[Medical specialties in crisis: causes of the crisis and possible solutions]

Several clinical specialties in Israel appear to be experiencing an ongoing crisis. In this paper the authors report a pilot case study of general surgery and internal medicine, which have been identified as "clinical specialties in crisis" in the medical literature, during preliminary interviews and in the testimonies presented to a Public Committee appointed by the Prime Minister (the Amorai Committee) that addressed this problem in 2002.

To identify the causes of the crisis and possible solutions.

Qualitative analysis of interviews and written testimonies of hospital directors, departmental heads of general surgery and internal medicine, key personnel in the Israeli health care system and heads of scientific associations abroad.

The causes of the crisis in general surgery and internal medicine appear to be at three different levels: those related to the health system and its environment; causes related to the organizational structure of the hospitals; and causes inherent to the characteristics of the relevant medical specialty. The solutions proposed by the respondents in Israel, Europe and the United States should be considered at each of these levels: at the system-wide level (such as increase in tenured positions, and improvements in the residency programs); at the hospital level (such as the addition of auxiliary paramedical employees with a view to reduce the administrative burden of the physicians); and at the level of the specific medical specialty (such as the development of new subspecialties, e.g., acute care surgeons).

It is possible to identify the perceived causes of the crisis and possible ways of coping with their consequences. The findings of this pilot study justify a broader survey of additional medical specialties and a larger number of physicians.