Understanding Israeli Healthcare Culture

 If you’ve spent any time in Israel, you’ll already have some sense of how the country runs. The culture here is unique: layers of different backgrounds, languages, and histories from all over the world merging into something vibrant, dynamic, and sometimes slightly baffling.

This is my take on how the charms of Israeli culture intersect with the healthcare system.

* Disclaimer - this does not cover all cultural differences and is based on my own unique experiences

People talk differently here

Israelis communicate very directly. This is a country built by army veterans and immigrants, and you won’t encounter much bubble-wrap, cotton-wool, or “snowflake” culture. People have thick skin, and the attitude is tough and that shows up clearly in working life.

If a colleague isn’t happy with something you’ve done or they disagree with a management plan, they’ll tell you. Staff are comfortable raising their voices and having “heated discussions” about all manner of things. If you’re not used to it, this can feel aggressive or uncomfortable. But Israelis are far less fazed by it, and disagreements are usually water under the bridge very quickly.

Words of encouragement and compliments also aren’t handed out freely. You often have to work hard to be told you’ve done a good job. But when you do get positive feedback, it’s incredibly meaningful and you know it’s genuine. Israelis just aren’t good at being fake. They’re honest, direct, and you usually know exactly where you stand.

At first, adjusting to this more blunt style of communication can be really hard. Over time, though, you learn that very little is meant personally. People simply have a lot of steam to let off, and this is how they know to express themselves and communicate. You’ll also find yourself adapting, learning to express your needs clearly, give honest feedback, and push back when necessary.

That said, olim can find it difficult to adjust to such direct and sometimes unpleasant communication. Being on the receiving end of this can be challenging.

Army service matters

Army service plays a central role in Israeli society. Different types of service often signal important things about a person’s background, leadership experience, and responsibilities, and can provide significant “credit” later in life and in career progression.

Practically speaking, doctors in Israel tend to train later. After army service, often a couple attempts at getting into medical school, and then completing training, doctors will often start internship and residency in their late twenties and thirties. Many are already in long-term relationships, and a significant number have children.

This was a striking contrast for me compared to my cohort in the UK, which was largely made up of young, single, party-minded students who entered medical school straight after high school. In Israel, the interns and residents I worked alongside often had senior army experience and were balancing intense hospital work with demanding home lives.

I’ll never forget one intern (a married father of two), whilst working through the blood work, casually sharing that the day before (whilst on army reserve duty in the air force) he had piloted a rescue helicopter to Gaza following a major incident with multiple fatalities. A real hero, quietly back on the wards the next day. Definitely, not the interns you're used to!

Certain elite army units are particularly well regarded and can help with future career progression, including:

• Sayeret Matkal (strategic reconnaissance and counter-terrorism)

• Unit 8200 (cyber, intelligence, data, and advanced technology)

• Shayetet 13 (naval special operations and counter-terrorism)

• Shaldag (air force elite unit focused on deep operations and targeting)

Army service is deeply woven into Israeli culture and shapes societal dynamics. Recognizing the sacrifice, strength of character, and skills behind each person’s service deepens both understanding and respect for your colleagues.

It's all about who you know

In Israel, everyone is family. And in families, we try to help each other out. This cultural quirk is underpinned by a strong sense of brotherhood and a culture of having each other’s backs. If your clinic secretary’s neighbour’s son needs an urgent appointment, she'll make sure he gets one. Connections matter, and they play a significant role in helping people get where they need to go. Whether this feels right or wrong, good or bad, it’s important to understand that this is simply how the system works.

In a young country with an even younger healthcare system, formal structures are not always in place, or the ones in place are not efficient or accessible enough. If you’re looking for a residency position or a job opportunity, you may quickly realize there’s no official application portal, no clear timeline, and no accessible details for the application process. On your own you'll struggle to make heads or tails of where to start and so you'll need to rely on contacts to guide you. Hopefully you'll get hold of the WhatsApp number or email of someone who works within the organization you're trying to enter, and they will help you out.

Who you know really does matter, and you’ll see this play out across the healthcare system for both doctors and patients. While it can be frustrating and unfair that this approach can lead to less equal opportunity, and that transparency and accessibility are sometimes lacking, it’s important to recognize that this way of working cuts both ways. You’ll benefit from contacts in hospitals and kupot when you're job searching and whenever you need medical attention for family members, someone will have your back.

Whilst it does sometimes feel a bit backwards, the systems are constantly developing and improving. Understanding how it works helps you set realistic expectations and navigate it more effectively.

Don't take no for an answer

You only have to look at the establishment of the State to understand that Israelis know how to turn the impossible into the possible. Strong characters and strong wills have shaped this country, and to get where you want to be, you often need to develop and apply those same strengths.

When you find yourself up against a wall, it doesn’t necessarily mean you should give up. More often, it means you need to apply pressure and try again. If you don’t build the muscle to stand up for yourself, push back, and use a bit of Jewish chutzpah, you risk becoming a pushover and not advancing as you'd like.

Very often, there are ways to make things happen and to work around obstacles, you just need to show how serious you are and apply the right amount of pressure to the right people. If paperwork is moving painfully slowly, if no one at the hospital is responding to your emails, or if you’ve been waiting weeks to hear back about a residency position, don’t just wait politely. Be proactive. Identify the right people, follow up, and push.

As one ADII member recently put it: “The speed of processing is directly related to how much pressure your department head is willing to exert to make it happen.”

In a country with so much noise and energy, you sometimes need to be louder to get things done. That doesn’t mean being rude or aggressive, but rather being determined, confident, and persistent.

This will not always come naturally, and it won't always be easy, but this is the way to get things done in this country.

Things are more informal

For a country that can feel intense in temperament, politics, and pace, the healthcare system is surprisingly relaxed.

Doctors and staff will often dress informally. I got used to seeing sandals on the wards, Crocs in clinics, and jeans and T shirts everywhere. Staff have no problem letting their hair down (literally) and dressing for comfort. There are, of course, occasions that call for smarter dress, such as conferences or formal events, so don't bin all your suits just yet. Doctors in the private sector also tend to dress more formally. But overall, the dress code is loose and rarely enforced. What matters most is that you feel comfortable and come as yourself.

Relationships between patients and practitioners are also more informal. Patients often feel comfortable calling doctors by their first names, asking personal questions, knocking on the door, or even walking into the room during another patient’s appointment (I know!). Doctors frequently mirror this informality, handing out their personal phone numbers to patients, answering calls mid consultation, and communicating in a relaxed, familiar manner.

As mentioned earlier, we are all family here, and there is little room for airs and graces.

That said, boundaries can sometimes be crossed, and this can make providing optimal care more challenging. At times, it is important to set and maintain clear boundaries to ensure you have the professional space needed to practice effectively.

L'chaim!

The Israeli calendar revolves around the Jewish chaggim (festivals), and this is one of the very special aspects of working in Israel. You live in sync with the Jewish year, and the workplace reflects this. From secular to religious, everyone marks the holidays in their own way. It is deeply woven into the culture and cherished across society.

In clinics and wards, it is common to “raise a toast” before the chaggim, particularly ahead of Rosh Hashanah, Chanukah, and Pesach. Staff usually gather to share a few words, offer brachot (blessings), and say l’chaim over a small glass of wine and some pot-luck dishes. It's always moving.

Purim is an especially joyful time in hospitals. Visitors move from room to room handing out gifts and food packages, singing and blaring music through the corridors. Hospitals buzz with energy as strangers come and go, trying to lift spirits with guitars and dancing.

Hospitals also offer a real window into Israeli culture. Visiting hours are not a thing. Patients are allowed visitors around the clock. Family members sleep overnight in chairs beside beds. Large extended families come and go, bringing containers filled with home cooked food. Elderly patients shower blessings of health and sustenance on those caring for them, and genuine relationships form between patients and providers.

Practicing medicine in Israel is a real privilege and a blessing.

When you are one big blended family, ups and downs are inevitable. Tensions exist between brotherly dynamics and professionalism, structured regulation and energetic (read chaotic) progress, and comfort and professionalism. Finding the balance is an ongoing process.

Living and working here gives you the opportunity to help shape the system from within, contributing significantly to its unique blend of chaos and efficiency.