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Biomedical subjects

J T Shuval

Publications and source records attributed to J T Shuval.

At least 19 recordsLinked to original sources
PubMed2000

The reconstruction of professional identity among immigrant physicians in three societies.

The paper concerns the processes by which migrant physicians seek to re-establish themselves professionally in a new society. The empirical findings are drawn from a study of physicians who emigrated from the former Soviet Union in the early nineties to three different destinations: Canada, Israel, and the United States. The existential quality of the migration experience was explored by means of a set of life-history narratives related by immigrant physicians. Despite major structural differences among the three hosts, there are several important similarities in the processes observed in the three settings. The first concerns the high salience of the professional role for immigrant physicians and their determined efforts to regain their lossed status. These efforts are constrained by structural elements characterizing the three hosts. The second relates to the mediating effects of gender and age in the reconstruction of professional identity: female immigrant physicians are relatively disadvantaged as are older persons in the occupational sphere. Immigrant physicians who decide not to pursue medical licensure often redefine their occupational identity in areas that are close to the health field. Differences noted among the three groups are a function of structural differences among the three host societies.

Journal Article↗
PubMed1998

The occupational integration of former Soviet physicians in Israel.

This paper reports the findings of a five-year, three-stage study of the occupational status persistence of 333 physicians who immigrated to Israel from the former Soviet Union in 1990. The first data collection, by way of a structured questionnaire in Russian, was undertaken in 1991, during their participation in preparatory courses for the medical licensure examination. The second and third stages of data collection were undertaken by mail in 1993 and 1995. Data are presented regarding the influence of gender and age on employment status and on the relationship between employment status and psycho-social well-being, including work and general satisfaction, self-esteem, mood, health and overall adaptation, at both stages. The dynamics of occupational integration are investigated by looking at the effects of occupational stability vs occupational change between stage 2 and stage 3 on the psycho social outcome variables. After three years in Israel, men were more likely to be working as physicians than women, and women were more likely to be unemployed. However, after five years, women were equally likely to have found work in their profession, albeit in lower status positions. Younger respondents were more successful than older respondents in passing the licensure examination, finding work in their profession, and entering residency programs. The gap between them did not close between stage 2 and stage 3. At both stage 2 and stage 3, those working as physicians had significantly more positive well-being scores than those not working as physicians. All occupational groups had more positive scores at stage 3 than at stage 2, except for those who were working in non-medically related jobs. The greatest improvement in psycho-social well-being was among those who became physicians between stage 2 and stage 3, compared to those who were not physicians at either stage and those who were physicians at both stages.

Adult↗
PubMed1998

Credentialling immigrant physicians in Israel.

Credentialling of immigrant physicians is discussed in the context of two sets of high-priority values which have remained constant in Israel since its founding: (a) an open, non-selective migration policy which has resulted in the entry of thousands of immigrant physicians, (b) the high priority accorded to quality health care. These values and their social implications are discussed in terms of the licensing procedures before 1988 and after that date when more stringent procedures were initiated. These processes are discussed with special reference to the large number of immigrant physicians that have come to Israel from the former Soviet Union since 1989.

Credentialing↗
PubMed1997

Nonconventional medicine in Israel: consultation patterns of the Israeli population and attitudes of primary care physicians.

This paper reports the findings of a study of nonconventional medicine in Israel. Data regarding patterns and correlates of consultations with alternative medicine practitioners were obtained from structured face-to-face interviews with a representative sample of 2030 Jewish adults aged 45 to 75. In addition, in-depth open-ended interviews were conducted with a convenience sample of 20 primary care physicians in order to explore their beliefs, attitudes and behaviors regarding nonconventional medicine. Six percent of the respondents interviewed in the population study visited an alternative practitioner in the year prior to the interview. For most of them, the consultation was a consequence of disappointment with the lack of success of conventional medical treatment. Most felt that the alternative medicine treatment had helped. Nearly 40% were seeing their regular primary care physician at the same time as they were seeing an alternative medical practitioner. Women were more likely than mean to consult an alternative medicine practitioner; consulters rated their health status more negatively than non-consulters. Consulters had a higher level of education than non-consulters, but the two groups did not differ in terms of age or economic status. Nearly all of the physicians stated that they refer patients to alternative practitioners; in most cases, the referrals are in response to patients' requests. Although skeptical of the scientific basis of alternative medicine therapies, most of the physicians believed that some therapies, even if only because of the "placebo effect", were effective in some cases. Almost all felt that the Ministry of Health, which today does not recognize any form of alternative medicine, should establish control over the training and practice of alternative medical practitioners. The findings from both parts of the study suggest that patients and primary care physicians in Israel do not view nonconventional medicine as a threat to conventional medicine, but rather as complementary to it.

Aged↗
PubMed1996

[Consultations with practitioners of alternative medicine].

More than 2,000 Jewish adults, aged 45-75, in urban areas of Israel were interviewed regarding consultations with practitioners of alternative medicine. 6% (122) of the respondents reported visiting such practitioners in the year prior to the interview. Homeopathy was the most frequent therapy, followed by reflexology, naturopathy, and acupuncture. The most common medical complaint was pain, particularly back pain. The most frequent reason for consulting the practitioner was disappointment with the outcome of conventional treatment. 39% of respondents who visited a practitioner were being treated by a conventional physician at the same time, for the same problem. The medical problems of a large majority had been relieved, but 22% said they were not helped by the practitioner. Women were more likely than men to consult a practitioner. Respondents with secondary or higher education were more likely to visit than those with less education. There were no age or socio-economic differences between users and nonusers. The mean payment for the whole series of treatments was NIS 770 (about $250). Respondents who visited practitioners reported worse health and more pain than nonusers, and were also more likely to have visited their conventional primary care physician in the past month. The findings suggest that nonconventional medicine should be seen as complementary to, rather than in competition with conventional medicine.

Acupuncture Therapy↗
PubMed1996

The dynamics of professional commitment: immigrant physicians from the former Soviet Union in Israel.

The paper examines professional commitment among physicians who immigrated to Israel form the former Soviet Union during the early 1990s. This population faces severe limits regarding occupational continuity because of the highly saturated market in which non-negligible groups will, in the long run, of necessity undergo occupational change. The theoretical background for the analysis is drawn from the literature regarding recent changes in professional roles with particular reference to the shifting meaning of work in post-modern societies and its consequences for occupational commitment. The professional context of medical practice in the former Soviet Union and the social and economic constraints of Israeli society in the 1990s set the scene for the analysis. Several dimensions of professional commitment are examined empirically, on the assumption that there are a variety of ways to consider the notion of commitment and that no one measure tells a complete story. Prolonged processes of deprofessionalization of medicine in the Soviet Union, suggest that medicine for most immigrant physicians is not so much a 'calling' to which they are devoted; rather it is a necessary means to gain a livelihood, the only occupation for which they have been trained for many years after stringent selection to medical school and the only job in which they have worked consistently since completing their formal training. Two and a half years after arrival in Israel the immigrant doctors are characterized by a short-range time perspective which makes them unwilling to accept the constraints of the saturated market; intense efforts are made by most to obtain a license despite the fact that only a fraction of them will be able to work in their profession on a regular basis. Despite this over-riding reality, many hope that they will be among the selected few who will be able to obtain a medical post.

Acculturation↗
PubMed1994

Emigrant physicians evaluate the health care system of the former Soviet Union.

This study is a retrospective evaluation of the Soviet health care system by 1,100 Jewish physicians who immigrated to Israel in 1990, but were professionally active in the former Soviet Union before and during the Gorbachev era. Medical education and the process of specialization; gender differences within the medical profession; sources of work satisfaction and dissatisfaction; self-evaluations of professional behavior; and assessments of patient behavior are included in this empirical study. Although high levels of dissatisfaction were found regarding instrumental aspects of work, the physicians reported high levels of satisfaction with their relationships with colleagues and patients. The recent emigrants assessed their own role behavior and that of their patients more critically than did physicians who left the Soviet Union in 1972, and who answered identical questions in 1975. Among the recent emigrants, men, older physicians, and those with higher status within the profession tended to be more satisfied with their work and less critical about their own and their patients' behavior than their female, younger and lower status colleagues. The subjective perceptions of former "insiders," which complement the reports that have appeared in recent years in the medical literature, are discussed in terms of the impact of glasnost and perestroika on reporting behavior and on the real deterioration that occurred in the health care system of the former Soviet Union.

Aged↗
PubMed1991

Lay self-care in health: the views and perspectives of Israeli laypeople.

A random sample of 407 Israel laypeople was interviewed about several dimensions of their attitudes toward lay self-care in health. The dimensions studied were perceptions of laypeople's motives in undertaking self-care, views regarding the division of responsibility for individual health between laypeople and professionals, and opinions regarding the effects of lay autonomy and initiatives in health care and seven specific self-care behaviors. These attitudes were analyzed in relation to sociodemographic and health-related variables. The findings suggest that Israeli laypeople take a medically-dependent view of health care, and indicate that self-care in health is not a particularly salient or widely advocated behavior. This research complements previous studies on Israeli physicians and allied health professionals' attitudes towards self-care.

Adult↗
PubMed1990

Patient initiatives and physician-challenging behaviors: the views of Israeli health professionals.

The views of Israeli physicians, nurses, physiotherapists, occupational therapists, and medical social workers were compared regarding patient behaviors which express autonomy and initiative in the doctor-patient interaction. The data show that these professionals do not view such behaviors positively. Gender is relevant to the physicians' views, with male physicians, particularly the specialists, having the least negative views, and female residents and general practitioners the most negative. Allied health professionals express less negative views than the physicians, and attribute to the physicians more negative views than those actually expressed by the physicians. There is overall agreement among the different professional groups about the relative acceptability of these behaviors. Those which threaten the physician's dominance in the process of diagnosis and prescription of treatment are rejected outright, while others are tolerated but not accepted. The findings are interpreted in the light of the status-related motives of Israeli health professionals.

Allied Health Personnel↗
PubMed1990

Health in Israel: patterns of equality and inequality.

While Israel does not have a nationalized health care system, 94.5% of its population is covered by comprehensive health insurance which includes curative and preventive ambulatory care as well as hospitalization. There is formal equality in access, distribution, and quality of the health services; nevertheless, there are pockets of deprivation that affect certain segments of the population. The paper focuses on three topics: (a) structure of the health care delivery system in terms of coverage, geographical and social distribution, and the public/private balance of the services; (b) processes of health care delivery in terms of utilization and quality; (c) health outcomes in terms of mortality, morbidity, health behavior, and disease vulnerability. Inequality in Israel appears to be structured in terms of six dimensions: coverage of health insurance, distribution of health services, the balance of public and private sectors of health services, utilization of existing services, quality of health services, and health outcomes as expressed by mortality, morbidity, health behavior and risk factors. Only two types of health care are not covered by the general health insurance: (a) dental care, and (b) long-term nursing care. Given the small area of Israel there are striking differences in the geographic distribution of health personnel of various types. There is evidence for gaps between needs and institutional services for many elderly who are on waiting lists for institutionalization. The ratio of primary care physicians to population is 1:2326 in development towns and 1:1852 in the older more established veteran communities. Kibbutzim, which are also located in large part in geographically remote areas, enjoy high quality health services and are not characterized by low ratios of health care personnel. In 1968-69, 6% of those insured by the sick funds purchased services at least once from a private physician, while in 1975-76 this figure rose to 32%. As in other countries, utilization of preventive services is generally correlated with socio-economic status and with education. While the network of primary care facilities in Israel is widespread and generally accessible, it is poorly integrated with the hospital system. Longevity has increased over the past years and is relatively high; 76.6 for women and 73.1 for men in 1984. Nevertheless, differences between Jews and non-Jews may still be seen among both men and women. The same may be said concerning mortality and especially with regard to infant mortality. Differences with regard to certain risk factors among Jewish infants and adults are correlated with socio-economic class and country of origin.

Cross-Cultural Comparison↗
PubMed1989

Self-care in Israel: physicians' views and perspectives.

This paper examines physicians' perceptions about potential effects of lay self-care. The research was designed to explore these perceptions regarding three types of effects with particular reference to their general distribution and their inter-relationships. The findings showed that physicians distinguished clearly among the effects of self-care but that their opinions differ considerably regarding the effects on utilization, costs and hospitalization rates. The implications of these findings are discussed.

Attitude of Health Personnel↗
PubMed1982

Professional socialization in dentistry. A longitudinal analysis of attitude changes among dental students towards the dental profession.

In a longitudinal study conducted as part of a broad project dealing with socialization of health professionals in Israel, it was observed that during the course of professional socialization several major transformations occur in the dental student's image of the 'competent' dentist and in his self-image as a professional. Although students initially emphasized people-oriented traits as important to the competent dentist, this emphasis gradually decreased as their professional socialization advanced, concomitant with an increase in importance placed on status-oriented traits. The people-oriented elements likewise decreased in importance with regard to the student's self-image as professionals as they became more accustomed to professional reality. The correlation between these variables indicates the changes occurring in the students' acceptance or rejection of various aspects of their chosen profession throughout their years of study.

Attitude of Health Personnel↗