Aliyah — One month in. Some thoughts after a month…
By: Dean Lutrin
Tags: Aliya, Emigration, Surgeon, Colorectal, South Africa

The quest to carry on as a colorectal surgeon in Israel is progressing. I didn’t realize how much of the administrative work I could have done from South Africa but it is not a train smash that my registration is a bit delayed. Using this time to settle in my children is the most important thing and it would not be good for our family for me to have started working already.

To register as a specialist in Israel one needs to register with two bodies. The Ministry of Health and the Israel Medical Association (The equivalent of the HPCSA). I have received my approval from the Ministry of Health but await my approval from the IMA. They don’t just see if you fulfil criteria, but they go through you as an individual. They asked for a list of every operation I did since the start of my registrar time all the way until now, and have asked me to clarify a few things on my CV. It is quite unsettling to know that people are scrutinising me with a fine-toothed comb. I am still waiting for exemption from having to write any exams. I hope (and expect) that this will come through soon.

I will need to do a three-month period of work under supervision before I can receive my Israeli specialist certificate.

I have had two interviews at the Sheba Medical Centre. One with the head of the hospital and one with the head of the Department of Surgery. I took Josie with me for both interviews not only because she makes me look good, but also because surgery can be tough on a family and I want us to approach this as a team; and I want them to know how dedicated we are to this cause.

The interviews have gone well. It has just been summer holidays, and we are now heading into a period of Jewish Holidays. Israel is not functioning as efficiently as it normally does. It’s like trying to do work in SA between Christmas and New Year. I have not got a firm offers yet, but things are moving forward. It sucks having to be patient, to be in a position of uncertainty, and to not be ‘needed’ by the system.

There is a fortune of competition here. It is a small country filled with very competent people. But I remain pretty convinced that everything that I have gained from South Africa will be an asset to the Israeli healthcare system. I also have some wonderful people on the inside who are helping me as much as they can. Israel is not a pure meritocracy and having people who are able to help you get going makes life a lot easier.

The hospital that I am keen on working in is massive. Somewhere around 1400 beds in total. Huge campus, lots of research going on, and is a self-contained city with banks, clothes shops, and multiple restaurants. Josie believes that I will get her better gifts there than I managed to get her at Killarney Mall. It’s around 20km from where we live and time to get there is very dependent on traffic.

Once I get a job, it will be in the state healthcare system. It would be the equivalent of working at Bara or the Gen — albeit in a better resourced environment. There is private practice here, but it is a complex multi-level system that I don’t understand yet. Everyone in the country has basic medical aid but can choose to top it up at various levels, which allows them to choose specialists etc. I have been told that the medical aids limit the number of surgeons approved to do private practice work because they know that the more private practice surgeons there are, the more operations will be performed. One HPB surgeon who has been here from the USA for two years told me that he has not received approval to do private practice surgery for the medical aids despite trying very hard. He supplements his income by doing extra cases and calls at the state hospital. Pure health economics. But, as I said, I don’t yet understand this system. Just like in South Africa, a state salary is not enough to support a family.

An interesting aside: We received the J&J vaccine in SA and we received one dose of Moderna in Israel. We would like to have covid serology done to see if we have proof of immunity so that we can get our vaccine passport. Otherwise, we need to wait another few weeks for our second Moderna dose. An infectious diseases specialist needs to approve the serology test. A specialist physician or family physician are not allowed to request covid serology. Once again, pure health economics. The government knows that lots of people want serology done and have created real hurdles to doing this test.

I miss looking after patients and I miss operating. I cannot wait to be back in a hospital, talking to patients, and doing operations. It is a very happy place for me and I long for it.

I also miss DGMC very much. I miss the hospital, staff, theatres and my colleagues and friends there.

Yet, for the first time in over two decades, I am not working for a protracted period and it’s nice to be relieved of the stress of patient responsibility for a while.