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Introduction: The change in the world of medicine and in the future generation of doctors, also requires the world of medical education and training to change, so that we do not find ourselves extinct like the dinosaurs. As Charles Darwin famously once said, "It is not the strongest of the species that survive, nor the most intelligent, but the one most adaptable to change".

Introduction: Seasonal influenza is a significant disease affecting public health due to substantial morbidity and mortality and a high economic burden. in view of its high propensity for genetic mutations, the virus can easily evade preexisting immunity acquired from prior exposure to it, thereby causing severe seasonal epidemics. Influenza vaccination has been shown to be safe and effective. In many countries, including Israel, it is recommended to all members of the population aged 6 months and older, especially those with a higher risk of developing severe complications. Its adverse effects are mostly minimal, local and systemic. No evidence-based relationship between the vaccination and neurological syndromes was found. Infected health care workers (HCWs) may transmit influenza to patients, many of whom have serious underlying conditions that increase their risk of complications. Therefore, influenza vaccination among HCWs is recommended in the United States and in >40 other countries including Israel. In spite of that, the vaccination coverage rates remain low in Israel and in many countries. The reasons include low levels of awareness to the disease severity, to the safety and effectiveness of the vaccine and low levels of trust in authorities. The effectiveness and safety of the vaccine in preventing influenza among the recipients is well documented. High quality evidence on the effectiveness of the vaccine in preventing the disease among patients and family members of HCWs who receive the vaccine is limited. However, combining the existing evidence and the clear biological plausibility lead to the conclusion that the recommendation for vaccinating health care workers against influenza to protect patients is a well-based policy. This is the policy of the WHO, CDC and health authorities in most developed countries. The Ministry of Health in Israel will continue to promote programs to increase vaccine compliance rates among HCWs and to define the uptake of vaccination as a moral duty.

This article presents findings from professional and scientific articles written on the subject of direct access to physical therapy services. Direct access is sometimes referred to as "self-referral"--the patient does not require a physician's referral prior to receiving physiotherapy treatment. The article provides insight from the experience of countries where direct access is accepted practice, which will serve as a theoretical and scientific basis for the use of direct access in Israel. Findings include the influence of direct access on the health care system: cost-benefit analysis, advantages and challenges, as well as the perspective of main stakeholders: physicians, physical therapists and patient-clients. .

The practice of medicine has changed in the last decade. Physicians no longer work largely solo but are part of interdisciplinary medical teams, and patient cases are more complex, as they suffer from multiple diseases. Today, the physician must also deal with economic, legal and public opinion issues. All of these factors pose new challenges to physicians. Apart from the changing world, there is also a shortage of physicians in Israel, as the number of new immigrant physicians has decreased over the last decade. Other medical professions and infrastructures are also lacking, including nurses, acute care hospital beds, intensive care beds and more. This increases the burden on physicians who must face a rapid turnover of patients per bed, more than in any other OECD country. In our work, we have suggested some new approaches to the physician shortage, apart from increasing the number of positions in medical schools, including changing the residency program and canceling the internship. The residency program will be divided into two stages: Two years in general medicine surgery or pediatrics and the second part in subspecialties such as pediatric surgery, neurology, gastroenterology, cardiology and others. An option to continue residency in general medicine, pediatrics, or surgery will also be possible and must be encouraged. We believe that the Scientific Council of the Israeli Medical Association is the professional organization that must evaluate this proposition.

The management of medical organizations is based on a profound understanding of the essence of the organization, its vision and missions, as well as the methods the organization utilizes to gather and analyze information. In order to maintain a maximal function level in an ever-changing environment, all organization components must function in tandem. In a previous article the authors presented medical organizations as macro systems composed of micro systems, and discussed the challenges these organization face today. Basing optimal system management on micro medical systems allows the organizations to make maximum use of the advantages that professionalism encompasses, in a flexible micro-system environment. In this article, the authors attempt to present an interactive solution for performing assessments and management in the medical arena--the CHESS model. This solution was developed at the Sheba Medical Center. The CHESS Simulator (Clinical Health Economic and Satisfaction Simulator) was formulated to function as a clinical organizational intelligence system, whose function was to supply quantitative, analyzed data regarding activity on the clinical production floor. The system is unique in that it has a differential view of the complex medical procedures which are highly variable, and also has the capability to locate elements that are based in a common similarity. Data gathering will be based on an online system computerized medical file (EMR), which is a priority for a functioning system. This solution allows medical organization (macro-system] managers and the departments (micro system) directors to make informed decisions that will ensure that the organization's goals are achieved. This is defined as evolving from a reactive management pattern to a proactive management pattern that is mandatory in the competitive atmosphere of the 21st Century.

Background: During the Golden Age of Medicine (20th Century), scientific and technological breakthroughs enabled physicians to cure people's illnesses. The idealist, romantic approach of medical practice believed in the right of every human being to receive the best treatment possible, regardless of cost. However, the rise in health care expenditure at the end of the 20th Century made this impossible, therefore other approaches were adopted. The aim of this study is to investigate the causes of the change in medical approaches while distinguishing between the different methods practiced by nations in order to deal with the disparity created by ethical dilemmas caused by scare resources and delivery of medical treatment., Method: This study is based on the evaluation of macro economic data and the comparison of international health data. Special emphasis was given to the evaluation of Israeli health economics since the National Health Insurance Act (1995)., Results: The study shows two different approaches to the problem of scarce resources: the liberal approach, as practiced in the USA, and the Social Democratic approach which is common in many European countries, including Israel. The Social Democratic ideology believes in public financing of defined health care services to all citizens. This method implies rationing and managed care in order to absorb medical expenses., Discussion: The ethical dilemmas arising from the necessity to add economic considerations to a physician's care of his patient, demand that any given healthcare system find the right equilibrium. This balance between clinical, social, and economical considerations is not easily achieved. Only dialogue within the health care system itself, and with the public, can achieve the best possible balance.

Our conception of medicine in the 21st Century is different from the way it was conceived in the 20th Century, and parallel to that, and medical organizations have changed and become more complex. These changes demand transition in traditional thought patterns and perception of the medical system as a "Complex Adaptive System" (CAS). In this article, the authors describe medical organizations as macro systems comprised of micro systems. They present a model of a Complex Adaptive System that permits us to address the challenges that face medical systems in the 21st Century. Management actions can no longer be based on a linear thought pattern and solutions such as "Planning-Study-Action". Action must be innovative and based on the advantages latent in micro systems, as an effective way to realize the macro system mission. In hospitals, for example, a clinical department consisting of the physician and medical staff, certainly a focal point of clinical knowledge and skill, can advance the quality of medicine, and the service and performance of the entire organization. But this is with the stipulation that synchronization is maintained between the micro system and macro system, which ensured that the organization function will serve the goals and vision of the hospital, while still contending with the challenges and competitive environment of the 21st Century.

Today, medical organizations have to contend with a highly competitive environment, an atmosphere saturated with a multitude of innovative new technologies and ever-increasing costs. The ability of these organizations to survive and to develop and expand their services mandates adoption of management guidelines based on the world of finance/commerce, adapted to make them relevant to the world of medical service. In this article the authors chose to present a management administration assessment which is a process that ensures that the management will effectively administer the organization's resources, and meet the goals set by the organization. The system demands that hospital "centers of responsibility" be defined, a management information system be set up, activities be priced, budget be defined and the expenses assessed. These processes make it possible to formulate a budget and assess any possible deviation between the budget and the actual running costs. An assessment of deviations will reveal any possible deviation of the most significant factor--efficiency. Medical organization managers, with the cooperation of the directors of the "centers of responsibility", can assess subunit activities and gain an understanding of the significance of management decisions and thus improve the quality of management, and the medical organization. The goal of this management system is not only to Lower costs and to meet the financial goals that were set; it is a tool that ensures quality. Decreasing expenditure is important in this case, but is only secondary in importance and will be a result of reducing the costs incurred by services lacking in quality.