A dire pediatric health crisis is unfolding in South Korea, and families like Kim Kyu-jong’s are feeling the brunt of it. When Kim’s toddler developed a fever, the lack of available emergency rooms forced him to take a taxi to a pediatric emergency room. His child was admitted for outpatient care only.

“I felt resentful and helpless when sent back home with a still-suffering kid,” Kim told Korea Pro. “Luckily, she improved the next day, but I keep wondering — what if it happens again?”

This harrowing experience is not isolated. Across South Korea, a growing number of incidents reflect a critical shortage of pediatricians, leading to dangerous delays in care and limited access to emergency services. The issue is stoking public concern and calls for immediate action.

In a case that sent shockwaves through the nation, a five-year-old boy tragically died in May from acute respiratory symptoms after being turned away by multiple hospitals. The lack of available beds, rooms and staff to accommodate him became a flashpoint in a crisis that seems to be worsening.

This alarming shortage of pediatric healthcare providers is multifaceted. Medical trainees and incumbent pediatricians are increasingly shying away from the field, daunted by persistently low incomes, difficult interactions with parents and a shrinking pediatric patient base owing to the country’s falling birth rate.

PARENTAL ATTITUDES

​​Over the past half-decade, South Korea’s pediatric medical landscape has faced a worrisome contraction. The number of resident doctors specializing in pediatrics at training hospitals has plummeted by 64%. This year alone, an alarming four out of five university hospitals received no applications for pediatric training programs.

The reluctance of aspiring medical students to enter this field has roots in a 2017 incident at Ewha Women’s University Hospital. Four infant deaths led to a lengthy court case, resulting in a five-year legal battle for the medical staff of the hospital’s intensive care unit. They were ultimately acquitted of involuntary manslaughter charges related to the bacterial infections that caused the deaths.

“When I was in school, a few students still applied for the pediatric department. But now I hear there are no applicants, and even those considering it are often dissuaded by those around them,” Lee Soo-jeong, a plastic surgeon and former trainee at Yonsei University Hospital, told Korea Pro.

Lee’s comments illuminate a broader concern. Medical students are fully aware of the challenging working conditions pediatricians face. These include managing upset or angry parents and, in unfortunate circumstances, the potential for legal action, even when the practitioners believe they have performed their duties as expected.

Park Yang-dong, chairman of the Korea Children’s Hospital Association (KCHA), highlighted additional challenges. He emphasizes the issue of young parents becoming verbally aggressive out of frustration with long waits and anxiety. This mistreatment of medical caregivers has prompted an exodus of existing staff.

“They are often verbally aggressive and take out their frustration on the medical staff, turning them into emotional laborers,” Park told Korea Pro.

Earlier this year, Park transitioned his practice from a pediatric to a family care model, rebranding CNA Seoul Children’s Hospital as Seoul Family Hospital. In anticipation of the continuing shortage of pediatricians, he revealed that 70% of children’s hospitals plan to reduce operational hours during nights and holidays in the next five months.

Compounding the issue, hospital-based pediatricians are currently working an average of 78 hours a week to meet demand, according to Park.

A waiting room at Seoul Children’s Hospital, Nov. 10, 2021 | Image: Seoul Children’s Hospital

MORE LUCRATIVE AVENUES

South Korea’s falling birth rate is having unintended consequences on its healthcare system, notably in pediatrics. A profession that once thrived on large numbers of young patients now struggles with a declining child population. This comes when the fees for pediatric services, overseen by the National Health Insurance Service (NHIS), have remained stagnant, exacerbating the financial strain on pediatric practitioners.

“Pediatricians’ average income has plummeted by 25% over the last 10 years,” Lim Hyun-taek, the chief of the Korean Pediatric Association (KPA), stated at a press conference in March. He noted that the medical appointment fees, which form the primary source of income for many pediatricians, have been frozen for three decades.

This financial pressure is taking a toll, with 662 local pediatric hospitals shuttering their doors in the last five years, according to Lim. The economic challenge is far-reaching, driving pediatricians to search for more lucrative avenues within the medical profession.

The KPA’s conference in June, attended by around 700 participants, highlighted this shift. The event featured lectures on potentially lucrative avenues, including administering aesthetic treatments such as Botox.

The South Korean government’s proposal in March to increase the operational hours of hospitals and expand public pediatric medical centers has ignited a vigorous debate, facing staunch resistance from an already strained medical industry. Critics argue that the plan overlooks central issues such as a glaring shortage of personnel and stagnant service fees, marking it as an inadequate solution to a complex problem.

Oh Young-ho, a senior researcher at the Korea Institute for Health and Social Affairs, acknowledges the government’s constraints, viewing the proposal as the “only realistic measure” presently on the table. Raising pediatric service fees would necessitate cuts in other departments, given the limited finances under the NHIS, he explained.

“The insurance pricing system should start from a zero base, but, of course, it is difficult to get cooperation from the other high-earning departments,” Oh told Korea Pro.

Oh’s position emphasizes governmental oversight in regulating pediatrician supply, asserting that healthcare — a fundamental human right — should not be swayed by market forces.

An idea gaining momentum is the establishment of public medical schools, where graduates would commit to serving underserved areas or specializing in vital medical fields such as pediatrics or obstetrics and gynecology, following free training.

However, this concept is hardly novel. Previous attempts by the Moon Jae-in administration to implement such schools were met with strikes and protests from the Korea Medical Association, resulting in a stalemate.

Professor Kim Dong-won of Incheon National University emphasizes the urgency to cultivate a “new pool” of pediatricians, expressing skepticism about the efficacy of mere adjustments to working conditions or insurance fees in attracting medical students to pediatrics.

“Many hope to specialize in plastic surgery, dermatology, or ophthalmology for better rewards,” Kim told Korea Pro. “It’s market logic, and human nature can’t be stopped by a few pennies given by the government.”

Botox vials, Feb. 17, 2023 | Image: Pexels

URGENT NEED FOR REFORM

Calling for profound structural reform, KCHA Chairman Park has urged for the creation of a system to triage pediatric patients by symptom severity. He highlights the problematic congestion of emergency rooms with non-urgent cases, noting that 80% of visits consist of minor symptom evaluations. This misuse strains the system, impeding timely care for gravely ill children.

“The current system in every aspect is falling apart. It would require CPR if it were a patient,” Park said.

As South Korea grapples with pending healthcare reforms, the once abstract problem of pediatrician scarcity has transmuted into a tangible crisis for families seeking prompt medical care for their children.

“When my child is ill, I get to the clinic an hour before it opens, yet a line of nearly 20 parents typically beats me to it,” Yoo Jung-hoon, a 39-year-old father, told Korea Pro. “Each time I go to the clinic for my child takes about half a day. I really wonder if it is possible to have more children.”

The strain isn’t only logistical; it’s eroding confidence in the system itself. 

“I saw other sick children being turned away despite there being vacant emergency room beds, presumably due to a lack of doctors,” Kim Ji-eun, a mother of an 18-month-old daughter, told Korea Pro.

Her faith in the system has waned to such an extent that she now takes matters into her own hands: “I have started to prepare extensively in case my child falls ill again, learning about symptoms and stocking up on crucial medicines.”

The stakes are high and broader reforms that can ensure the long-term sustainability and trustworthiness of the system will have real and lasting impacts on families across the country.

Edited by John Lee