The Hadassah Crisis – State Employed Physicians’ Letter

In a previous post I translated a letter from a current Hadassah hospital doctor explaining his point of view as to the source of the current crisis and the justification for bailing the hospital out with public money. Here I would like to bring an unsolicited rough translation of part of a letter of support sent by the chair of the Israeli organization of state employed physicians:

What is the cause of the Hadassah crisis?

Most of the blame for the monetary crisis should be put on the ministry of finance and not on the Hadassah management, its doctors and its other workers. Here is how the system works:

  • Israeli citizens pay a health tax that is then transferred to HMO’s through social security
  • HMO’s must use this money to finance medical care as outlined by law. If the HMO’s lack sufficient funds, the ministry of finance bridges the gap (this is called “support”)
  • The Ministry of Health sets the prices for healthcare administered in hospitals, but the Ministry of Finance forces hospitals to offer HMO’s discounts and work at a loss to minimize the “support” it will later need to offer them
  • For this reason all hospitals in Israel operate at a deficit, however the Ministry of Health covers the deficit in state owned hospitals while private hospitals such as Hadassah remain “orphan”.

A hospital’s deficit varies according to the level of discount it offers HMO’s. For instance, the Nahariya hospital, offered a 7% discount and has a 90 million shekel deficit this year. The Ichilov Hospital in Tel Aviv offered a 25% discount and has a 190 million shekel deficit. Finally, the Hadassah Medical Center offered 30-40% discounts and respectively has a 300 million shekel deficit.

Hadassah hospital crisis

Was there a salary spending “party” at Hadassah?

The physicians at Hadassah make the same salaries that the rest of the country’s (Israel) physicians make as per the agreement with the government. The vast majority of the doctors at Hadassah make the same salary we do. They earn it through hard work, loyalty and dedication. They have been pulled into this crisis against their will as part of a power play by the Ministry of Finance.

What about private medical care in Hadassah? Is it to blame?

Millions of shekels that have been paid to a small number of physicians as part of private medical care at Hadassah has generated income for the hospital. In other hospitals across the country there are doctors that make similar amounts of money, but that earn it outside of the hospital, in private practices, and thus their employers do not see part of this revenue. Therefore, private medical care at Hadassah cannot cause a deficit, only profit.

Dr. Rachamimov continues to explain why his organization is supporting Hadassah at this time. He specifically says:

Our organization sees the hospitals in Jerusalem as an example for excellent healthcare delivery, dedication and professionalism that combine private and public medical care under one roof. Supporting them and their success is important in the dispute between us and the Ministry of Finance and may affect each and every one of us.

He also outlines what he feels the solution should be:

We support the doctors at Hadassah in their struggle. We feel that the Ministry of Finance is using this crisis to stop private medical care in Hadassah, to limit the amount of students and residents being taught and to cut research funds. We see this as blackmail and we oppose it. We therefore strongly urge that:

  • The Ministry of Finance must immediately release the discount funds that have been offered to the HMO’s and use it to pay workers their salaries and to return the hospital to its normal function.
  • We fully support a serious negotiation to find a lasting long-term agreement.

Please do your part by sharing this information.

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The Hadassah Crisis – The Physician’s Side

As the crisis at the Hadassah hospital threatens the hospital and its employees, it seems to me that the English language information that is available is mostly generated by one voice, the voice of the ministry of finance and its supporters. I would like to use this humble stage to bring forward a translation of some of the correspondence that has been going around in Hebrew between physicians that are current Hadassah employees, former Hadassah graduates and supporters of Hadassah.

Hadassah bleeding

My friend, Dr. RS, a talented (not to say one of a kind) nephrologist, wrote:

In the media we, the physicians of Hadassah, are portrayed as greedy corrupt pigs. A very small group of “millionaire doctors” are constantly in the headlines, but there is very little between them and the current deficit, even if the criticism towards them is justified. The vast majority of physicians earns an average salary that is a result of many hours of work and dedication, much more than the hours that are formally acknowledged.

The state and the public were granted, and without investing one dime, two amazing medical centers that became a Mecca for medical pilgrimage from within Israel and from abroad. But the Hadassah management did not think that was enough. For reasons I cannot understand they also offered the public further discounts (by saying public I mean the HMO’s) and these are the core cause of the current crisis.

True, there were managerial failures. True, there are salary issues that need to be rectified. True, there was private medical care that was sometimes greedy. But these do no explain the crisis. Now we need the public to repay Hadassah some of the debt they owe it for 100 years of unsolicited giving.

And by the way, in the agreements that were almost signed between the doctors and the ministry of finance, physicians were willing to forgo parts of their salary in the sum of 250 million shekels for 5 years! for the benefit of Haddasah and against any healthy logical argument, just to save our place of work. But even this was not enough for the ministry of finance and they chose unilateral action.

Please do your best to spread this letter around. Thank you. You can read more about the crisis in the translated letter from the State Physician organization.

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A Boston Hawk

When you think of Boston you may think of the Boston Bruins. I don’t think hawks immediately come to mind. But today, while running along the Charles River Esplanade I came across this hawk. I have seen it around before and I think it nests somewhere around here. Keep your infants and pets safe!

Boston hawk

A hawk perched on a fence near a baseball field along the Charles River Esplanade

Boston Hawk 2

Here is the hawk again

And just to complement my story, here is some amazing footage of hawks on the hunt:

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5 Things to eat during a long run

A long run requires a lot of energy. Failing to supply this energy to the body will result in poor results and in muscle cramps and even in injury. In my opinion a long run is any run that requires more than 90 minutes to complete. Shorter during a hot humid day. There have been many books written about things to eat during a long run. In my experience there are three things to eat during a long run:

  1. Gels or “gel blasts” – I like “GU Energy Gel“, but “Hammer” is also good. Their advantage is that they are easy to carry, easy to gulp down quickly and that they contain broken down nutrients that are easy to absorb. Their disadvantage is their consistency (the gel has a consistency of snot). The gel blasts (powerbar have “Energy Blast” that have worked for me) are great because you can nibble on them easily over a long period. This gives you a constant energy supply.
  2. Snack bars (granola bars) – there are multiple brands. I found that there are many differences between them as far as how my body deals with them. I do like to use them for variety. During a run, make sure not to use an energy bar that is rich in protein. This may be too much for your body to handle. Try to pick an energy bar that is rich with carbs. A great option are “LARABAR” that come in a variety of flavors and are all natural.
  3. Fruit (banana chips / raisins etc.) – I have heard of people using them. I have not. I have also heard of people using beef jerky. You keep a piece between your gums and cheek and constantly suck on it for the salt. Then you eat it for the protein.

Then there are two more things to eat during a long run that are not only there to supply calories:

  1. Fluids – I only drink water. If you drink energy drinks then remember they contain calories and minerals – it makes a difference when it comes to absorption limits of your stomach. There are also multiple brands of energy drinks. Some may work better for you than others. A famous brand is “Gatorade” (which you can buy in powder form), but there are many others. If you do plan on consuming energy drinks during a run, test them beforehand.
  2. Salt tablets – I have never used them but I have friends who swear by them. Supposedly, using salt tablet may reduce cramps during a long run, especially in warmer climates. I have heard that “Saltstick tablets” work well.

It is important to eat, especially if you are anticipating a run time (or a triathlon time) of greater than 1.5 hours. The same goes for drinking. You have to find the right balance for you. That requires testing and tweaking (and improves with experience – It took me over 2 years of long-distance racing to figure out my prefered pattern). A rule of thumb would be to drink a cup or two (standard race side-road cups) every 1-2 miles (depends on your ability to absorb) and to eat every 45 minutes. You can also try to weigh yourself before and after a run to figure out how much you tend to sweat (and thus how much you need to replenish).

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