[Criteria for a medical specialty in crisis: a case study of general surgery and internal medicine].

Background: Several clinical specialties in Israel appear to be experiencing an ongoing crisis. Recently, a Public Committee addressed this problem and recommended its further study. In this paper, the authors report a pilot case study of general surgery and internal medicine, which have been identified as "clinical specialties in crisis" in the medical literature, in the testimonies presented to the Public Committee, and during our preliminary interviews.

Objectives: to identify (a) the criteria for a "medical specialty in crisis" and (b) measures for the assessment of the extent of the crisis.

Methods: (a) Qualitative analysis of interviews and written testimonies of hospital directors, departmental heads of general surgery and internal medicine, and key personnel in the health care system; (b) Analysis of data derived from national administrative data databases and (c) Secondary analysis of data from a nationwide survey of board certified Israeli specialists.

Results: We identified five criteria of "medical specialties in crisis": shortage of "good" applicants for residency training; difficulties in filling vacant positions; excessive workload due to the limited number of staff physician and residents; a perceived low remuneration and limited opportunities for additional income; poor quality of professional working life. Some of these criteria can be used as a proxy for measuring the extent of the crisis.

Conclusions: It is possible to identify criteria defining clinical specialties in crisis, as well as its extent, as a first step toward identification of possible ways of coping with it. The findings of this pilot study justify a broader survey of additional medical specialties and a larger number of physicians.