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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 September 15; 335(7619): 535.
PMCID: PMC1976515

Israel's anaesthetists protest at plan to expand role of nurses

The Israel Anaesthesiology Society is angry with the country's health minister, Jacob Ben-Yizri, and finance minister, Ronnie Bar-On, for signing a secret agreement aimed at allowing nurses to perform certain anaesthesia procedures.

The society, whose members work in 28 medical centres around the country, declared after learning of the agreement that its members “will not participate in training nurses to give anaesthesia or authorise their activities in operating rooms under our authority.”

Allowing nurses to perform such procedures would require the passage of legislation, but it could not be implemented easily if anaesthesiologists refused to cooperate.

The 80 year old health minister, a representative of the Gil pensioners' party, has in recent months acceded to budget cutting policies under finance ministry pressure, against the recommendations of professionals in his own ministry. Only recently the health ministry director general, Avi Israeli, told a committee of the Knesset (parliament) that he strongly opposed approving the profession of nurse-anaesthetist, which is becoming common in the United States and other countries.

“The field of anaesthesiology is very complex, and any error can cause serious harm to health and even death,” leading members of the anaesthesiology society wrote in a letter to the ministers. “Any compromise on the quality of professional training of those who work in anaesthesiology will endanger patients' lives.” They demanded that the government instead seriously discuss the proposals the society submitted to increase the number of accredited anaesthesiologists, including incentive pay.

An article last year by Charles Weissman, head of anaesthesiology and critical care medicine at Jerusalem's Hadassah University Medical Centre, and colleagues said that there are only 10.8 anaesthesiologists or anaesthesiology residents for every 100 000 Israelis, whereas the figure in France, for example, was 14.7 per 100 000 (Israel Medical Association Journal 2006;8:255-60).

Between 1990 and 2000 Israel's major source of anaesthesiologists was the former Soviet Union, but this supply is drying up along with the reduced pool for potential Jewish emigration from there.

Many female anaesthesiologists are married with children and work part time. If an effort was made to persuade young doctors to study the specialty, the conditions would have to be “more friendly” to women, the society says.

Anaesthesiology is regarded by young Israeli medical school graduates as an unattractive specialty because it doesn't offer the opportunity for private practice and extra earning that other specialties do. Also, there is much shift work, lawsuits are relatively common, and the prestige is lower.

A few months ago Professor Israeli issued a circular expanding the authority of nurses in a small number of defined fields, such as in counselling diabetic people; this was welcomed by the Israel Diabetes Society but opposed as a matter of principle by the Israel Medical Association.

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