pass the USMLE inhibit formal trauma training for
many surgeons. Essentially, many Israeli surgeons feel
that a trauma fellowship in the U.S. is arduous work
for the same pay.
To incentivize recruitment, one solution would be to
raise the salary of expert trauma surgeons. Drs. Klein
and Bahouth, however, described trauma care as one
of the least recognized divisions of medicine in Israel.
Only two Level I hospitals have dedicated trauma beds.
Expert trauma surgeons even provide specialty services
on the side because they are paid four to five times more
for private practice. More recognition, according to
Drs. Klein and Bahouth, would allow trauma care to
become more organized, raise salaries, and attract residents. A fellowship does exist in Israel, but the current
program does not expose fellows to enough penetrating and operative cases.
Dr. Klein believes that adding a three-month operative experience in the U.S. would correct this gap.
This proposal, however, lacks funding. The health care
system in Israel provides a low volume of trauma services on an everyday basis, which hinders obtaining
additional financial support. In fact, some directors
have stated that too many centers have the potential
to take trauma cases, which dilutes staff opportunities
to train with significant numbers of cases.
Tel Aviv has a population of 3 million, yet has three
Level I trauma centers. A potential solution to the lack
of expert trauma surgeons would be to concentrate the
trauma surgeons into two centers in Tel Aviv rather
than three to further consolidate severe trauma patients
and increase direct resources, including staff. Forcing
a Level I unit to step down, however, is a controversial
proposition. Nonetheless, concentration of expertise
would not solve the problem of developing a new generation of expert trauma surgeons.
While Israel’s newly established trauma system
significantly reduced inhospital patient mortality by
33 percent between 2000 and 2010, steps need to be
taken to ensure that the system remains fully opera-
tional. 1 Because the Israeli medical system is a hub for
Western medicine in the Middle East, to deny optimal
functioning of a trauma care system would be the
equivalent of denying the best treatment possible for
emergency cases to both Israelis and Palestinians.
With the recent escalation of terrorist attacks and
rising tensions in Gulf states, a need for a trauma
care system is critical for Israel and its neighbors. As
relations with surrounding territories and countries
hopefully improve, a well-established Israeli trauma
system can further foster cooperation and sustained
peace through collaborative training programs. Dr.
Schrier’s training in the UM Ryder Trauma Center
is a step in the right direction, but a national push to
maintain the efficacy of Israel’s daily trauma system
needs to be ensured.
A call for action
The authors are sharing these experiences as an example of the opportunity that academic programs have
to help develop trauma systems globally. We believe
our partnership with Israeli trauma centers can serve
as a model for other academic institutions that are
interested in helping other countries to develop sustainable trauma care systems. It is interesting to note
that the UM tented hospital worked collaboratively
the first days of the Haitian earthquake with the Israeli
military rescue team. One of the graduated Israeli UM
fellows, Guy Lin, MD, was in the Israeli military team
that participated in the relief effort.
Based on UM Ryder Trauma Center’s more than
20 years of experience in offering a successful international trauma training program, the authors offer
the following suggestions to academic medical centers interested in establishing a similar opportunity
for trainees from other countries:
•Establish a sustainable funding source, either through
salary support from the U.S. hospital or through the
ministry of health for the country sending the trainee.
•Locate a champion at your institution who has a passionate interest in promoting better access to and quality
To assess the present trauma care system in Israel and
determine the ongoing need for the training program, in
2015 the members of the UM Ryder Trauma Center team
interviewed the directors at the six Level I trauma centers in
the country. All of the directors indicated that the greatest need
was for more surgeons formally trained in trauma care.