Israeli doctors are bracing for a fight. On Sept. 12, the Israeli Supreme Court is set to hear challenges to a core component of Prime Minister Netanyahu’s judicial overhaul — and he has refused to commit to abide by the ruling. Thousands of Israeli doctors have announced they will go on strike if Netanyahu chooses to ignore an adverse ruling.
As the current Israeli government is pushing legislation designed to curtail judicial independence, Israeli doctors have emerged as unexpected protagonists in the popular protests against the government’s anti-democratic campaign. Sporting T-shirts proclaiming “There’s No Health Without a Democracy,” Israeli doctors have taken to the streets, joining weekly pro-democracy protests.
The Israeli Medical Association (IMA), which represents 95% of doctors in Israel, usually avoids partisan politics. But it has declared that the legislative changes represented an imminent threat to the independence, professionalism, and equity of Israel’s universal and successful health care system.
Specifically, the IMA highlighted that the changes Netanyahu seeks would open the door to laws that reduce privacy protections and allow discrimination against women, LGBTQ+ patients, and underrepresented racial and ethnic groups. Furthermore, because of the expansive authorities of the health minister, the IMA worries that the elimination of judicial review of political decisions would allow unprofessional and corrupt appointments, alter checks and balances of licensing and certification, and encourage discriminatory allocation of resource, most likely to hurt Arab communities.
Some of these specific concerns reflect current events: Ultra-Orthodox parties are working to remove academic and licensing requirements for paramedical professionals such as speech therapists, and key Israeli ministers openly support discrimination of Arab citizens of the state. Israeli physicians fear that without a constitution protecting the equal rights for of all citizens, eliminating judicial review will adversely impact care of patients.
After surveying its membership in July, the IMA declared a labor dispute, encouraged its members to participate demonstrations, held a 24-hour strike, and is planning additional actions including longer strikes should Netanyahu not to abide by Supreme Court rulings against his legislation.
Israeli physicians have also been vocal as individuals, joining hundreds of thousands of Israelis demonstrating against the judicial overhaul for 36 weeks. Most recently over 6,000 Israeli doctors, representing nearly 20% of the physicians in the country, signed on “relocation” lists, threatening to leave the country if the legislative revolution passes. The number of physicians requesting certifications needed to work overseas has doubled this year, reaching 2% of the country’s medical workforce.
These developments constitute a substantial threat to the country’s health care system, which is already is experiencing a physician shortage, and to its security, because many of the physicians serve regularly as reserve medical offices in Israel’s armed forces. It is particularly brave because many Israel physicians are employed in government-owned hospitals, and half of the acute care beds in Israel belong to the government.
While it is too early to assess the success of the Israeli doctors’ protest, it is subject of constant discussion on Israeli TV, social media, and WhatsApp groups. It has also led some Israeli right-wing politicians to promise retaliation, while a group of North American physicians, including the two of us, have sent a letter supporting the actions of the IMA.
The parallels to challenges in the United States are obvious. Efforts to ban, limit, or delay evidence based medical intervention and interfere with the sanctity of patient- doctor relationship have proliferated in recent years and our patients face profound challenges in accessing equitable, evidence-based, high-quality care. States have increasingly interfered in medical professional decisions: They have placed restrictions on gender-affirming care and on access to lifesaving reproductive care (including but not limited to abortions), sought to criminalize FDA-approved interventions such as mRNA vaccines, and outlawed public health interventions including masking and vaccine requirements. Florida has recently enshrined in a law that gives providers the right to deny providing any care that would run counter to their moral, ethical, and religious convictions, which in our view is a thinly veiled attempt to target LGBTQ+ communities in the state.
While medical professional organizations that represent specific physician specialties, including the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, have been outspoken in their opposition to such laws and individual physicians have joined the fray, it is hard to find evidence of organized action along the lines of what we’re seeing in Israel.
Texas, which has instituted one of the most restrictive bans on abortion in the country, has already seen a rise in infant and maternal mortality. Similar increases in infant and maternal mortality are expected in states that have instituted similar bans on access to lifesaving reproductive care. Where is the urgency? Why are American doctors not on the streets, on TV, and ultimately on strike to save their patients’ lives?
U.S. physicians enjoy a great deal of independence in their practice, are rarely sanctioned by professional boards, and only a small minority are government employees. We doctors in the U.S. are among the highest-paid physicians in the entire world and enjoy greater financial benefits and freedom than their Israeli counterparts.
Yet we rarely ever leverage this privilege in a centralized way to fight for our patients. Furthermore, there is no tradition of physician strikes in the United States, although there is no law restricting their ability to do so, and only 7% of practicing physicians belong to a union, limiting the use of labor disputes ad collective bargaining methods.
The reason is, in part, organizational. For more than a century, the American Medical Association functioned essentially like a professional guild. Designed to protect the narrow pecuniary interests of its members — largely private-practice physicians — the AMA had historically opposed attempts to expand access to health care, increase health insurance coverage, and experiment with non-fee-for-service approaches (such as early group plans in the early decades of the 20th century), derailed the Truman plan for universal health insurance, and sabotaged the proposed Clinton reforms. For many progressive health care advocates, the AMA is why we can’t have nice things.
Today the AMA represents a relatively small percentage of practicing physicians, and a disproportionate number are trainees whose membership is subsidized. It struggles to shake its past, including racism, sexism and a perception of the group being concerned primarily about physician independence and payment. Perhaps because of this history, it is organizationally unable to swiftly and effectively respond to the threats to physician independence, patient rights to equitable and evidence-based care, and to states’ efforts to erode public health measures.
American doctors looking to shake things up should look to their Israeli peers. The first thing is to recognize that given the stark challenges to the independence of the profession, physicians need strong professional organizations that protect the rights of physicians and can take unified action against legislation and regulations that hurt patients.
Secondly, physicians have to overcome their reluctance to strike, given concerns over patients safety. The right of physicians to strike is accepted all over the world, and most professional discussions of the ethics of physicians strikes highlight the balance between the immediate risk to patients and the long-term benefits.
Just imagine if physicians would strike, instead of being forced to obey harmful laws that limit their patients access to lifesaving care. Think about the case of Amanda Eid, sent home when she presented with early labor, to wait to become “sick enough” to warrant treatment, which in this case meant terminating the pregnancy. She nearly died, and suffered scarring to her uterus, which may keep her from carry a baby to term in the future. In Texas, gender-affirming clinics were preemptively closed in anticipation of further restrictions and in response to political pressure.
Without doubt, many politicians would be less cavalier about the threats to the lives of women and children, and many voters less indifferent, if they faced true consequences, such as doctors walkouts, closure of health care systems, and a constant reminder that the doctors they trust believe this legislation is harmful to their health.
While many individual physicians are brave and tireless advocates for their patients, organized medicine in the United States has failed to meet its moment. Current physician organizations and hospital leadership have been ill-equipped to counter political pressures and harmful restrictions on their practice, thus failing to protect the work of individual physicians and ultimately failing their patients and the public at large.
Facing the changing political climate, it is obvious American physicians need to adopt the tools of organized labor to become better advocates for their patients, and public health at large.
If Israeli physicians can do this to help preserve democracy in their country, we can do this to help save our patients’ lives.
Mical Raz is a practicing hosptialist and a historian of health policy at the University of Rochester. She is the author of “Abusive Policies: How the American Child Welfare System Lost Its Way.” Naftali Kaminski is a profesor of medicine and chief of pulmonary, critical care and sleep medicine at Yale and past president of the Association of Pulmonary, Critical Care, and Sleep Medicine Division Chiefs.The opinions presented do not represent any of the insitutions or organizations they are affiliated with.