[Additional remedies for the failing departments of internal medicine]

An evolving crisis within the departments of internal medicine in Israel reflects increase in the number of patients, age and morbidity, with a concomitant shortage of appointed personnel, the outcome of anachronistic manpower standards. Consequently, the extremely high occupancy rate and work burden are among the leading causes of growing dissatisfaction among the medical personnel and the evolving shortage of recruited trainees in internal medicine. In addition to the unequivocal necessity to adjust manpower standards to the growing needs, the authors critically review processes involved in hospital admissions and patients' discharge that intensify the growing crisis. Among such processes are economic incentives that limit the evaluation capabilities within the emergency rooms, with ensuing unnecessary admissions, erroneous decisions that lead to unselected referral of dying patients from chronic care facilities and forces that retard and limit the discharge of disabled patients at the conclusion of their hospitalization course. More efficient and rational control of patients' influx and discharge is clearly needed for the failing wards of internal medicine.