The good, the different, and why I’d do it all over again

My name is Nachum, and I made Aliyah in the summer of 2025 after practicing Urology in the New York City area for more than 40 years. This move was the culmination of a lifelong dream, and being able to use my skills as a healer in our homeland has added a new layer of meaning to my work.

Changing hospitals is always complex. Every institution has its own jargon, workflows, and culture. Transitioning to an entirely different medical system, however, comes with a unique set of challenges.

In the spirit of paying it forward, I wanted to share a few reflections for physicians considering Aliyah. I am also happy to connect personally if I can be helpful to others navigating this journey.

1. General Workflow

Having practiced in the same hospital system for more than 20 years — and in an American environment with a shortage of specialists — I had grown accustomed to not needing to actively build a patient base.

Moving to a new country means starting over professionally. You must establish yourself within both formal and informal referral networks, something I had not done since finishing medical school in the 1970s.

Many olim naturally seek physicians who were trained in their home country and speak their native language, which can create a built-in patient cohort. Even so, it is important to understand how your new hospital or medical group allocates patients. Although there are generally more patients than practitioners, patients were already receiving care before your arrival, and integrating thoughtfully into an existing system matters.

2. “The System”

Restarting your career in a new healthcare system means beginning without a local track record. There may be legal, administrative, or practical limitations on the types of cases you can initially take or procedures you can perform while you establish local experience and trust.

Over time, this changes. In retrospect, I have come to appreciate the slower start, which gave me time to learn the system before diving back into 60–70 hour workweeks.

Retirement Age

The Israeli public medical system is generally structured around mandatory retirement at approximately age 67.5. For most public-sector positions, including many hospital and Kupah-based roles, this can function as a hard stop.

You can still work privately — through private hospitals or independent practice — but physicians should understand that many employee-protective labor laws are not designed for people working beyond the formal retirement age.

Private Practice

If you choose to see patients privately, you are not simply practicing medicine — you are also running a business.

This means obtaining self-employed status in Israel, managing taxes and reporting requirements, and potentially navigating tax implications in your country of origin, particularly for Americans.

Private practice offers autonomy, but many physicians intentionally left business management behind when they chose medicine. In Israel, you may find yourself simultaneously restarting your career and learning an entirely new legal, financial, and cultural system.

Depending on your specialty and expertise, private practice may still be the right fit. It is worthwhile to speak with experienced local physicians in your field before making decisions.

Working through a Kupah, a hospital, a private hospital framework, or an independent office all carry major differences in compensation, schedule, taxes, benefits, and the types of care you can provide. Those decisions may also affect obligations in your home country. Consulting experienced olim as well as Israeli legal, tax, and medical professionals is extremely important.

3. Same Body, Different Medicine

My extended family always assumed physicians would have an easy time rebuilding a career after Aliyah. After all, biology is biology everywhere.

I have discovered that while the human body is universal, “being a doctor” is highly system-dependent.

A. Medications

Every physician develops familiar prescribing habits over time. You know your local antibiograms, formularies, and preferred treatment patterns.

Much of that changes in Israel.

Some medications available in your home country may not exist here, while drugs commonly used in Israel may never have been approved or widely adopted where you trained. Local resistance patterns also differ, requiring adjustments in prescribing habits.

Some differences are medically appropriate. Others are driven by formularies, insurance structures, or government policy.

For example, compounded multi-dose injectable medications may not be available for certain treatments. Patients may instead need to purchase single-use syringes, significantly increasing costs. Conversely, some procedures considered experimental in the United States are more accepted under Israeli and European guidelines.

Medication costs may also differ depending on whether prescriptions are written privately or through the national healthcare system, which becomes especially relevant for patients with chronic conditions or financial limitations.

Ultimately, you must rethink your “standard toolbox” of medications and protocols. That adjustment takes time.

If you are uncertain, ask colleagues and administrators. One of the most important lessons I have learned is that “different” does not necessarily mean “worse.”

B. Processes

Like any healthcare system, Israel has its own standards of care, workflows, and institutional norms.

You may discover that procedures routinely done in clinic in one country require hospital authorization in another. Some processes that once seemed automatic may require special approvals or additional documentation.

There are also meaningful cultural differences regarding healthcare expectations, physician accessibility, bedside manner, referrals, and who performs various procedures.

For physicians arriving from countries with public healthcare systems, such as the UK or Canada, some of this may feel familiar. For Americans coming from highly privatized systems, the learning curve can be substantial.

A few examples that stood out to me:

• Many labs close around 11 a.m., sometimes earlier.

• Routine OR time and outpatient clinics often end around 2–3 p.m. sharp.

• If earlier cases run late, your case may be postponed or rescheduled.

• SHaRaP (Sherut Refui Prati — private medical services) cases often begin after the public session ends and continue until completed.

Within the public system, many physicians are compensated based on patient volume per quarter. Acute problems are addressed efficiently, but highly specialized or time-intensive care may be more difficult to access quickly. SHaRaP appointments are often longer and more flexible, though they may require private payment or supplemental insurance.

C. Insurance Coverage

For physicians coming from the United States, understanding Israeli insurance structures can be surprisingly complicated.

It is essential to familiarize oneself with the various types of health insurance plans available in Israel.

Israel’s healthcare system combines universal public coverage with layers of supplementary private insurance. The result is nuanced and sometimes difficult to navigate.

Coverage is not simply divided into Medicaid, Medicare, HMO, PPO, and cash-pay categories. Even within the same insurance provider, a procedure may only be covered if the patient purchased a higher tier of supplemental coverage.

Certain procedures may only be reimbursed if performed at approved facilities or by approved physicians. In some situations, a patient who initially sees a doctor privately may temporarily lose the ability to see that same physician through the public system.

As physicians, we therefore need to understand not only what care is medically appropriate, but also what care is realistically accessible and affordable for the patient.

If there is uncertainty regarding coverage or costs, it is important to discuss this openly with both the patient and the administration.

D. Language and Communication

Communicating in the Israeli medical system involves far more than learning the Hebrew word פלסטר (“Band-Aid”).

You must learn a new EMR system — often in a new alphabet — and EMRs have their own language even before translation enters the equation.

Israeli chutzpah is real, and frankly, probably necessary. A country surrounded by existential threats could not survive otherwise. Still, physicians accustomed to more formal or restrained communication styles may experience culture shock.

In my experience, warmth and bluntness often coexist here. Patients, nurses, administrators, and physicians may sound direct or impatient, especially under stress, but that tone rarely reflects hostility.

As in every hospital system, the nurses and administrators truly keep the institution functioning. Building strong relationships with them early is invaluable.

I have also learned that speaking Hebrew, understanding Hebrew, writing Hebrew, and communicating nuanced medical information in Hebrew are four entirely separate skills.

Depending on your starting level, I strongly recommend a medical-Hebrew focused ulpan. It is important not only for patient care, but also for communicating with colleagues and documenting appropriately.

Personally, I dictate many notes in English and then translate them into Hebrew using translation software. Occasionally this produces amusing or unexpected results. I therefore often place both the English and Hebrew versions into the chart.

Interestingly, Microsoft Copilot has worked fairly well for this purpose.

Some Closing Thoughts

These are simply a few observations that stood out to me — things I wish I had better understood before beginning this process.

Even when you intellectually expect these challenges, there can still be an emotional adjustment in once again becoming “the new person” after decades in practice, especially if you previously held leadership roles.

It helps to stay humble, ask questions, learn the local system, and maintain open dialogue with colleagues and leadership about where your expertise can be most useful.

Despite all the adjustments — from learning new systems to simply locating the doctors’ coffee machine — I have no regrets.

I feel privileged to be here, to care for my people, and to contribute in some small way to helping this country thrive.

To those who helped me along the way: thank you for your generosity and kindness.

And to those who will arrive after me: welcome home.

If I can be helpful, please feel free to reach out.

Nachum Katlowitz, MD