Ultimate Guide to Practicing Medicine in Israelby Dr. Deena Wasserman
Israel sits on the shores of the azure Mediterranean Sea and cradles Jerusalem, one of the holiest cities in the world, and Tel-Aviv, a global center of nightlife, culture, and cuisine. In a country the size of New Jersey, there is every imaginable type of historical site, outdoor adventure, cultural experience, and more. The quality of life and clinical satisfaction of practicing in Israel should be weighed against the lower earning potential as compared to the US. Native Israelis are called sabras – meaning prickly pear – they may be rough on the outside but are soft and sweet on the inside. There are many reasons to consider transitioning to Israel and here we provide a guide to help an American-trained doctor practice in Israel.
The first piece of advice – everything in Israel is constantly changing and you will not necessarily be notified if something changes. It is imperative to check websites and be in contact with the governing bodies to confirm requirements. Additionally, there is a compulsory military draft for physicians, until age 35 for eligible men, and 30 for women. This is subject to change at any time and depends on your marital status, children, etc. If you are in the draft age group, you should reach out to the medical liaison for the Israeli Defense Force.
Second piece of advice – be persistent. Israeli bureaucracy is second to none in its inefficiency. You cannot expect paperwork to be filed or people to do their jobs in a timely manner. You should be persistent bordering on rudeness to ensure whatever you are trying to do is progressing appropriately. Don’t be discouraged by this – assertiveness is an important and respected character trait in Israeli culture.
Introduction to the Israeli Medical System
All Israeli citizens are entitled to healthcare and health insurance as part of Israel’s socialized national health system. Citizens pay bituach leumi, a tax that funds the healthcare system and qualifies a citizen for insurance. There are four kupot holim (public HMO): Meuhedet, Clalit, Leumit, and Maccabi which provide a standard benefits “basket” as mandated by the government. The services, procedures, and medications covered by each HMO varies by location. People usually choose an insurer based on their geographic location in the country and the available in-network offices and services.
Many people also purchase private insurance (such as Harel) to supplement the standard benefits. Clinics and outpatient physicians are associated with a certain kupah (health insurance provider) or if operating a private clinic the physician can accept insurers of their choosing. Public hospitals are affiliated with a certain kupah while private hospitals are not affiliated with a kupah and choose to accept certain health insurance.
In general, knowing Hebrew is helpful to practice within the Israeli Healthcare System. That said, many people arrive without prior knowledge of Hebrew and spend the first few months in ulpan, an intensive language immersion program, paid for by the government for new immigrants. They have general language classes and also language classes specifically geared toward medical professionals. Depending on the region of the country, other languages that are very useful include English, Arabic, Russian, and French.
The Israeli Medical Association (IMA) allows post-graduate physicians, those who are in residency or beyond, to obtain a visiting physician license to volunteer in Israel. This enables an individual to experience the Israeli healthcare system prior to potentially moving and becoming a citizen. The visiting license is typically granted for anywhere from one month up to one year. This may be a good option for a senior resident who would like to do an elective, or someone seriously considering moving to Israel. The required documentation (including an application form, medical school diploma, medical license, letter of good standing, copy of passport, and a specialty certificate (if applicable)) must be submitted three months prior to the requested work period. You do not need to be an Israeli Citizen or be a permanent resident to apply for this experience.
General License to Practice Medicine
Any physician who has attended an accredited US medical school, completed USMLE (steps 1, 2CS, 2CK, and 3), has completed one year of internship, and holds a current license to practice medicine (in any state) is eligible for a temporary medical license without any additional exams or training. Graduates from a Caribbean medical school will need to take an Israeli Licensing exam. A temporary license allows you to work for 12 months, and after 12 months you can submit a formal letter of recommendation/good standing from your place of employment, which will enable you to graduate to a permanent physician license. Of note application for specialty recognition (see below) can be done at the same time as application for the temporary license.
There are several documents required for a temporary license including:
- 2 passport photos
- 2 copies of your national ID card or passport:
- Every Israeli citizen or permanent resident has a national ID card, Teudat Zehut. For application purposes, you can use your US passport. However, you will be unable to pay for your license and complete the application file until you receive your Teudat Zehut and submit a copy to the Ministry of Health (MOH)
- A copy of your medical school diploma (must be notarized)
- A copy of a certificate of completion of internship (Notarized copy of residency diploma will work for this)
- Official confirmation of having worked at prior place of employment, specifying start and end dates
- A copy of your US medical license (must be notarized)
- A letter of good standing from the board of medicine of the state in which you are licensed
- This letter should be sent directly to the MOH. Israeli bureaucracy can be a bit dysfunctional, so it is important to only send this AFTER you have sent in your initial application packet and have a file established. The MOH will provide you with a file number, and this should be provided to your state’s board of medicine to include on your letter in addition to your name, as they will refer to it to ensure your letter makes it into your file. If the letter arrives before you have an established file, it will likely get lost and you will have to send it again.
- Two copies of the Questionnaire for Health Professionals
- It is highly recommended that you provide the MOH with an ISRAELI address and phone number on this application. They will communicate with you mostly via text and email. If you have a friend or family member that will allow you to use theirs, do it. It is easy to change the phone number and address on file once you arrive.
The IMA Scientific Council is the governing body in charge of specialty recognition. While one can work with a basic medical license, one will not be recognized as a senior physician, which affects both job opportunities and pay. Every specialty has different requirements for recognition, so it is important to research your specialty specifically. In general specialty recognition depends on your years of experience and training when compared to the duration of Israeli residency in your specialty, and your specialty board certification status.
- A letter of Intent: You will need to submit a letter of intent requesting the specialty in which you wish to be recognized, along with supporting documentation. Application for specialty recognition can be done AT THE SAME TIME as your application to the MOH for a general medical license. Unlike the MOH, the IMA has accepted these documents via email in the past.
- Committee Review: The committee for your specialty will review your submitted application. They will make a recommendation regarding your requirements for adaptation/observation period, histaklut, and which (if any) further exams are required. In general, a board-certified US physician will not require additional exams.
- Adaptation Period: Every immigrant physician is required to do an adaptation period, spanning anywhere from one month to one year, though on average is 3-6 months. During this time, you are under the purview of a senior licensed Israeli physician in your specialty. The salary is paid by the government, and therefore is EXTREMELY low (the equivalent of about $1600 a month).
- Specialist Recognition: At the end of the adaptation period, your supervising physician will write a recommendation letter to the IMA to recognize you as a full specialist.
Finding a Job
Finding a job is far more complicated than medical licensure. There are many jobs available and there is a long list of specialty shortages in Israel. However, working conditions in Israel are different than in the US.
Physician jobs are available on the inpatient side, outpatient medicine in HMO clinics, and private practice. In general, inpatient work requires longer hours and has lower pay.
Networking is the best way to find an opportunity – recruiters don’t really exist here. Go to a conference, send some messages, ask around! Reach out to physicians already working in Israel and ask them for potential job opportunities. You never know who knows whom and in Israel making a phone call could put you in touch with the department chair or the head of a hospital, getting you a step closer to a solid job. You have to be persistent.
Salary & Work Culture
In the context of the national healthcare system the earning potential for US trained physicians in Israel is significantly lower than in the US. Before moving to Israel make sure to ask Israeli colleagues within your specialty for the typical income. While there are many reasons to live and work in Israel, salary is not the main draw, and it is important to ensure that you plan accordingly.
Persistence is incredibly important to live in Israel: you MUST be persistent and proactive – so much so that in American culture it would be perceived as rude. In Israel nothing happens unless you are constantly checking to make sure things are progressing. If you are not an assertive person, this country will be very difficult to navigate.
The advantages of the work culture here lie in clinical satisfaction. Unlike the US, patients have an excellent follow up network and access to primary care. There is also almost no “litigation culture”, defensive medicine is not part of the culture, and documentation is more succinct and clinically relevant. Every HMO and hospital utilize a national EMR, so you can easily access all of your patient records online.
Israel is NOT an immigration country given the historical context in which the country was founded. In order to become a citizen or permanent resident, one must (almost always) apply under the Law of Return. This law states that any individual born to a Jewish parent or grandparent, or who is the spouse of such an individual, has a right to apply for citizenship. If one does not qualify under the Law of Return, it is extremely rare to be eligible for permanent residence/citizenship, and such an individual would need to contact the consulate and the ministry of interior directly.
If you qualify under the law of return, you may apply for either a temporary residence visa, under which you qualify for long term residency and many social benefits (including healthcare), or an immigration visa, under which you will be able to enter the country and upon landing naturalize as a citizen. This process is relatively streamlined, although there have been changes due to COVID. If you are interested in applying for an immigration visa, the easiest way is to use Nefesh B’Nefesh, an organization that helps eligible persons apply for citizenship and move to Israel (“make Aliyah”). They have a very clear process of which documents are required and act as an intermediary between you and all the government agencies.
Immigrants to Israel receive an “absorption basket” of benefits, including a monthly stipend for the first year, tax discounts, mortgage discounts, and more.
You cannot obtain a medical license on a work visa.
You must be an Israeli Citizen, a permanent resident, or eligible for either immigration status to practice medicine for the long term. For Non-Israelis, the Visiting Physician pathway is a wonderful volunteer opportunity to experience the Israeli Healthcare system and culture. American credentials are recognized for medical licensure. An American-trained doctor transitioning to practice medicine in Israel will need to be assertive and persistent to network and navigate the job scene.
Appendix: Important Terms
- Staj – internship
- Hitmachut – residency
- Mumche – specialist/senior
Dr. Deena Wasserman completed her residency training in Emergency Medicine in Philadelphia, PA and fellowship in EMS and Disaster Medicine in Camden, NJ. She holds a Fellowship in the Academy of Wilderness Medicine from the Wilderness Medical Society. She now lives in Ashdod, Israel where she practices Emergency Medicine and spends an inordinate amount of time on the beach. She is the author of the Ultimate Guide to Practicing Medicine in Israel.
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