In a unanimous decision delivered on November 14, 2017, the National Labor Court in Israel rejected the claim of DMD residents to be recognized as employees of the hospital in which they were residents and to receive pay similar to MD residents. The claim was submitted against Hadassah Medical Organization (“HMO”), represented by Adv. Shoshana Gavish, head of the employment practice at S. Horowitz & Co.
Apart from HMO, there are only a few institutions in Israel that offer a residency in dentistry (for example, Tel-Aviv University and Rambam Hospitals).
The residency in dentistry is highly expensive and requires vast investments in equipment and teaching time. Residents in dentistry, apart from maxillofacial residents, pay fees in large sums of tens of thousands of NIS per year, depending on the field of residency.
At the end of the residency, the residents receive a certificate of specialty.
Each field of residency has a separate detailed program that can take from 3.5 to 5 years, depending on the field. The residency is based upon hands-on dental treatment and includes rotations in hospital departments, such as internal medicine, radiology, and pathology.
Despite the claimants’ attempt to draw similarities between DMD residency and MD residency, the National Labor Court ruled that there was no comparing the two; DMD residency is education by way of practical training that and its correct classification is post graduate studies and not employment. The National Labor Court was also persuaded that the purpose of the transaction, on both the side of the residents and HMO, was for the residents to receive training and not to be engaged as employees.
Had the claim been accepted, the result may have been to shut down the residency program in HMO, due to lack of resources to finance it. Contrary to the MD residencies, which are financed by the State of Israel, the DMD residency (apart from maxillofacial residency, which takes place within a hospital department) receives no public financing, and the institutions that offer the residency programs have to bear the costs. These costs are extensive, and the fees paid are not sufficient to cover them.
The lack of public funding and high residency fees have resulted in a shortage of specialists in dentistry; compared to medicine, in which the majority of graduates become specialists, only approximately 10% of the graduates of dentistry school become specialists. Needless to say this has an adverse effect on the level of the profession.
The problem is well known and has been publicly debated, yet no public finance has been forthcoming.
The National Labor Court did not ignore the existing problem of a shortage of specialists in dentistry. However, the court was persuaded that the problem is a public problem and one that must be solved by the State; it cannot be solved by defining the relationship of the residents with the institutions providing the residency as an employment relationship, thereby burdening the institutions with additional costs.
Now that the Labor Court has clarified that the solution will not come from super-imposing an employment relationship on the educational institutions vis-à-vis the post-graduate residents, there is hope that the State will work more quickly towards finding a solution.