A new Bank of Israel report for 2024 reveals that the Yatziv Reform, which regulates medical studies in faculties abroad, is expected to cause a severe shortage of doctors in Israel in the coming years. The reform, designed to improve the quality of medical training, will reduce the number of new doctors by approximately 400-600 each year starting in 2026, with a particularly significant impact in peripheral areas.
According to the report, to be published at the end of the month, this shortage is expected to worsen given Israel's demographic characteristics – high natural growth and an aging population, alongside the expected retirement of many doctors in the coming years. The Bank of Israel emphasizes the urgent need to implement measures to increase the number of doctors in Israel.
The Yatziv Reform, which began in 2019, represents a turning point in Israel's medical training policy. The reform was born following complaints received by the Ministry of Health in 2017-2018 about interns lacking clinical experience who were trained in some institutions abroad. In response, the Medical Professions Licensing Division examined medical study institutions abroad and defined required professional criteria for their graduates to work in Israel as doctors.
According to the new criteria, all institutions located in OECD countries and certain institutions in non-member countries, such as several institutions in Jordan and Romania, were approved. The remaining institutions were disqualified, and it was decided that Israelis who began their studies in 2019 and onward at non-approved institutions would not be able to take licensing exams in Israel.
The impact of the reform is expected to manifest starting in 2025, in two main ways – a decrease in the number of new doctors and an improvement in the average quality of doctor training due to the disqualification of weaker institutions.
The report's data shows that in 2019-2021, the number of new doctors who graduated from disqualified faculties was approximately 500-600 per year, representing about 30 percent of new doctors who received licenses during those years. Considering the upward trend that has characterized recent years, it is reasonable to assume that in 2022-2024 this number grew beyond 600.
The research highlights the significant gaps between three groups of doctors who differ from each other in their place of study – graduates of Israeli faculties, graduates of approved faculties abroad, and graduates of faculties abroad that were disqualified as part of the reform. The test scores and pass rates of graduates from Israeli institutions are significantly higher than those of graduates from approved faculties abroad, and their data is significantly higher than the data of graduates from faculties abroad that were disqualified as part of the reform.
The large gaps to the detriment of graduates from non-approved faculties abroad suggest that many who would have studied medicine at disqualified institutions without the reform will struggle to be accepted for studies at approved faculties abroad, let alone in Israel. However, analysis according to the 25th and 75th percentiles indicates significant overlap between graduates from abroad at a non-approved institution and graduates from abroad at an approved institution, suggesting the possibility that some who would have studied at disqualified faculties without the reform may be able to gain acceptance to faculties that were approved under it.
Therefore, the Bank of Israel estimates that the decrease in the number of new doctors in the coming years as a result of the reform will be slightly lower than the number of doctors who studied at faculties that were disqualified in recent years, namely about 400-600 doctors. This assessment is consistent with additional assessments that appeared in previous reports on the subject.
Two additional points emerge from the report's findings: First, insofar as achievements in the psychometric exam reflect the cognitive abilities of examinees, the Yatziv Reform is expected to be reflected in an improvement in the average level of doctor capabilities in Israel. Second, the large gaps in exam scores between graduates of institutions in Israel and graduates of institutions abroad (even the approved ones) show that those who went to study abroad are not necessarily those whose scores were close to the Israeli acceptance threshold.
The report concludes that many talented Israelis give up on medical studies because of the high threshold and choose to study other professions or travel to study medicine abroad and do not return to Israel after completing their studies. The implication is that the very high threshold for medical studies in Israel causes the Israeli healthcare system to lose many talented doctors. This finding supports increasing the number of medical students in Israeli faculties as the central tool for increasing the number of doctors in Israel.
The report indicates that the geographical distribution of residences of doctors who were trained at disqualified institutions is not uniform. The prevalence of doctors from this group in the northern and southern districts is significantly higher than in the central districts. This finding leads to two central insights: First, a relatively high percentage of doctors in peripheral areas are characterized by a low level of training relative to doctors in central areas, which can affect the quality of health services provided in those areas; Second, it is reasonable to assume that without taking steps on the matter, the impact of the reform on the number of doctors is expected to be felt especially in these areas.
This point is of great importance, because peripheral areas already suffer from a shortage of specialists, as recent studies show. The Ministry of Health has been taking a number of steps in recent years to increase the number of doctors in the periphery and improve their average quality.
Against the backdrop of the expected decrease of 400-600 new doctors starting in 2026 as a result of implementing the reform, the Ministry of Health has begun in recent years to take steps to increase the number of medical students in Israel, to nurture the connection with Israeli students who traveled to study at approved institutions abroad, and to encourage the immigration of doctors.
The main steps taken in this regard since 2019 include: opening a medical school in Ariel in 2019 (70 students), canceling programs for foreign students and converting infrastructure for Israeli students from 2023 (130 students), approving the opening of a private faculty for medical studies at Reichman University in 2025 (80 students), providing conditional loans to students who travel to study medicine at approved faculties abroad as part of the "Ofakim" program starting in 2024 (100 students per year), and additional programs on a smaller scale.
In addition, two new medical faculties, at the Weizmann Institute and the University of Haifa, are in the approval process and are expected to open in the coming years. According to the 2025 Arrangements Law, the number of new medical students in Israel in the 2024 academic year stood at 1,228, and it is planned that this number will rise to 1,700 by 2027, as part of a plan to increase the number of medical students in Israel.
The significant growth in recent years and the planned growth in the coming years are expected to largely mitigate the impact of the Yatziv Reform. However, as several reports on the subject indicate, there are a number of additional factors that highlight the need to implement steps to increase the number of doctors in Israel.
These factors include population growth and aging, the age distribution of doctors in Israel, which indicates the expected retirement of many doctors in the coming years, the ratio of doctors to population size, which in Israel is low compared to the average of OECD countries (3.48 compared to 3.7 in 2022), and additional factors.
The report emphasizes the importance of periodically reviewing the program every few years in order to update it according to various developments in the healthcare system. Also, it should be taken into account that there is a gap of several years between the expected impact of the reform (from 2026) and the maturation of most measures to increase the number of new doctors in Israel. This gap may create a temporary shortage in the coming years.
Israel is facing an exceptional situation on a global scale, as 58 percent of the doctors who were active in Israel in 2020 were trained outside its borders, an exceptionally high rate compared to other OECD countries. This group includes new immigrants, but it is mostly composed of Israelis who went to study medicine abroad due to the high acceptance threshold for medical studies in Israel, a result of the limited supply of places for students in Israeli faculties.
In this reality, the Israeli healthcare system relies heavily on doctors trained abroad, and this has several disadvantages; for example: it is impossible to supervise the quality of training; theoretical and clinical studies do not necessarily align with what is accepted in the Israeli healthcare system; and the probability of talented people emigrating from the country increases.
The institutions abroad where Israelis study are diverse in terms of the level of professional and academic training they provide, and this affects the professionalism of their graduates. In 2017-2018, the Ministry of Health received complaints about interns lacking clinical experience, who were trained in some institutions abroad, which ultimately led to the implementation of the Yatziv Reform.
The Bank of Israel report reviewing Israel's economy in 2024, to be published at the end of the month, is expected to provide a more comprehensive picture of the implications of the reform and the challenges facing the Israeli healthcare system in the coming years.
