medical education in israel

Medical School in Israel

Doctors are a valuable resource in the State of Israel, which is facing a shortage of doctors in the coming years. Medicine is a prestigious field in Israel, and getting accepted to medical school is a journey of its own. Below is a brief overview of medical school in Israel and the criteria for acceptance.

Tracks of Study

There are two ways to study medicine in Israel:

The first option is a full six-year track, followed by a medical internship in Israel. These programs are offered at Hebrew University , The Technion , Tel-Aviv University ,  Bar-Ilan University and Ben – Gurion University . In addition to excellent high school grades and a bagrut equivalent * , schools only accept students with a very high score on the Psychometric Exam (usually not less than 740 although the “official” requirement is lower). SAT and ACT scores are not accepted. Olim applicants must obtain a score of at least a 105 or higher on the YAEL Hebrew proficiency exam, although some of the medical schools require an even higher score.

The second option is to study in a  pre-med program (or a BSc which includes the prerequisites delineated below) followed by a four-year Medical School program offered at Tel Aviv University , Bar-Ilan University , Ariel University and Ben-Gurion University.

Olim students must have completed the Aliyah process in order to apply for any medical school program in Israel. The international schools at the Sackler School of Medicine at Tel Aviv University and the Technion American Medical School have permanently closed for enrollment as of the fall of 2023.

Ben-Gurion University is keeping its Medical School for International Health (MSIH) open for Olim/Israeli citizens only . Studies in years one and two are in English, and studies in years three and four are in Hebrew. More information is here. The acceptance criteria are here .

In order to be accepted to a 4-year medical program in Israel, students must have completed a Bachelor’s degree recognized in Israel and maintained at least an 80 average (and in some cases higher) with the following prerequisites ** :

• Biochemistry- 4 credits
• Cell biology- 4 credits
• Molecular biology- 4 credits
• Genetics– 3 credits
• Microbiology- 4 credits
• Physiology- 4 credits
• Statistics- 3 credits

Applicants must take a Mivhan Yeda , a medical knowledge exam (administered in Hebrew), once they have applied to the medical schools of their choice. This exam is offered twice a year, usually in May and June at Tel-Aviv University. More information about the test and registration is here . The application process includes an in-person, individual interview before final acceptance.

Each program has different acceptance criteria, and some may require applicants to take a personality test. Since each medical school program has its own unique requirements and application process, we recommend you see the websites of each medical school for exact prerequisites and updated information.

* A bagrut equivalent for applicants from the United States is 6 APs with a score of 4 or 5. Bagrut equivalency for Canadian Olim can be found here . For more information on bagrut equivalency, please see this.

** At present, BGU’s Medical School for International Health accepts applications with an MCAT score (in addition to applications with a Mivhan Yeda score). If applying with an MCAT score, the required prerequisites are different from the above. Please be in touch with BGU for more information: [email protected]

Updated: December 2023

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Medical Education and Training in Israel

• The future of health systems
• Health workforce

Cite this content as:

Achieving universal access to medical care in Israel, as in other OECD countries, requires having a sufficient number of doctors, with a proper mix of generalists and specialists, and a proper geographic distribution to serve the population in the whole country. This review analyses some of the main challenges facing medical education and training policies and programmes in Israel by drawing on comparative analyses and useful experiences from other OECD countries.

Related publications

• How's Life in Israel? 30 July 2024

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Medical Education in Israel: Directions and Challenges

• Medical School for International Health

Research output : Contribution to journal › Article › peer-review

Israeli medical education faces considerable stresses that include severe budgetary constraints and a recent influx of immigrant physicians who need professional upgrading or retraining. Ben-Gurion University developed a licensing preparation course after the government in 1988 required foreign-trained physicians to take a licensing examination. A standard, countrywide licensing examination is under study, but its development is hampered by the almost-complete autonomy of Israeli medical schools and minimal staffing of medical education units. To overcome these problems, the Israeli Society for Medical Education was founded in 1991. Ben-Gurion University Medical School, the newest and smallest, but most innovative, has sparked by its example many changes in the more traditional medical schools. It has introduced an increased emphasis on family medicine, early clinical teaching, integration of health services and medical education in the Beer Sheva region, the teaching of interviewing and communication skills, unification of single-discipline departments, courses in medical decision making and medical ethics, advances in computerization of medical records and in local budget autonomy for community clinics (a change from rigidly centralized medical administration), and voluntary peer evaluation.

ASJC Scopus subject areas

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

• 10.1080/10401339109539512

Other files and links

• Link to publication in Scopus

Fingerprint

• Israel Keyphrases 100%
• Medical Education Keyphrases 100%
• Medical School Keyphrases 60%
• Israeli Social Sciences 60%
• Ben-Gurion Keyphrases 40%
• Licensing Examination Keyphrases 40%
• Autonomy Social Sciences 40%
• Israeli Society Keyphrases 20%

T1 - Medical Education in Israel

T2 - Directions and Challenges

AU - Glick, Shimon

AU - Margolis, Carmi

PY - 1991/1/1

Y1 - 1991/1/1

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AB - Israeli medical education faces considerable stresses that include severe budgetary constraints and a recent influx of immigrant physicians who need professional upgrading or retraining. Ben-Gurion University developed a licensing preparation course after the government in 1988 required foreign-trained physicians to take a licensing examination. A standard, countrywide licensing examination is under study, but its development is hampered by the almost-complete autonomy of Israeli medical schools and minimal staffing of medical education units. To overcome these problems, the Israeli Society for Medical Education was founded in 1991. Ben-Gurion University Medical School, the newest and smallest, but most innovative, has sparked by its example many changes in the more traditional medical schools. It has introduced an increased emphasis on family medicine, early clinical teaching, integration of health services and medical education in the Beer Sheva region, the teaching of interviewing and communication skills, unification of single-discipline departments, courses in medical decision making and medical ethics, advances in computerization of medical records and in local budget autonomy for community clinics (a change from rigidly centralized medical administration), and voluntary peer evaluation.

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JF - Teaching and Learning in Medicine

22 Best Medical schools in Israel

Updated: February 29, 2024

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Below is a list of best universities in Israel ranked based on their research performance in Medicine. A graph of 7.58M citations received by 255K academic papers made by 22 universities in Israel was used to calculate publications' ratings, which then were adjusted for release dates and added to final scores.

We don't distinguish between undergraduate and graduate programs nor do we adjust for current majors offered. You can find information about granted degrees on a university page but always double-check with the university website.

1. Tel Aviv University

For Medicine

2. Hebrew University of Jerusalem

3. Weizmann Institute of Science

4. Technion - Israel Institute of Technology

5. Ben-Gurion University of the Negev

6. Bar-Ilan University

7. University of Haifa

8. Ariel University

9. Interdisciplinary Center

10. Tel-Hai Academic College

11. Max Stern Academic College of Emek Yezreel

12. Ruppin Academic Center

13. Jerusalem College of Technology

14. Holon Institute of Technology

15. Ono Academic College

16. Sapir College

17. College of Management - Academic Studies

18. ORT Braude College

19. Netanya Academic College

20. Afeka Tel Aviv Academic College of Engineering

21. Jerusalem College of Engineering

22. Shenkar College of Engineering and Design

The best cities to study Medicine in Israel based on the number of universities and their ranks are Tel Aviv , Jerusalem , Rehovot , and Haifa .

Medicine subfields in Israel

• Open access
• Published: 12 November 2015

Undergraduate medical education in the U.S. and Israel: contrasts and common challenges

• Arthur M. Feldman 1  

Israel Journal of Health Policy Research volume  4 , Article number:  56 ( 2015 ) Cite this article

2446 Accesses

1 Citations

Metrics details

In 2014, the Israeli Council for Higher Education (CHE) commissioned an international panel of outstanding educators to prepare an ad hoc report reviewing the four established medical schools in Israel. The report described the strengths, weaknesses and challenges facing medical education in Israel with a focus on three specific areas: workforce planning, the structure of the curriculum and the financing of medical education.

There are interesting parallels between the challenges facing medical education in the U.S. and in Israel: a lack of clarity regarding the optimal size for the workforce and the optimal method for enhancing the number of primary care physicians; an absence of methodologies for evaluating innovations in medical education and a lack of transparency in funds flow. However, there are also important differences, one of the most important being an absence in Israel of students’ hands-on responsibility for their patients until year six of their undergraduate medical education.

The presence of a small number of medical schools with common funding and geographic proximity, in a relative sense, provides the Israeli medical schools with a unique opportunity to evaluate innovations in medical education and to set a high bar for inter-school collaboration and cooperation.

In 2014 the Israeli Council for Higher Education (CHE) commissioned an ad hoc committee composed of internationally respected physician-educators (four from the U.S., two from the U.K. and two from Israel) to provide an external review of Israel’s four established and accredited medical schools. In a recent IJHPR article, the report’s authors discuss three inter-related topics that bridge medical education and health care delivery: planning the physician and healthcare workforce to meet the needs of Israel’s population in the 21 st century; enhancing the coordination and efficiency of medical education across the continuum of education and training; and the financing of medical education. The members of the committee undertook an enormous task and have provided a comprehensive and scholarly assessment of the strengths and weaknesses of undergraduate medical education (UME) in Israel as well as the challenges faced in educating the next generation of physicians. Many of these challenges cross borders and continents; the overwhelming amount of new knowledge emanating from research laboratories and clinical trials, the financial stresses on hospitals and physicians that limit the resources that can be allocated to education, and pressures to shorten hospital stays and increase ambulatory care. How individual medical centers face those challenges is predicated in part on the influence of regulatory agencies in each country, the support – or lack of it – from universities, governments, and philanthropies, and the external influences of local and national politics [ 1 ]. However, the CHE report provides an opportunity to compare and contrast how Israel and the U.S. have approached the fundamental issues that face each of us and to explore ways in which lessons learned in the U.S. might inform efforts to reform UME in Israel.

Workforce planning

There are both interesting similarities and significant differences in “workforce planning” between Israel and the U.S. – although in both countries the term “workforce planning” might be described as an oxymoron. The CHE Report points out correctly that workforce planning in the U.S. is “highly fragmented” and experts cannot agree whether there is an actual physician shortage or whether the problem can be solved by better geographic distribution and an increase in the percentage of medical school graduates who pursue careers in primary care [ 2 ]. The latter view fails to recognize that an aging population requires not only primary care physicians but subspecialists who have expertise in caring for patients that have diseases that are over-represented in an aged population: degenerative joint disease, age-related macular degeneration, coronary artery disease, heart failure, critical care medicine, neurodegenerative diseases and cancer [ 3 , 4 ].

The paucity of U.S. students who pursue careers in primary care has been attributable to the high medical school debt of U.S. students - ~ $180,000 [ 5 ]. The fact that Israel has a similar shortage of primary care physicians despite substantial governmental support and far lower tuition costs suggests that career decisions are made on factors that are more complex than financial exigencies alone [ 6 ]. Both the CHE task force and U.S. primary care groups have proposed innovative programs to increase students’ interest in primary care: early immersion in a primary care setting, identification of ideal role models, and enhanced compensation models [ 7 ]. Unfortunately, none of these efforts have effectively shifted students’ interests. The current process of expanding Israel’s medical schools will help mitigate the existing and expected shortages in primary care physicians, but apparently this will not suffice and additional solutions are needed. Dr. Schoenbaum and his colleagues have proposed in the CHE report a concept that is gaining substantial interest in the U.S. for mitigating the shortage in primary care physicians: an increased use of non-physician clinicians as primary care providers [ 8 ]. While there is presently a limited number of non-physician clinicians in Israel, the opportunity to train physician assistants in a medical school environment using the model first described by Dr. Eugene Stead at Duke a half-century ago may mitigate some of the workforce issues while at the same time providing a new opportunity to increase medical school revenues.

The CHE report notes that the U.S. medical workforce is less dependent on foreign trained physicians than the Israeli workforce. This should not be construed as being a disadvantage for Israeli medicine because the demographics of the foreign trained workforce in the two countries are quite different. The majority of foreign-trained physicians who enter the Israeli workforce are Israeli citizens. By contrast, the majority of foreign-trained physicians who enter the U.S. workforce are foreign nationals who graduate from nearly 2,000 different medical schools worldwide including many from countries with whom the U.S. has relationships that are at times problematic. Without information about their schools of origin, these post-graduate trainees are selected based almost exclusively on scores on the USMLE examination; a test that provides limited information about a physician’s clinical capabilities. As a result there is wide variation in how these physicians perform on subsequent testing for licensure in the U.S. [ 9 , 10 ]. However, those who become licensed in the U.S. appear to perform well in practice although acculturation is an important but not obligatory part of their training. U.S. citizens who enter the U.S. medical workforce from abroad are most commonly graduates of for-profit medical schools in the Caribbean Islands that are unregulated, often graduate over 1,000 students per year, and farm their students out to U.S. hospitals for clinical clerkships by compensating the hospitals at a rate exceeding $500 per student per week – a reimbursement strategy that is problematic for a U.S. medical school [ 11 ].

Enhancing the coordination and efficiency of medical education across the continuum of physician education and training

The structure of pre-clinical and clinical ume.

The construct of UME in Israel differs substantively from that in the U.S. The most important difference between UME in the U.S. and Israel appears to be that Israeli students have less substantive contact with patients. William Osler, the father of American medical education, pointed out a century ago that: “To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all. [ 12 ]. Students are benefited when they are exposed to patients from day one of medical school and by incorporating clinical cases into basic science instruction or problem based learning [ 13 ]. During the clinical years students should be an integral part of the medical team – caring for assigned patients under the guidance of a resident and a faculty member rather than simply observers, and they should not be allowed to have “jobs” or any other extra-curricular activities that limit their participation in the medical curriculum and in particular, their clinical rotations. Not mentioned in the Report is the valuable role that standardized patients have played in the U.S. for nearly two decades [ 14 ]. They help students learn how to interview and examine a patient, they allow students to hone their clinical skills, and they provide both summative and formative feedback for the students. More recently, new technologies have supplemented the traditional standardized patient format in order to optimize assessment and evaluation such as adding Google glasses [ 15 ]. Small group workshops that use role play prior to patient interviews as well as videotaping patient encounters followed by group discussion have also proved useful [ 16 ]. In the U.S., a relatively new standard for medical education is inclusion in the curriculum of “translational medicine” [ 17 ]. Some schools have approached this by including instruction in the social sciences, statistical analysis, population health, the fundamentals of healthcare safety and quality, bioethics and health care finance. We believe that wherever possible students should have hands-on experience in translational research; however, this is not practical for schools that do not have programs in translational research. This could be an opportunity to link medical education in Israel with the robust and medically oriented Israeli biotechnology industry and the outstanding basic and translational science laboratories at Israeli academic institutions.

Dr. Thomas Nasca, the President of the American College of Graduate Medical Education (ACGME),m pointed out that medical school graduates today are an “undifferentiated primordial mass that must be shaped during residency” into medical practitioners [ 18 ]. Thus it is critical that UME and GME be viewed as a continuum during which a student progresses from a student to a practicing physician as they develop increasing competencies [ 19 ]. Each pre-clinical block and clinical clerkship should have well defined core competencies that each student is expected to attain. As individual specialty and subspecialty organizations develop milestones and entrustable professional activities (EPA’s) for GME, these concepts should be introduced into the undergraduate curriculum and incorporated into the assessment and evaluation of each student [ 20 ]. The CHE Report suggests that grading students based on achieved milestones might provide an opportunity for students to transition from a student to a resident based on their individual timeframe for understanding and using information. While intriguing, the complexities associated with assessing, tracking and scheduling hundreds of students based on individual metrics would likely be problematic if for no other reason than the need for additional support staff and the attendant costs.

The authors of the CHE Report were clearly influenced by the 2010 Carnegie Report on UME and the recent survey by Nara et al. [ 21 , 22 ]. These reports posited that there is a need for medical schools to decide whether to “continue in the directions established over a hundred years ago [by the 1910 Flexner Report] or take a fundamentally different course guided by contemporary innovation and new understanding about how people learn”[ 21 ]. It must be remembered that the definition of “innovation” is a “new idea or method” but not one that has necessarily proven successful. Thus, while changes such as flipped classrooms, active learning, e-learning, team learning, and simulation have been implemented at some – but certainly not all – U.S. medical schools, they have not yet undergone a thorough evaluation because the requisite tools have not been developed and it often takes many years to reach measurable endpoints [ 23 ]. In addition, many of the innovations in UME are expensive. For example, flipped classrooms and active learning require the availability of a large teaching faculty to facilitate small group discussions, multiple small classrooms and a collection of professionally produced on-line lectures. These novel teaching tools can be incorporated into the curriculum in selected areas rather than across the entire curriculum. For example, in our own curriculum, we use the more traditional lecture format for didactics in anatomy, biochemistry, immunology and microbiology. The remainder of the curriculum is system-based with approximately 40 % of the curriculum presented in the lecture format.

The CHE Report raised the concern that there were limited sites for clinical clerkships in Israel due to a paucity of hospital beds per capita and an over-reliance on hospital versus ambulatory teaching. This raises two possibilities. First, the possibility of increasing the number of clerkship opportunities for students by decreasing the number of patients on each clinical team could be evaluated. Kenneth Ludmerer pointed out in his book Let Me Heal that in an era of cost containment, a resident’s primary job is to churn patients through the hospital system as rapidly as possible [ 24 ]. This obviates the ability of students and residents to see the full spectrum of a patient’s disease, to have the time to get to know each patient and to ensure that students have appreciated the key elements of the history and physical examination. Students are invariably part of large teams. Two innovative programs have taken a very different approach. Hopkins Bayview (The Aliki Initiative) and the Brigham and Women’s Hospital have created teams with half the normal complement of patients so that students and residents have more time to spend with each patient [ 25 , 26 ]. The Aliki Initiative is associated with higher patient satisfaction, higher resident satisfaction and improved patient outcomes although the cost of restructuring the clinical teams might be prohibitive. Second, opportunities for increased outpatient exposure should be evaluated. In the U.S., there is a strong financial incentive for providing as much care as possible in the outpatient environment. In fact, many health care economists and policy pundits posit that the hospital of the future will be a large intensive care unit – much of today’s care being administered in outpatient clinics. How to compensate busy outpatient physicians for teaching will be the challenge of increasing outpatient exposure albeit with a strong societal benefit.

Financing of medical education

Medical education financing is a universal problem with enormous differences in UME and GME funds flow across different countries and in the U.S., across different medical schools: a problem that has increased as reimbursements have precluded cost-shifting from practice plans and hospital revenues to support the academic missions of the medical school [ 27 ]. At research-intensive medical schools in the U.S. tuition does not begin to cover the medical school budget because Federal funding does not cover the cost of research even if all investigators were optimally funded. Research-intensive medical schools in the U.S. therefore depend on university support, endowments, philanthropy and commercialization of intellectual property to support the research enterprise and in some cases, obtain support from associated health systems. An increasing number of medical schools in the U.S. have received significant financial contributions from wealthy individuals whose names are now incorporated into the name of the medical school: for example, Weill Cornell Medical College, Icahn School of Medicine at Mount Sinai, and Warren Alpert Medical School at Brown University. By contrast with Israeli schools, many U.S. medical schools compensate basic science teachers based on the number of hours they teach and the number of hours required to prepare a lecture. As a result, tenured faculty who no longer have grants to support their salaries often increase the time they spend teaching. For clinical faculty who spend significant amounts of time with students on their inpatient or outpatient services, many U.S. medical schools lower the relative value unit (RVU) expectations commensurate with the time they teach or pay teachers directly for their services [ 28 ]. This is important because without incentives, both pre-clinical and clinical educators are less likely to teach. Many medical schools have also developed multiple pathways to promotion in order that educators can be promoted based on their teaching evaluations and education scholarship rather than on extramural funding and the number of scientific publications and in some institutions educators can also achieve tenure. These incentives are critical for not only attracting teachers but also in making them feel that they are an important component of the medical school and university.

Lost in discussions of U.S. medical school financing is the fact that medical schools that do not or cannot support a research program have an economic profile that is significantly better than that of the traditional research-intensive schools [ 17 ]. In fact, a publicly traded company owns at least one offshore for profit medical school. In addition, the Liaison Committee on Medical Education (LCME) recently accredited the first for-profit allopathic medical school in the U.S. and for-profit osteopathic medical schools have previously been approved in the U.S. We have argued that it is important for medical students to have exposure to physician-scientists and clinician investigators who pursue translational research in either laboratory or clinical research centers while at the same time caring for patients [ 29 ]. Exposure to these research-oriented clinicians provides important role models, the opportunity to have hands-on participation in research activities and a perspective on medicine and medical education than is different from that which a student would obtain when their instruction is in a community hospital. The absence of physician-scientists and clinician-investigators at new medical schools and at for-profit medical schools threatens to create a two-tiered system of medical education in the U.S., yet without resources, more and more U.S. medical schools may shift to the second tier model. Thus, the presence of governmental funding for medical education in Israel is a critically important financial foundation that should be continued and increased as necessary.

Unique opportunities for Israeli medical education

Israel has only five medical schools – the four established schools covered in the report and a new medical school in the Galilee. The existence of only five medical schools which are largely funded by the government through the Council for Higher Education and which are located relatively close to one another, provides unique opportunities for both UME and GME. First, as pointed out in the CHE Report, there is the opportunity to share resources. The best lecturers and the best lectures from across the five schools can be used for the didactic portion of pre-clinical courses across the schools. In an era when many medical schools are implementing innovative but unproven and often expensive new teaching formats, there is also an opportunity to use the five Israeli medical schools as innovation incubators to actually test whether one educational strategy is better than another. Outcome metrics for comparisons of different education formats can include scores on standardized tests, OSCI’s or even oral examinations. The outcome of these studies would be useful to Israel for optimizing the educational experience for students and student outcomes as well as benefiting medical schools in other industrialized countries.

The economies of scale across the five schools might also provide novel opportunities for the medical schools to create ambulatory care facilities that could provide a collaborative learning environment for students from multiple schools. If these facilities are built in areas that are underserved in medicine, the creation of joint programs focused on health disparities and population health could also decrease health disparities that have occurred in ethnic or economically deprived areas. The five medical schools should also work together to lobby the government to transition from a university-centric funding model to a medical school-centric funding model as there is little rationale for the funds flow coming through the university as it is unlikely that this can be done with complete transparency. Furthermore, there will always be questions as to whether the universities apportion some of the funds for university infrastructure rather than for direct support to UME. The five medical schools should also look for opportunities to participate and actually lead the development of new physician assistant and nurse practitioner programs. By embedding these programs in the medical school both medical students and non-physician clinicians are exposed to the concepts of inter-professional education and learn to work seamlessly as a part of the care delivery team.

Israeli medical schools should also take advantage of the enormous investment in biotechnology in Israel by creating medical school-based incubator facilities and early stage venture funds to take advantage of intellectual property coming out of medical school laboratories. This effort should be collaborative across the five medical schools because the expertise of each may be distinct yet synergistic - making the aggregate intellectual property more valuable when bundled rather than put out to the market as individual pieces. Finally, Israeli medical schools should follow the lead of successful U.S. medical schools in pursuing philanthropy from both Israel and the U.S. that supports all three missions of the academic medical center: teaching, research and patient care. The message to potential donors and to grateful patients is the same in the U.S. as in Israel – without a continuing supply of new medical graduates with the skills to provide effective and efficient care in the short term and the ability to be learners throughout their careers, the health of the nation will suffer.

Conclusions

There are both differences and similarities between medical education in the U.S. and Israel. Important differences could be mitigated by focusing restructuring on: increasing the clinical exposure for medical students both during the pre-clinical and clinical years of medical school; eliminating student “moonlighting;” evaluating innovative methods for restructuring clinical teams in order to provide more clerkship opportunities; enhancing utilization of outpatient clinics for student education; developing clear rewards for educators including new pathways to promotion and tenure; establishing transparent funds flow for both pre-clinical and clinical educators; and financing undergraduate medical education through direct funds flow to medical schools rather than through university finance offices. Finally, the presence of only five medical schools within a relatively small geographic footprint should provide an opportunity for the schools to collaborate and cooperate in medical education in order to lower costs, optimize patient and space resources and take advantage of the unique academic and scientific strengths of the medical schools in Israel.

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Feldman, A.M. Undergraduate medical education in the U.S. and Israel: contrasts and common challenges. Isr J Health Policy Res 4 , 56 (2015). https://doi.org/10.1186/s13584-015-0053-4

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You are here, medical education in israel: achievements and problems.

When Reichman University initiated the establishment of Israel’s first private medical school, it was, as its website put it, "with the aim of helping to solve the existing shortage, and to immediately increase in the number of medical students in Israel.

The new school, according to Reichman’s optimistic plan, will open as early as 2024, if the curriculum receives approval from the Council for Higher Education of Israel (CHE). It will initially train about 80 students a year in the first phase, and will peak at approximately 120 students a year. The school will be established in cooperation with Sheba Medical Center at Tel HaShomer, and health funds Clalit Health Services and its central region hospitals, and Maccabi Health Services.

While the program’s leaders are excited about its implementation, and tout its use of medical simulators, there are those who claim that it is a delusion, a project that will not really help increase the number of doctors but will be established using public resources at the expense of other solutions. There is no doubt that the school will charge its students significantly higher fees than those at Israel’s public universities, but the opponents of the move also cast doubt on the professional standard that the students will receive in return.

Racing to stay in place

But first, some background on the situation which the new school is entering. There are about 30,000 doctors in Israel, only 3.2 doctors per thousand people, compared with an OECD average of 3.4 T. Even this low number is will soon fall significantly, mainly because of the Yatziv reform in licensing foreign medical graduates (Prof. Shaul Yatziv is head of the Division of Licensing of Health Professions in the Ministry of Health) that disqualified many institutions, but not just that. Other reasons include population increase and, in the coming years, a massive retirement wave of doctors who came to Israel during the mass immigration from the former Soviet Union during the 1990s and filled a void which had already begun to form at that time and was never dealt with.

During the past decade, the number of medical school graduates in Israel has increased significantly, but still has not managed to keep up with population growth. A committee headed by Prof. Ronni Gamzu, CEO of Tel Aviv Sourasky Medical Center (Ichilov), published a report in early 2022 with recommendations for a rapid increase in the number of students so that the number of medical license recipients in Israel would increase to 2,000 a year by 2035 (compared with approximately 1,800 today), of which about 1,200 (60%) would be home-grown. Meaning, by the middle of the next decade, the ratio of doctors per capita would return to roughly the same level as today. However, if the plan is not implemented, is delayed, or not budgeted, or if doctors leaves the country or the profession en masse, it will be very difficult to close the gap. Currently, another Gamzu committee is working on expanding the recommendations, while the Ministry of Health is itself preparing a plan that should make these recommendations operational, although nothing has yet been officially decided or budgeted.

Today, only about 40% of new doctors entering Israel’s medical system have studied in Israel, the lowest rate of locally-trained qualified doctors among all OECD countries. In a special OECD report on medical education and training In Israel, published in May of this year, Israel received low marks for its number of medical school graduates, the lowest in the OECD relative to the population.

The reason is that there are not enough places in Israel’s medical schools to train enough doctors for the country’s entire medical system. But there is also a revolving door: universities in Israel -- Tel Aviv University, Ben-Gurion University of the Negev, and the Technion-Israel Institute of Technology -- train foreign students (in 2021, 113 out of a total of 1,020 new registrants for all of Israel). In addition, those who study in Israel do not always remain within the system, but move abroad for work, with 9% of Israeli-trained doctors employed abroad at any given time.

The gaps in the system are filled by Israeli students who studied abroad, usually in Western or Eastern Europe. Some, but not all, of these foreign education institutions are excellent. The Yatziv reform defined threshold conditions for medical schools abroad graduates of which could be integrated into the Israeli health system. According to Gamzu report estimates, the Yatziv reform will subtract about 400-500 doctors a year from the supply of new doctors available to the Israeli health system, mainly in the periphery.

The country woke up late to the need to train a critical mass of new doctors, but steps have nevertheless been taken in recent years. Up until 2009, four faculties of medicine operated in Israel, at the Hebrew University of Jerusalem, Tel Aviv University, the Technion, and Ben Gurion University, with only 250-350 graduates each year. By 2020, 850 students began studying at Israel’s various faculties of medicine, that is, triple the number of students within a decade. This was done by consolidating the existing faculties, opening a four-year medical study track at Tel Aviv University for those already holding a bachelor's degree, with another similar track at Ariel University, as well as establishing a new medical school, the Bar-Ilan University Azrieli Faculty of Medicine in Safed, where there is also supplemental training for foreign-trained graduates who do not meet the new criteria. A special degree is also planned for research physicians at the Weizmann Institute, which will open in the coming years.

Despite the claims about the limited capacity of the medical training system in Israel, the universities themselves are not the bottleneck. The main problem: the clinical fields (clinical rotations), meaning, the training that students undergo at hospitals. Today, all the medical teaching institutions in Israel rely on clinical fields. Naturally, competition for places will intensify as new institutions enter the picture.

NIS 90,000 yearly tuition, no cadavers

Prof. Uriel Reichman, founding president and chairperson of the board of directors of Reichman University, explains why he decided to enter the arena: "Up until 1995, the gates of higher education were closed, and under the control of seven large universities. Hundreds of thousands of people were denied social mobility. Anyone who wanted to study law, for example, and was not accepted to one of these very few places, had to go to study in England, and this damaged the social fabric of our country.

"Fortunately, the Freedom of Occupation law was passed in the meantime, and they told me - okay, open a university, but you won't get a cent from the state. My goal has always been to establish an institution that will be a university in every respect. The medical school is important to us because of this vision, and because we are an interdisciplinary institution. We want to make medicine part of the other faculties here. We’re also doing it as a mission, because of the lack of doctors, and even though this faculty will be loss-making in the first years. We were happy to receive a large donation from Udi Recanati [the school will be named after his late mother, Dina Recanati - G.W.], which helps us get started and later we will raise more."

The person designated as the dean of the new school is Prof. Arnon Afek, the associate director general and acting director of Sheba General Hospital. Afek has some innovative ideas for the new school. "We’re educating the doctors of the future and it is a big challenge to teach them differently. We want to give them skills and not just knowledge. This will be a discussion."

Afek plans to rely more broadly on medical simulators than other institutions do, to enable additional practice beyond the medical internships at hospitals, and reduce clinical fields demands. Also, unlike its competitors, the Reichman School of Medicine will not dissect cadavers. "Not because we can't do it, but because we don't need that today. Simulations are enough," says Afek.

"Every additional seat in a medical school is a blessing," says Dr. Orly Weinstein, deputy director and head of the Hospitals Division at Clalit Health Services. "I'm sure people raise an eyebrow at the fact that it's a private platform. But studying abroad at good institutions is more expensive than at Reichman. So, if there are going to be private schools, then better to keep the doctors here in Israel."

One of the major claims against the program is the very fact that it is private. The claim is that a public resource is being allocated to a private entity.

Afek: "I’d like to note that Reichman is not a for-profit institution. It is a non-profit. It is simply not funded by the CHE." Regarding the price, he says: "At a public university medical school, tuition is about NIS 12,000 per student. With us, the same student's studies will cost NIS 90,000 a year."

That’s a bit of difference.

"Yes, but it's not because we’re making a profit, but because at other universities, the state makes up the difference, while at ours, the student pays." Afek points out that one option being examined is for the CHE to fund tuition, but only for those students who, after receiving their degree, commit to working for a period of time in the periphery, or in a particular specialization that is in short supply. This seemingly solves two problems in one fell swoop. It enables students from financially weaker families to study, and more properly plans manpower allocation.

Institutions in Eastern Europe, not all of which will remain relevant after the Yatziv reform, can cost about NIS 15,000 a year, but there are also institutions in Europe where the cost of studying is about NIS 80,000 a year and they still attract Israeli students.

"What do they add? Nothing"

However, voices are heard from other schools claiming that there is no need for another university, certainly not a private one. A faculty member at one of the existing medical schools summed it up in the most emphatic way: "What does Reichman add? Nothing. Who’s going to teach there? Lecturers from other medical schools. Where will they do their training? At our clinical fields. The Gamzu program determines exactly how many doctors we need to train: 2,000 doctors a year. The existing medical schools can do it. Easily. I can add as many as the CHE will let me.

"Instead, they take something that is a college -- actually more like a high school -- and permit it to teach medicine. Medical studies are supposed to be academic. The lecturers are doctors and senior researchers. Reichman doesn’t even offer a bachelor's degree biology major yet. Who will they bring in? Either our doctors, or people who are not at research centers. This is dangerous and bad, and degrades the level of instruction.

"And then, where will they do their clinical training? This will also be at the expense of our clinical fields. If we had more clinical fields to work in, we would gladly increase the number of students we have. In practice, what’s happening is that they’re taking an institution that lacks experience and ability in the field, and it will basically sell our public system at a higher price, and use it less well.

"I have nothing against Reichman personally. But what’s the next step? Will every college be able to teach medicine? So, a lot of people can throw their caps in the sky and say they are doctors -- and the whole level of medical professionalism will decline. Just the way it happened with the legal profession. But the state will approve it in the end, if only as revenge on the Israel Medical Association for protesting and striking against the government’s legal system reforms."

"It's just not true," says Afek, who has a response to every critique. Regarding the lecturers, he says: "I don't intend to take professors from the other universities. That won't happen. I’ve chosen brilliant young doctors who are dying to teach, and I'm taking retired doctors to be their mentors. There are plenty of young doctors at Sheba, more than enough to fill the teaching hours for Tel Aviv".

One exception is Afek himself, who today is a professor at Tel Aviv University and who was formerly the head of the Sackler NY Medical Program at Tel Aviv University for medical students from abroad. When the new Reichman School of Medicine receives official approval, Afek is expected to leave his position at Tel Aviv University and join the Reichman faculty.

And what about the clinical fields?

"There is no shortage of clinical fields. There is every indication that the hospitals can and do want to teach more, and the OECD report that came out in May also agrees with us." Indeed, the report states that clinical fields in Israel are underutilized, and there are far fewer medical students per hospital bed than in other countries.

Reichman adds, "We’ve heard the criticisms and they’re disgraceful. If there aren’t enough clinical fields, and they are a 'national resource', how was it that, for years, the existing medical schools taught foreign students? Did they make a business out of it? This is hypocrisy."

Weinstein: "In the past, I also thought it was impossible to increase the number of medical students significantly because there were no clinical fields. But now that Clalit is also training doctors, we’ve seen there are unused resources in this area at the hospitals as well."

Training largely outside of hospitals

One of the proposed solutions is clinical fields in the community. Dr. Daniel Landsberger, chief physician at the Medical Division of Maccabi Health Services and responsible for the health fund’s relationship with the new medical school, explains: "Can you only learn about diabetes at a hospital, or can you also learn from the same endocrinologist who works at the hospital, but also treats patients in the community? After all, the medical world is actually trending away from hospitals and towards the community.

"No one intends for medical students in Israel to leave their studies straight away to specialize without going through a hospital internship at all, but that period can be divided into a year and a half in a hospital, and two and a half years in the community, for example. I have 400-500 doctors who are willing to be instructors. Even now, we have students doing some of their clinical fields in the community. This is happening not only here, but all over the world. In Canada, for example, all students are also required to train in the community."

And will these students aim to become community doctors?

"Not necessarily. When a student chooses their specialization, they usually follow a mentor. If they studied with an endocrinologist in the community, they will later join up with them at their hospital."

Landsberger also sees some challenges to this method. "The hospitals where Reichman's students are expected to undergo training are in the central region, but communities are all over the country. Perhaps it will be less convenient for them, but perhaps this way they will actually be exposed to the periphery."

In response, the official from the competing school muses: "Can you see Reichman students, the ones who drive to university in their SUVs and complain if their parking space isn’t wide enough, covering night shifts in the periphery? I don't think so."

There is also a diversity issue. Among students who go abroad to study, at the cheaper foreign institutions expected to be disqualified by the Yatziv reform, there is a higher proportion of students from Israel’s Arab population. We are eliminating this channel, and bringing Reichman students into the system instead.

Landsberger: "Things are not that dichotomous, of course. I know Arab families who have the resources, or make sacrifices, to send their children to very high-level institutions abroad, and they will also be able to send them to Reichman. At least that way they will stay in the country. And for those who cannot afford these studies, scholarships will be awarded. In any case, you must be realistic. Money plays a role today in every field."

Dr. Landsberger adds: "I’m not sure that the research universities are really prepared to expand their medical schools. These studies are considered loss-making. In Reichman, they will not be unprofitable, because the teaching methods are more efficient, with more emphasis on the virtual, and also, of course, because the price per student will be higher."

Do you understand the criticisms against you?

Afek: "All competition is disruptive. When they established the medical school at Ariel, it was a world war. Even when they opened in Soroka, the Hebrew University said, no way. And when the medical school of the Hebrew University was established, do you know what they said? Who needs it, there’s an excellent school of medicine in Beirut. Why set limits? I think we should open as many medical schools as possible. At Weizmann, and Haifa too. But it will take years."

Landsberger: "5% more medical students at Reichman University is not what will shake up the system."

Reichman : "We really are not taking anyone's place. There is room for another medical school or two besides us. We also want to help, lend a hand, especially during the current period which is so difficult, and although we oppose the regime coup, as an institution we also say, ‘Let's keep on building, let's keep on being optimistic.’ We continue to struggle for the future of our society. So that we shouldn’t lose heart."

Gali Weinreb

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Undergraduate medical education in the U.S. and Israel: contrasts and common challenges

Affiliation.

• 1 Temple University School of Medicine, 3500 N. Broad Street, Suite 1150, Philadelphia, 19107 PA USA.
• PMID: 26568820
• PMCID: PMC4644288
• DOI: 10.1186/s13584-015-0053-4

In 2014, the Israeli Council for Higher Education (CHE) commissioned an international panel of outstanding educators to prepare an ad hoc report reviewing the four established medical schools in Israel. The report described the strengths, weaknesses and challenges facing medical education in Israel with a focus on three specific areas: workforce planning, the structure of the curriculum and the financing of medical education. There are interesting parallels between the challenges facing medical education in the U.S. and in Israel: a lack of clarity regarding the optimal size for the workforce and the optimal method for enhancing the number of primary care physicians; an absence of methodologies for evaluating innovations in medical education and a lack of transparency in funds flow. However, there are also important differences, one of the most important being an absence in Israel of students' hands-on responsibility for their patients until year six of their undergraduate medical education. The presence of a small number of medical schools with common funding and geographic proximity, in a relative sense, provides the Israeli medical schools with a unique opportunity to evaluate innovations in medical education and to set a high bar for inter-school collaboration and cooperation.

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