The French medical Brain drain: Why are so many doctors leaving for Israel?

Agency officials say the average rate of disappointed returnees to France from 1990-2014 was 10 percent but that the number has dropped since.

BY BERNARD EDINGER, JPOST

MICHEL ALIMI says he was shopping at the Hyper Cacher kosher supermarket just a couple of hours beforean Islamist struck on January 9, 2015, shooting four Jews dead and holding 16 hostage before being killed by French police. Now, he, his wife and one of his daughters are moving to Israel.

The 62-year-old general practitioner says the attack, coming after other bloody instances of anti-Jewish violence by French Muslims, has sparked a wave of departures to Israel, including about 50 families from his own neighborhood of Saint-Mandé, on the edge of Paris.

But it’s not just the dangers of Paris life that have motivated hundreds of Jewish medical professionals to join thousands of other French Jews in moving to Israel. It’s also a slew of recent rule changes by Israeli authorities that will make the transition easier for people like him and daughter Aurelia, a 33-year-old pediatrician who specializes in pediatric oncology, who are preparing, or considering, aliya, according to Israeli officials in France and Israel.

France is recognized as having among the highest standards of medical care in the world, and there are thousands of Jewish doctors there, including many who have held prominent positions. André Lichwitz was Charles de Gaulle’s personal physician and Prof. Pierre Aboulker performed the French president’s prostate operation.

Dr. José Aboulker, a relative of Pierre, was a World War II hero who infiltrated Nazioccupied France as a secret agent and later headed the emergency medical unit that followed de Gaulle when he was targeted for assassination.

President François Mitterrand was twice operated on for prostate cancer by Prof. Ady Steg, and Dr. Bernard Kouchner was a founder of the international medical rescue group “Médecins sans Frontières” (Doctors without Borders) before becoming foreign minister.

Yet, immigration by French-trained medical professionals to Israel has long been problematic because of difficulties in getting their credentials recognized. Many French Jewish doctors have long alleged that the hurdles were placed by organizations of Israeli doctors to discourage competition.

Israeli officials say this is no longer a problem.

Ariel Kandel, former head of the Jewish Agency in France, is now director general of Qualita, a Jerusalem-based group aimed at smoothing the arrival in Israel for French Jews.

“There are, today, tens of thousands of Jews in France who are seriously thinking of moving to Israel,” he tells The Jerusalem Report. “We estimate that among them are hundreds of members of the medical professions. The figure does not include young people currently in medical school, but hundreds of young Jews each year begin medical studies in France.”

One problem for those wanting to settle in Israel has been that France doesn’t award an MD at the end of medical school (six years), but only after a further residency, or internship period, of three to five years. Most countries accept a French doctor as long as he or she has completed medical school, but Israel makes them wait until they receive the French MD degree, meaning they cannot practice medicine in the Jewish state until they are in their 30s.

The rules changed this summer when Israel finally recognized that a French diploma delivered after six years of medical school was equivalent to an MD elsewhere and that those French physicians who had completed at least one year of residency could continue that course in Israel where they would be practicing in hospitals. French medical school graduates who have not started their residency in France would spend an extra year of training in Israel and pass an examination before starting their residency there.

The rule change resulted from a campaign in France and Israel led by 26-year-old Raphaël Derman, currently an anesthetist in his first year of internship in France and now scheduled, following the rule change, to continue at Rambam Medical Center in Haifa, beginning in October or November.

Derman’s mother’s family hailed from Morocco where his grandfather was a doctor. His father’s family came to France from Poland before the Second World War.

“France is fine, but Israel is where I want to live. I want to come back to my own land,” Derman tells The Report. He says the rule changes will allow younger people to come to Israel now rather than putting off aliya to when they are already possibly committed professionally in France or have met a partner there who is less interested in settling in Israel.

With the backing of Israeli parliamentarians from different parties, Derman lobbied the Knesset, drew up petitions and rallied the support of Jewish doctors in France. He threatened to go to Israel’s High Court over the legality of regulations affecting French medical school graduates.

Under the new regulations, French medical graduates who complete their residency in Israel will have Israeli diplomas in their specialization but not Israeli MD degrees, since their medical school years were in France. However, medical school graduates who studied at least two of their six years in Israel will receive the Israeli degree.

French Jewish dentists and pharmacists also had complained of being subjected to unnecessary examinations and claimed these were meant to limit competition. New rules say a dentist with five years of professional experience may practice in Israel without passing such examinations, while pharmacists with three years of experience also soon will be exempt from examinations, though all have to pass an initial adaptation period under supervision, like doctors.

Unless it gets a boost from immigrants, such as the French, the Jewish state faces a serious shortfall in medical personnel over the next six or seven years, as a generation of physicians who arrived from the then-Soviet Union in the 1980s reaches retirement age. Israeli hospitals and clinics, therefore, are sending recruiters to France to fill the openings, such as for 250 doctors and hundreds of other personnel for the brand new Assuta Hospital in the port city of Ashdod, whose population includes many French-speaking North African Jews, as well as more recent immigrants from France.

OFFICIAL ISRAELI figures show that 1,166 French medical professionals have made aliya since 2012. Among them are 340 doctors, as well as dentists, pharmacists, optometrists and other medical and paramedical specialists. The only countries from which more medical professionals arrived during the same period were Russia with 1,776 and strife-torn Ukraine with 1,186. By comparison, the United States, which has the Diaspora’s largest community, contributed 668 medical professionals.

Alimi, who plans to move to Israel within the next few months, is exceptionally motivated; he has served for several years as a volunteer with the international reserve unit of Magen David Adom, Israel’s equivalent to the Red Cross; he comes to Israel periodically at his own expense for training periods during which he works 12-hour shifts with mobile rescue units; and he volunteered to serve with an MDA ambulance unit in 2014, when the latest major round of hostilities broke out with the Gaza Strip.

The Ashkelon-Sderot-Netivot area in which he served was the target of many rocket attacks from Gaza. His 25-year-old son, Elias, who already has immigrated, is now a combat soldier in an anti-terrorism unit of the Nahal Brigade in the West Bank.

“Those immigrants, like my son, who arrive after their 23rd birthday are exempt from army service. But he wanted to serve and virtually had to fight to be accepted into the army. Elias is a certified accountant by trade but he wants to retrain after his army service to be an officer in the Israel Police,” Alimi tells The Report.

Like many well-to-do French Jews, Alimi already owns a holiday apartment in a trendy area of north Tel Aviv. “At 62, I’m close to retirement age but I want to continue working when in Israel because I want to fully integrate into Israeli society and there’s no better way to do that than being a doctor in contact with the public,” he says.

However, the red tape facing someone wanting to practice medicine in Israel is formidable, especially for older doctors like him.

“I needed to present documents from hospitals where I worked decades ago at a time when there were no computer records. That meant weeks and weeks of going through paper archives in the basements of those hospitals,” he says.

Before practicing in Israel, Alimi will attend a five-month Hebrew language course there, followed by a three-month course in Hebrew medical parlance. His daughter, Aurelia, is already attending abbreviated courses in practical and medical Hebrew in France this summer for which 70 people are signed up.

Once his Hebrew is up to par, Alimi and others will be able to practice, but initially only under the supervision of Israeli colleagues, for an “adaptation period” of three months to a year depending on their medical specialty.

“It’s an observation period,” he explains. “I understand that the Israeli colleague recognizes quite rapidly that he’s working with someone competent and reports this to the authorities who will give the final certification. But the observation period has to be completed within the assigned time during which one receives no more than 3,500 shekels a month. That’s about 800 euros or dollars. Add time spent learning Hebrew and “you’re easily talking about at least a year without a real salary, which can be a problem,” says Alimi.

“I accept that the observation period is justified because one is working in a different country and a different language, but it’s a bit like being the pupil of someone who often has far less professional experience than you have,” he explains.

On the other hand, Alimi says, finding employment afterward is not a problem and he has already been in contact with two of the four major Israeli health care funds that insure all Israeli citizens.

“French professional experience is a plus for them [the funds] because our personal way of relating to patients makes the patients often want to stay with the same doctor,” Alimi says. “The health funds, after all, want as many clients as possible. Over the past decade or two, possibly 50,000 French Jews moved to Israel. Those whose Hebrew is not perfect are looking for doctors in their neighborhoods who can speak their language.”

Aurelia confirms that Israeli health insurance groups badly need pediatricians like her, but says she would rather work in a hospital in her own specialty, though there are far fewer jobs in that specialty in Israel than in France. “So, I may start in Israel as a general pediatrician and move back to hospital work later because it is intellectually more challenging.”

THE JEWISH Agency, which is organizing the Alimis’ move, in the past has been accused of painting too rosy a picture of the Jewish state, but both father and daughter have high praise for the organization.

“The Jewish Agency is now far more competent and honest than in the past with the information it provides for potential olim,” says Alimi. “In its Paris office, there is a young woman, Sarah Ganon, who does a great job informing people in scientific professions, including the medical fields. When she doesn’t know something, she gets back to Israel and gives us the real lowdown. When you can see a situation clearly, you avoid disappointments.

“As far as I know, and can see from my former neighbors who have already moved to Israel, there are far fewer people coming back disappointed to France than in the past.”

France is home to some half a million Jews; some 8,000 immigrated to Israel in 2015, the most from any country for the second year running, though the figure fell to around 5,000 in 2016, possibly because French Jews felt more secure after authorities posted armed troops around Jewish schools and religious institutions. The number in 2017 is expected to be around 4,000, according to Jewish Agency estimates.

Agency officials say the average rate of disappointed returnees to France from 1990-2014 was 10 percent but that the number has dropped since.

Like the vast majority of Jews leaving France for Israel, the Alimi family’s origins are the same as the hundreds of thousands who fled Algeria, Morocco and Tunisia when those Arab states became independent in the 1950s and early 1960s.

“I was born in Paris, but my parents came from Constantine in Algeria. They were very poor and my father had no real profession when he came to France so he became a ticket puncher in the Métro [underground railway] and my mother was a stand-in child care assistant. Precisely because my dad didn’t get a real education, he treasured the opportunities my two brothers and I had to go to school. He pressed us to work hard and all three of us became doctors, including one surgeon. Perhaps, we all chose the same profession because he only had enough money to buy a single set of textbooks,” Alimi jokes ruefully.

The Jewish Agency’s Ganon, 32, was herself a French immigrant to Israel.

“Aliya represents a radical change in one’s life,” she tells The Report. “It’s not a problem when one is 18 but it is far more delicate when one already has a family and a comfortable life and one has to start all over again. The medical professionals coming from France to Israel are people who are making a very good living here, so it is not money that attracts them but the lifestyle in Israel. They want to give their children a different education.

“There is also a feeling of freedom for them in Israel ? if you want to be a religious Jew, then you can be one. If you don’t want to be, so be it. They are seeking the values and ideals of Israeli society.

“I’m not saying that everything is easy, especially language-wise. If you’re an adult and have difficulty expressing yourself in a new language, you feel ‘infantilized’ and vulnerable. You need to speak Hebrew well to integrate well into the country. But Israel today drastically needs doctors and virtually all doctors are sure to find employment and earn very decent salaries, and specialists can earn far more than average Israeli salaries,” she says.

Caroline Ohayon, 32, born in France of Moroccan parents, arrived in Israel from Paris two years ago. She works part-time as a family doctor in a health fund clinic in Jerusalem’s Katamon neighborhood, and part-time in the emergency room of the city’s Shaare Zedek Medical Center.

“You have to be motivated and know why you’re here because no one is going to roll out a red carpet for you,” she tells The Report in a telephone interview. “There are plenty of other doctors here who trained in the US and Russia, who are extremely competent, so you have to work hard to make your place in the sun. I didn’t come here for money or for glory, I came because I’m a Zionist and a practicing Jew and the idea of a return to Zion had long been in my head.”

She, too, however, has a story about Israel’s notorious red tape.

“After I first arrived here, I spent months asking for my certification papers to be able to start working because I was already a fully licensed doctor in France. Nothing happened.

Then, in November 2015, there were the Islamist terrorist attacks against the Bataclan concert hall in Paris and simultaneously against cafés and passersby [killing 130 people]. Israeli journalists wanted to interview a Hebrew-speaking French doctor who had worked with Paris emergency medical services. I fit the bill and was interviewed that evening by Israeli radio, television and newspapers. The next morning at 7:40 a.m., I received a text message from the Health Ministry saying: ‘Come. Your license to work is here waiting for you’ ? I’d been laying siege to their office for four months.”