Immigrant Physicians Research Articles

The Israeli anesthesiology workforce crisis: a reassessment survey

BackgroundAnesthesiologists provide crucial anesthesiology services in the operating room and non-operating room locations. Combined with an aging and growing Israeli population, there is an increasing demand for anesthesiology services. A previous study performed in 2005 showed that most anesthesiologists are immigrant physicians with few Israeli medical school graduates. Since then, physician immigration decreased, many have retired and demand for anesthesia services has increased while insufficient numbers of new anesthesiologists were trained, leading to a shortage, limiting surgeries and other procedures in many hospitals. The present study examined the composition of the Israeli anesthesiology workforce in 2021and compared it to the 2005 workforce.MethodsA cross-sectional survey of demographic and professional information about each Israeli hospital anesthesiologists was solicited from 34 anesthesiology department chairs responsible for 36 Israeli acute care hospitals.ResultsThere are 1313 anesthesiologists in the 36 hospitals, resulting in a ratio of 14.2 anesthesiologists per 100,000 population. 22.6% of anesthesiologists will reach retirement age over the next ten years. The proportion of female anesthesiologists was 28.7%. While Israeli medical school graduates increased to 18.1% from 12.2% in 2005, non-Israeli citizens and non-permanent residents comprised 8.5% of the workforce.ConclusionsDespite growth in the ratio of anesthesiologists per population, a workforce shortage is expected to worsen over the next ten years due to retirements, shortened call hours, and the Yatziv reform which bans graduates of certain overseas medical schools from obtaining Israeli Medical Licenses. The current workforce has compensated for the existing shortage of anesthesiologists by enlisting non-Israeli trainees from overseas. Yet, it is crucial to maintain and enlarge the local Israeli workforce to forestall a worsening shortage.

Impact of Physician Characteristics on Late-Onset Sepsis (LOS) Evaluation in the NICU.

The threshold for a late-onset sepsis (LOS) evaluation varies considerably across NICUs. This unexplained variability is probably related in part to physician bias regarding when sepsis should be "ruled out". The aim of this study is to determine if physician characteristics (race, gender, immigration status, years of experience and academic rank) effect LOS evaluation in the NICU. This study includes a retrospective chart review of all Level III NICU infants who had a LOS evaluation over 54 months. Physician characteristics were compared between positive and negative blood culture groups and whether CBC and CRP were obtained at LOS evaluations. There were 341 LOS evaluations performed during the study period. Two patients were excluded due to a contaminant. Patients in this study had a birth weight of [median (Q1, Q3)]+ 992 (720, 1820) grams and birth gestation of [median (Q1, Q3)] 276/7 (252/7, 330/7) weeks. There are 10 neonatologists in the group, 5/10 being female and 6/10 being immigrant physicians. Experienced physicians were more likely to obtain a CBC at the time of LOS evaluation. Physician characteristics of race, gender and immigration status impacted whether to include a CRP as part of a LOS evaluation but otherwise did not influence LOS evaluation, including the likelihood of bacteremia.

Home Editorial Board Reviewers Online first CEEMR Issues View All Issues Current Issue Previous Issue Index by Author Author's Guidelines Open Access Statement Publication Ethics Privacy Policy Accessibility Statement Contact Subscribe Enter your email below E-mail * ‘For a Secure and Stable Life’: Constructing Life Satisfaction in the ‘Migratory Careers’ of Russian Immigrant Physicians in Finland

Home Editorial Board Reviewers Online first CEEMR Issues View All Issues Current Issue Previous Issue Index by Author Author's Guidelines Open Access Statement Publication Ethics Privacy Policy Accessibility Statement Contact Subscribe Enter your email below E-mail * ‘For a Secure and Stable Life’: Constructing Life Satisfaction in the ‘Migratory Careers’ of Russian Immigrant Physicians in Finland

The physician shortage in Israel and a policy proposal for improvement

BackgroundThere is a decrease in the supply of physicians in Israel resulting from the declining flow of immigrant physicians from the former Soviet Union, a large proportion of whom have reached retirement age in recent years. This problem could become worse because the number of medical students in Israel cannot increase quickly, especially because the number of clinical training sites is inadequate. The quick population growth and anticipated ageing will exacerbate the shortage. The aim of our study was to accurately assess the current situation and factors that affect it, and to propose systematic steps to improve the physician shortage.Main bodyThe number of physicians per capita is lower in Israel than in the OECD at 3.1 vs. 3.5 per 1000 population, respectively. About 10% of licensed physicians live outside of Israel. There is a sharp increase in the number of Israelis returning from medical school abroad, but some of those schools are of low academic standard. The main step is a gradual increase in the number of medical students in Israel with a transition of clinical practice to the community, and hospital clinical hours in the evening and in the summer. Students with high psychometric scores who were not admitted to an Israeli medical school would get support to study in quality medical schools abroad. Additional steps include encouraging physicians from abroad to come to Israel, especially in specializations in distress, recruitment of retired physicians, transferring functions to other medical professions, economic incentives for departments and teachers, and incentives to prevent physicians from quitting or migrating to other countries. It is also important to close the gap between the number of physicians working in central Israel and the periphery through grants, employment opportunities for physicians’ spouses, and preferential selection of students from the periphery for medical school.ConclusionsManpower planning requires a broad, dynamic perspective and collaboration among governmental and non-governmental organizations.

Foreign Practices: Immigrant Doctors and the History of Canadian Medicare. Sasha Mullally and David Wright

In Foreign Practices: Immigrant Doctors and the History of Canadian Medicare, Canadian historians of health Sasha Mullally and David Wright examine the interconnected history of Canadian healthcare and immigration. In documenting the relationship between the healthcare system and foreign-born and trained medical practitioners, Mullally and Wright demonstrate the profound impact that these physicians had on the success of Medicare and, in turn, on the shaping of Canadian identity in the mid-twentieth century. This text fills a significant gap in the historiography; the authors note that the social history perspective has long been lacking and the history of this multifaceted relationship has been dominated instead by policy histories, resulting in the absence of health care providers’ voices. This is remedied in Foreign Practices through both a micro and macro analysis, as chapter by chapter the authors first narrow the lens using existing and newly collected oral histories, published memoirs, and obituaries, and then broaden it using institutionally created sources such as published journals and the records of government offices. Through this methodology, the authors not only examine the relationship between Canadian institutions and foreign-trained physicians but also contribute to a growing pool of transnational histories studying the ways immigration policies were shaped across the global north and how immigrant physicians have in turn shaped the healthcare systems in their new home countries. While approaching this topic from the national and global perspectives, the authors skillfully negotiate the nuances that have shaped regional identity as they explore the motivations of immigrant physicians to settle or migrate within Canada after their arrival.

Immigrant Doctors and the Transnational Roots of Canadian Medicare

Immigrant Doctors and the Transnational Roots of Canadian Medicare Alex Myrick (bio) IN A RECENT FRONT-PAGE STORY published by the Telegram in St. John’s, Newfoundland, journalist Peter Jackson observed that only one 2021 Memorial University of Newfoundland medical school graduate has agreed to establish a practice in the province. Jackson states that this news comes at a time when “several existing family physicians” are reducing their practices or are retiring all together.1 According to Jackson, the lack of new doctors, and the retirement of the older ones, are adding to the province’s impending doctor shortage. During a recent visit to St. John’s, federal Immigration Minister Marco Mendicino stated “One of the ways that we can provide reinforcements to the front lines of the health care sector is through immigration.”2 Mendicino’s comment reflects the current federal government’s recognition of a much publicized doctor shortage, and that immigration may provide a solution.3 But while journalists are helping to raise awareness of this issue, the historic root causes are left unexamined. Fortunately, two of Canada’s most accomplished historians of medicine, Sasha Mullally of the University of New Brunswick and David Wright of McGill University, have published Foreign Practices: Immigrant Doctors and the History of Canadian Medicare. The central purpose of their text is to examine the immigration of foreign-trained doctors to Canada following the Second World War and the vital role they played in the delivery of health services during the transition to Medicare during the late 1960s and early 1970s.4 To frame this narrative, Mullally and Wright focus on the years between 1957 [End Page 117] and 1984 as immigrant physicians established themselves throughout Canada. Mullally and Wright primarily argue, as a result of their study of the links between immigration and health care, that universal health insurance in Canada was able to survive because of the influx of foreign-trained doctors, who bolstered the nation’s ability to deliver health services to an expanding population. Without immigrant physicians, Canada would have been unable to provide the number of doctors needed to make Medicare a success. By examining the statistics, the authors show that in the two-and-a-half decades after the passage of the 1957 Hospitalization Insurance and Diagnostic Services Act (HIDS Act) more than 15,000 foreign-trained doctors arrived in Canada. With this figure in mind, one of the authors’ goals is to observe the routes taken by international medical graduates as they migrated to and within the country.5 Because it concentrates mostly on Canada, Foreign Practices is also a national history as certain provinces and regions were affected by physician immigration more than others. According to Mullally and Wright, their text focuses, in particular, on the disparities that existed in the delivery of health services in “marginalized, rural, and remote communities,” the private or incorporated group practices, and the community health centres that were popular throughout these decades, as well as the growth of new Canadian medical schools. In analyzing these facets of health service delivery, the authors describe how immigrant physicians “fit into and exerted an influence on the economic and corporate structures” of Canadian health care. For example, as Mullally and Wright explain, the influx of foreign-trained doctors influenced the upper echelons of Canadian health care’s corporate structure as “a notable few of this generation of doctors” became “presidents of medical associations, heads of clinical departments, and deans of medical schools.” Yet, further down the corporate stratum, in rural or remote resource communities, “physicians’ health care practices” were restructured from “hierarchical to collaborative group practices” as a more democratic and equal working environment between physicians ensured higher rates of doctor retention in these difficult-to-service areas.6 Another contribution Mullally and Wright make is their analysis of the complex moral dilemmas surrounding the “brain drain,” which saw foreign-trained physicians leave developing nations in favour of opportunities in the developed world.7 And Mullally and Wright also present the problem of doctor [End Page 118] maldistribution that the Canadian federal and provincial governments tried to solve from time to time; this was done by forcing physicians to practise in...

Fighting Prejudice and Absorbing Refugees From Nazism: The National Committee for the Resettlement of Foreign Physicians, 1939-1945.

In the 1930s and 1940s, the medical profession reacted with hostility and erected formidable barriers to refugee physicians from Nazi-dominated Europe who sought to practice medicine in the United States. Yet, refugee physicians ultimately succeeded, with 77% of them working as doctors by 1945 and 98.6% by 1947. Although physician skills are readily transferable, and the United States had a genuine need for doctors after World War II drew 55 000 physicians into the military, refugee physicians' success can be attributed to the courageous physician leaders who lobbied on their behalf and the creation of the National Committee for the Resettlement of Foreign Physicians-an organization that helped immigrant physicians pass licensing examinations, identify locations for employment, and overcome barriers to integration into American society.

U.S. Immigrant Integration Policy in Light of the COVID‐19 Pandemic

AbstractThe COVID‐19 pandemic has highlighted a critical shortage of medical personnel in the United States. Yet, there is an untapped pool of an estimated 263,000 immigrant physicians, nurses, and health‐care technicians who are not using their training in the United States. This essay provides a brief explanation of the factors that result in underutilization of immigrants' skills. Connecting theory with practice, it then proposes potential policy solutions to the shortage of medical personnel through strategic immigration initiatives.

Mission Unify: Holistic Admissions Policies Should Include Both African American and Non-African American Blacks.

To the Editor: We congratulate Poole and colleagues for their thought-provoking Perspective on the challenges of diversity initiatives in medicine. The authors present two arguments to justify adequate representation of African Americans in medical school admissions: a social justice argument supported by affirmative action policies1 and a patient outcomes–based argument focused on racial or ethnically concordant care.2 Their first argument is sufficiently justified on its own. However, by conflating it with their second argument, the authors weaken their stance. Poole and colleagues suggest that improved clinical outcomes due to race concordance may justify affirmative action policies that recruit African Americans preferentially over non–African American Blacks. However, there is no evidence to support this notion. In fact, a prior study2 demonstrated that racial—and not ethnically—concordant care may be associated with improved clinical outcomes and better patient experience. Furthermore, there is no evidence in support of a difference between the proportion of African American versus non–African American Blacks practicing in underserved communities.3 In our experiences as first- and second-generation Nigerian American immigrant physicians practicing in different geographic regions of the United States, Black patients rarely inquire about the ethnicity of their Black clinicians as a prerequisite for seeking care. Nor does ethnicity appear to influence treatment adherence. If our objective is to improve clinical outcomes for underserved patients, an effective strategy is to increase the pool of qualified Black medical school applicants using holistic admissions processes. However, the application of genealogical assessments to identify suitable medical school candidates is divisive. With growing rates of immigration to the United States, interethnic and interracial mixing, how do medical school admissions committees quantify the appropriate level of “African Americanness”? Narrow definitions of race, ethnicity, and cultural experience come at the expense of inclusion and validation of all underrepresented Blacks in medicine. There is a critical need to improve diversity in the health care workforce. Strategies implemented early in the educational pipeline to increase exposure of African American students to the health sciences are lacking. Proposed solutions should not create more challenges for underrepresented Blacks and should focus on promoting unity. Uchenna Ikediobi, MD, MPHAssistant professor, Departments of Medicine and Infectious Disease, Yale University School of Medicine, New Haven, Connecticut; [email protected]Nneka Comfere, MDProfessor, Departments of Dermatology, and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; [email protected]; ORCID: https://orcid.org/0000-0002-8001-2639.Ogechi Ikediobi, MD, PharmD, PhDDermatology resident, University of California, San Diego, San Diego, California; [email protected]

Prevalence of US-trained International Medical Graduates (IMG) physicians awaiting permanent residency: a quantitative analysis

ABSTRACT Background International Medical Graduates (IMGs) contribute to about 23% of the physician workforce in the USA. Certain US-trained IMGs face long wait times for transitioning to a permanent resident status, which limits their ability to work to fullest capacity, especially during a public health emergency. Objectives To estimate the number of US-trained IMGs awaiting permanent residency. Study Design Data were obtained from National Residency Matching Program (NRMP) to quantify the number of IMGs who secured residency training in the US from 2004 to 2020. Estimates of physician demographics were based on NRMP/ECFMG 2014 match data and Federation of State Medical Boards (FSMB) physician census data. Results Between 2004 and 2020, a total of 57,160 non-US IMGs who were not US citizens successfully matched to residency training programs. Applicants from India and China were noted to be impacted by delays in adjustment to permanent resident status. Per our estimate, there are between 1,460 and 1,959 US-trained physicians from China currently awaiting permanent residency, with applicants waiting since October 2015, and between 13,250 and 14,230 US-trained physicians from India currently awaiting permanent residency, with applicants waiting since June 2009. Conclusions The total number of US-trained immigrant physicians in active practice awaiting permanent residency to the USA is estimated to be ranging between 14,710 and 16,189.

Immigrant Physicians Fill a Critical Need in COVID-19 Response.

Journal of Hospital MedicineVolume 15, Issue 8 p. 505-506 Perspectives in Hospital Medicine Immigrant Physicians Fill a Critical Need in COVID-19 Response Benji K Mathews MD, SFHM, Corresponding Author Benji K Mathews MD, SFHM [email protected] Department of Hospital Medicine, Regions Hospital, HealthPartners, St. Paul, MinnesotaCorresponding Author: Benji K Mathews, MD, SFHM; Email: [email protected]; Telephone: 651-254-5529; Twitter: @MDBenji.Search for more papers by this authorManpreet Malik MD, FHM, Manpreet Malik MD, FHM Division of Hospital Medicine, Emory University, Atlanta, GeorgiaSearch for more papers by this author Benji K Mathews MD, SFHM, Corresponding Author Benji K Mathews MD, SFHM [email protected] Department of Hospital Medicine, Regions Hospital, HealthPartners, St. Paul, MinnesotaCorresponding Author: Benji K Mathews, MD, SFHM; Email: [email protected]; Telephone: 651-254-5529; Twitter: @MDBenji.Search for more papers by this authorManpreet Malik MD, FHM, Manpreet Malik MD, FHM Division of Hospital Medicine, Emory University, Atlanta, GeorgiaSearch for more papers by this author First published: 22 July 2020 https://doi.org/10.12788/jhm.3473Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume15, Issue8August 2020Pages 505-506 RelatedInformation

Special Report: Asian American Hate Incidents—A Co-occurring Epidemic During COVID-19

<i>Special Report:</i> Asian American Hate Incidents—A Co-occurring Epidemic During COVID-19

Migration of Croatian physicians in the global context

As the global health care workforce faces a shortage, several EU nations focus on employing foreign-trained physicians. So much so, that in some countries of the EU, the percentage of foreign-trained physicians has reached 30 % and the percentage of foreign-trained psychiatrists has risen to 40 %. After Croatia entered the EU, together with a significant number of other Croatian citizens, a great proportion of Croatian physicians emigrated. Currently, Croatia is among the three EU countries from which the most physicians emigrate. There are both economic and non-economic factors that are influence individuals’ choice to emigrate. Benefits of emigration for Croatian physicians are high satisfaction with life standard, income, professional development, and better work conditions. However, there are also clear psychological costs involved, which hinder both the emigrants and their families, and make building of a social network and integration into society difficult. These are: moving away from family members, friends and a familiar environment, mastering another language, finding work opportunities for partners, adjusting to life in another country under discrimination by colleagues, patients and the general public. Countries of immigration face challenges with foreign-trained physicians because of their native linguistic and cultural background. Language proficiency training and national familiarization programs can improve integration of immigrant physicians and their families. In recognition that national skill shortages can cause disbalance on a global level, the WHO calls on high-income countries to strive for self-sufficiency, through educating, retaining, and sustaining enough physicians to staff their own health care systems.

International migration of health labour: monitoring the two-way flow of physicians in South Africa

IntroductionAlthough health labour migration is a global phenomenon, studies have neglected the flow of health workers into low-income and middle-income countries (LMICs). In compliance with the data-monitoring recommendation of the...

Informed consent at stake? Language barriers in medical interactions with immigrant anaesthetists: a conversation analytical study

BackgroundLanguage barriers in doctor-patient interactions are still an understudied phenomenon. This is particularly true concerning interactions with immigrant physicians who are learners of the patient’s language; there is a lack of research even though labour migration is increasing internationally. This conversation analytical study focusses on language errors in one specific type of doctor-patient interaction, namely pre-anaesthesia evaluations with immigrant anaesthetists.MethodsThe study combines the research field of language acquisition with that of medical interaction. It is a qualitative study with an ethnomethodological framework which addresses the following research question: How do language errors, produced by immigrant anaesthetists, impact pre-anaesthesia evaluations? The primary data comes from naturally occurring pre-anaesthesia evaluations carried out by immigrant anaesthetists. The analysis method is a combination of conversation and error analysis.ResultsThe study shows that the anaesthetists produced a considerable number of unintelligible utterances, due to various language errors. Despite the lack of understanding, hardly any negotiation of meaning occurred and both sides (anaesthetists and patients) claimed to be satisfied.ConclusionsThe findings appear to be contradictory. An explanation for this can be found in the effect of the roles and scripts that are given in pre-anaesthesia evaluations. Since no negotiation of meaning is initiated during the interactions, the anaesthetists’ insufficient language competence leads to a considerable impairment of informed consent, which is the main goal of the pre-anaesthesia evaluations. Based on these findings, the study reveals an urgent need for action regarding immigrant anaesthetists’ language skills.

Lääkärin työtilanteiden kielellisen vaativuuden määrittäminen

Työelämän kielitaidon koulutuksen ja testauksen tueksi tarvitaan tarkempaa tietoa siitä, millaista kielitaitoa eri aloilla ja ammateissa vaaditaan. Nykyään vallalla on näkemys, jossa kielitaitoa pidetään tilanteisena taitona, mutta tilanteen käsitettä ei ole juurikaan määritelty eikä tilanteiden ominaisuuksia eritelty. Tässä artikkelissa tarkastellaan lääkärin työtehtävien kielellistä vaativuutta työyhteisön jäsenten haastatteluiden avulla. Terveydenhuollon ammattilaisten ryhmähaastatteluista (n = 32) etsittiin temaattisen sisällönanalyysin avulla sellaisia työtilanteiden ominaisuuksia, jotka ovat yhteydessä maahanmuuttajataustaisten lääkärien kielelliseen suoriutumiseen. Löydetyt ominaisuudet liittyvät muun muassa tilanteen seurausten vakavuuteen sekä tilanteen osallistujiin. Analyysin tulosten perusteella muotoiltiin kymmenen kriteeriä lääkärin työtilanteiden kielellisen vaativuuden määrittämiseksi: kriittisyys, sosiaalinen vastuu, yhteinen taustatieto, sosiaalinen variaatio, sosiaalinen tuttuus, kommunikoinnin monisuuntaisuus, tilanteen harvinaisuus, kiireellisyys, kieliriippuvuus ja häiriötekijät. Kriteerien tarkoituksena on parantaa erityisalojen kielikoulutuksen ja -testauksen validiutta suhteessa työssä vaadittavaan kielitaitoon. Kriteerit on abstrahoitu aineistosta siten, että niitä voi soveltaa muihinkin ammatteihin, mutta toisaalta muiden ammattien konteksteista saattaa nousta esiin myös uudenlaisia kriteereitä.

In Rural Towns, Immigrant Doctors Fill A Critical Need.

Immigrant doctors have helped fill physician shortages for years. In the current political climate, are they welcome?

Giving Back: A mixed methods study of the contributions of US-Based Nigerian physicians to home country health systems.

BackgroundThere is increased interest in the capacity of US immigrants to contribute to their homelands via entrepreneurship and philanthropy. However, there has been little research examining how immigrant physicians may support health systems and what factors facilitate or raise barriers to increased support.MethodsThis study used an observational design with paper questionnaire and interview components. Our sample was drawn from attendees of a 2011 conference for US Based Nigerian physicians; respondents who were not US residents, physicians, and of Nigerian birth or parentage were excluded from further analysis. Respondents were randomly selected to complete a follow-up interview with separate scripts for those having made past financial contributions or medical service trips to support Nigerian healthcare (Group A) and those who had done neither (Group B). Survey results were analyzed using Fischer exact tests and interviews were coded in pairs using thematic content analysis.ResultsSeventy-five of 156 (48 %) individuals who attended the conference met inclusion criteria and completed the survey, and 13 follow-up interviews were completed. In surveys, 65 % percent of respondents indicated a donation to an agency providing healthcare in Nigeria the previous year, 57 % indicated having gone on medical service trips in the prior 10 years and 45 % indicated it was “very likely” or “likely” that they would return to Nigeria to practice medicine. In interviews, respondents tended to favor gifts in kind and financial gifts as modes of contribution, with medical education facilities as the most popular target. Personal connections, often forged in medical school, tended to facilitate contributions. Individuals desiring to return permanently focused on their potential impact and worried about health system under-preparedness; those not desiring permanent return centered on how safety, financial security and health systems issues presented barriers.ConclusionsThis study demonstrates several mechanisms by which health systems may benefit from expatriate engagement. Greater identification of reliable local partners for diaspora, deeper collaboration with those partners and a focus on sustainable interventions might improve the quantity and impact of contributions. Ethnic medical associations have a unique role in organizing and facilitating diaspora response. Public-private partnerships may help diaspora negotiate the challenges of repatriation.

‘Peculiar Resistance’: Tuberculosis, Identity and Conflict among Jewish Physicians in Early- Twentieth-Century America

‘Peculiar Resistance’:Tuberculosis, Identity and Conflict among Jewish Physicians in Early- Twentieth-Century America Adrienne Denoyelles (bio) Throughout the nineteenth century, tuberculosis (TB) killed more Americans than any other infectious disease.1 For much of this period, people regarded TB as an age-old, private malady caused largely by hereditary factors. Only after German physician Robert Koch’s discovery of the TB bacillus in the 1880s did its image begin shifting into that of a modern, public scourge requiring medical intervention.2 This reconceptualization also reflected Americans’ reactions to the modern forces transforming their physical and cultural landscape. Prominent citizens questioned whether unchecked immigration, industrialization, and urban development had compromised their nation’s ability to compete for resources, defend its borders, or even reproduce effectively, triggering widespread fears of “race suicide.”3 Tuberculosis, an infectious disease that saps the inner strength and vitality of its victims, embodied these fears perfectly. Social anxiety, together with the fluid etiology of TB, created ideal conditions for associating tuberculosis with “new” immigrants—particularly Eastern European Jews, whose urban backgrounds, indoor occupations, [End Page 349] and popular caricatures suggested strong ties between modernity and physical weakness.4 Immigration Restriction League officer Prescott Hall spoke for many antisemitic Americans when he portrayed Jews as potential societal burdens who were likely to contract tuberculosis shortly after their arrival.5 These depictions of the foreign-born as deadly vectors of disease comprised a central component of the growing debate over immigration, which became increasingly racialized and reinforced by scientific or pseudoscientific arguments.6 While historians have shed considerable light on the role of immigrant physicians as cultural mediators, much work remains in examining the difficult terrain they negotiated as aspiring professionals and as representatives for their minority groups.7 The writings of Maurice Fishberg, Theodore B. Sachs, and Charles David Spivak demonstrate that Jewish immigrant physicians did not speak with one voice as they worked to safeguard their fellows’ health and advancement opportunities. Fishberg, who was also a physical anthropologist, promoted Jews as hardy, tuberculosis-resistant survivors whose cultural values resonated with America’s white middle class. This argument placed him into conflict with Sachs and Spivak, who founded sanitariums to address a growing tuberculosis crisis among the Jewish poor. These approaches in turn faced criticism from Solomon Solis-Cohen, a nativeborn physician whose [End Page 350] assessment of Jewish tuberculosis called for a drastic restructuring of American society altogether. Placing these physicians into conversation through their professional publications yields valuable insights into the challenges of American identity-building for immigrant Jews and their communities—most notably the intra-ethnic and individual conflicts accompanying that process.8 Fishberg, Sachs, Spivak: Common Background Factors A glimpse into these immigrant physicians’ formative years suggests that they, along with a generation of aspiring Russian Jews, encountered discrimination and the challenges of bridging their cultural and national identities long before arriving in the United States. Born between 1860 and 1875 in different regions of present-day Ukraine, Maurice Fishberg, Theodore Sachs, and Charles Spivak grew up amid the social and intellectual ferment of the Haskala, or Jewish Enlightenment movement.9 As the tsarist government began easing restrictions in the 1860s regarding where educated Jewish professionals could live and work, increasing numbers of Jews abandoned traditional religious training to pursue a secular education in state-sponsored gymnasiums and universities.10 There, they hoped to find new paths upward where “a person would [End Page 351] be judged not by his wealth, fame or race, but by his knowledge and character.”11 These opportunities introduced Fishberg, Sachs, and Spivak to a broad range of Western languages and ideas, situating them within an emerging “Russified,” Jewish intelligentsia.12 Many Jewish students at the university level, Sachs and Spivak among them, achieved a measure of solidarity with their Russian classmates through common causes, most notably radical political activism.13 Fishberg, who attended university in the United States, listed his Russian secondary-school education among his professional credentials throughout his thirty-seven-year career, suggesting that he valued it highly as a mark of distinction.14 As they sought social mobility through state-sponsored channels, these men experienced the pressures of representing their ethnic group in non...

Female physicians: trends and likely impacts on healthcare in Israel

BackgroundFemale physicians have become an increasing proportion of the medical workforce in Israel. This study investigates this trend and discusses its likely impact on the quantity and quality of medical care available.MethodData on licensed physicians and new licenses issued to physicians were taken from a Ministry of Health database, and analyzed by gender, age, academic origin (Israeli graduates, immigrants, Israeli-born who studied abroad), and specialty for the years 1999–2011.Data on employed physicians, their population group, and work hours were taken from the Central Bureau of Statistics (CBS) annual Labour Force Survey for the years 2009–2011.ResultsThe proportion of women amongst physicians aged under 65 rose from 38% in 1999 to 42% in 2011, and was even higher for younger physicians. The highest proportion of females is found amongst new immigrant physicians who studied abroad. The corresponding proportion has been rising steadily amongst Israeli-educated physicians, and is lowest amongst Israeli-born physicians who studied abroad.Similarly, among newly licensed physicians, the proportion of females has traditionally been highest among immigrants who studied abroad and lowest among Israeli-born graduates who studied abroad. Among newly-licensed physicians who studied in Israel, the proportion of females has historically been intermediate between the other two groups, but it has recently risen to 54% and now parallels the proportion of females among immigrants who studied abroad. In recent years, the mix of academic origins among newly licensed physicians has changed dramatically, with important implications for the proportion of women among newly licensed physicians.The highest percentage of females was found in family medicine followed by oncology, pediatrics and psychiatry. The greatest increase over the years in this percentage was for gynecology and internal medicine.Female physicians worked shorter hours than males, particularly at younger ages. The proportion of females among employed Arab physicians is much lower than among Jewish physicians.ConclusionsThe proportion of female physicians has been steadily rising, although in recent years the increase has leveled off. This has been due, in part, to the decline in the flow of immigrant physicians and the increase in the number of Israelis studying abroad. Future developments in medical education options and immigration will determine whether their proportion will continue rising. Planning for future medical personnel must take these results into consideration.