protesters settled near the house of Health Minister Nitzan Horowitz.

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After years of objections to the Israeli health system’s practice of 26-hour shifts for interns, Health Minister Horowitz and Finance Minister Avigdor Lieberman announced a plan to gradually shorten the shifts. Critics point out that the reduction would initially apply only to ten hospitals in Israel’s periphery — with a promise to formulate a plan in the next five years to expand the shift reduction to all hospitals across the country, under the condition that the reduction is found to be financially feasible and not to damage the quality of medical care.

Mirsham’s chair, Dr. Rey Biton, addressed Horowitz and Lieberman directly in her speech at the protest: “Let’s see you try working a 26-hour shift wearing full personal protective equipment, and after you’ve done that you can tell us that it makes sense for us to keep working like this.”

Mirsham chair Dr. Rey Biton speaks at the protest in Tel Aviv. (Photo: Elad Gutman)

On Thursday, Mirsham submitted letters to the Ministry of Health on Thursday from about 2,500 interns who have stated that they will resign from their jobs within two weeks, in protest of the piecemeal plan. The letters will not have an effect on the doctors’ employment status unless the signatories also submit a resignation letter to their direct employers. A Mirsham representative has said that hundreds of the signatories do intend to submit resignation letters to their direct employers this coming Sunday.

The letters also include signatures of medical school graduates and current medical students declaring that they will not begin an internship in medicine.

Interns protest the piecemeal plan to shorten shifts at the Tel Aviv Cinematheque (Photo: Elad Gutman)

In the letters, the interns explained the damage that the 26-hour shift model does to doctors as well as patients: “In this model of employment, working for 26 consecutive hours without sleep or rest, we are unable to perform quality medical operations and make fateful decisions about the health and lives of the patients who depend on us.”

“In the 26-hour model of employment we cannot provide our patients with the best care and service, as is expected and required from us as doctors. In addition to harming patients and the quality of medical service, this deal also harms our personal health and the lives of our families,” the letters continued.

The interns addressed Horowitz directly: “You broke your promises to shorten the shifts of all interns without exception, and you stuck with a tiny move instead of bringing a great achievement to those on the frontlines.”

Interns demonstrate near the home of Health Minister Nitzan Horowitz in Tel Aviv (Photo: Elad Gutman)

In response to the protest, Horowitz said, “I am attentive to all voices. I visit hospitals across the country and see the situation on the ground, the difficulties and challenges. I understand and identify with those who want a full shift reduction for everyone immediately. I would also very much like to do it in one go all over the country, but it's not possible, simply because there are not enough doctors to fill the missing shifts.”

Horowitz added: “I keep my promises: I brought forward a budget to shorten the shifts, we overcame extensive objections, and we managed difficult negotiations to bring about this achievement. But more doctors still need to be recruited and trained, and it is a process that takes time.”

“Therefore, we have presented a gradual plan to achieve the maximum reduction that can be done almost immediately, without fatally damaging the functioning of hospitals. This is what happens after 20 years of neglect to the [health] system, years in which governments buried their heads in the sand and ignored the problem. There has been no training of new personnel, no long-term vision and no reserves that can be used to improve the system.”

Minister of Health Nitzan Horowitz. (Photo: Avi Dishi / Flash90)

While Mirsham has led the protest to shorten interns’ shifts in recent years, it does not formally represent interns in labor disputes. Interns, like all doctors, are formally represented by the Israel Medical Association. Mirsham is therefore not involved in collective agreements between doctors, hospitals, and the government. Since Mirsham therefore cannot declare a strike or other such measures by interns, the only tool available to it is mass resignation or the threat of resignation.

The letter states that the resignation will take effect within two weeks, a period in which Mirsham will be able to put additional pressure on decision-makers to improve the planned shift reduction.