South Korea’s healthcare system is under scrutiny following instances of patients facing challenges in accessing medical care. An illustrative case involves a teenage girl from Daegu who, after a fall from a four-story building, was reportedly denied admission by seven hospitals due to the unavailability of emergency facilities or specialists. Following a two-hour delay, she suffered cardiac arrest and died.

In 2022, South Korea’s health ministry’s data highlighted that there are 2.5 doctors for every 1,000 people in South Korea. When excluding practitioners of traditional Korean medicine, this ratio stands at 2, marking the lowest among the Organization for Economic Co-operation and Development countries, pointing to a disproportionate distribution of medical professionals.

Should the current pattern persist, the Korea Institute for Health and Social Affairs predicts a potential shortfall of over 27,000 doctors by 2035.

Demographic data adds another layer of complexity. The government’s projections indicate that by 2025, individuals over the age of 65 will make up 20% of South Korea’s total population.

A widely held belief is that the stagnant medical school admission cap, consistently set at 3,058 since 2006, plays a significant role in the impending doctor shortage.

In response, the South Korean government has proposed increasing the medical school admission capacity, with changes slated for 2025. However, this proposal was met with strong reservations from the Korea Medical Association (KMA), the foremost coalition of doctors in the country with memberships totaling some 130,000.

The KMA has declared the possibility of a nationwide walkout, drawing parallels to similar actions the group took in 2020, if the government pursues its policy without “adequate” consultations with the group.

DISTRIBUTION CHALLENGES

The KMA has expressed concerns that simply augmenting the number of medical students may not effectively resolve longstanding challenges within South Korea’s healthcare system. Key among these challenges are disparities in specialization choices by medical professionals and geographical imbalances in their distribution.

Particular specialties, such as pediatrics, obstetrics and gynecology and cardiothoracic surgery, are experiencing pronounced shortages. This is attributed to the demanding nature of these professions and their perceived lower earning potential. For instance, professionals in maternity and pediatric care often encounter legal and emotional challenges, including potential disputes following unforeseen complications or confrontations with distraught parents.

Correspondingly, with declining birth rates, fewer doctors are specializing in pediatrics, leading to a reduction in pediatric clinics nationwide.

On the opposite end of the spectrum, specialties such as dermatology, ophthalmology and cosmetic surgery attract a higher number of aspiring doctors. “These fields are often viewed as profitable with a favorable work-life balance,” Lee Choon-hee, a reporter, told Korea Pro.

Many treatments within these specialties are not covered by the National Health Insurance Service (NHIS) scheme, allowing some clinics to set higher fees, maximizing profitability.

Another pressing issue is the concentration of medical professionals in urban centers, notably Seoul. This concentration has resulted in healthcare disparities across the country, with rural regions grappling with physician shortages.

Despite enticing offers, many rural clinics and healthcare facilities struggle to attract doctors. A notable instance is a medical center in Incheon, which has been unable to provide kidney dialysis treatments for years due to a lack of specialists.

The subsequent strain on Seoul’s medical infrastructure is evident. Patients from rural areas often travel significant distances to the capital, where the majority of renowned medical institutions, including Seoul National University Hospital and Samsung Medical Center, are located.

Data provided by Democratic Party lawmaker Kim Won-i, based on NHIS records, indicates a 42.5% increase in rural patients seeking treatment at these premier Seoul hospitals since 2013.

In response to these challenges, the KMA has advocated for nuanced policy interventions. These include enhanced compensation for essential specialties and significant investment in medical infrastructure in underserved regions. The group stresses that solely expanding the medical student quota might not necessarily direct professionals to less popular specialties or rural areas, given existing perceptions about earnings and career trajectories.

An illustration of protesting doctors | Image: Korea Pro

ADDRESSING CONFLICTING INTERESTS

“Addressing the imbalance in the medical sector is imperative, and while the KMA provides valid arguments, increasing the medical student quota could be a starting point,” Lee Ye-sol, a former nurse, told Korea Pro.

She further detailed the challenges she witnessed firsthand, “Numerous doctors grapple with overwhelming workloads because of the medical staff shortage. And often, this strain trickles down to nurses and nursing assistants.”

Many, like Lee, recognize the need to augment the medical student intake. Yet past endeavors by the government to modify this quota have consistently encountered resistance from the medical community.

A notable instance was in 2020 when the KMA and the Korean Intern Resident Association initiated a nationwide strike, compelling the government to retract its proposal. This plan aimed to increase medical student numbers, mandating that additional graduates serve in underserved specialties and regions.

Such stances have prompted criticism, suggesting that a segment of doctors might be influencing the supply of doctors to maintain their compensation levels through professional exclusivity.

Among the vocal critics is Kim Yoon, a medical professor at Seoul National University’s College of Medicine. He has expressed concerns about the KMA’s perspective, labeling it as prioritizing collective interests over broader public healthcare needs.

Refuting the KMA’s apprehensions, Kim emphasized the stringent quotas each medical specialty adheres to. “Given the principles of supply and demand, it’s unlikely for an influx of new doctors to solely gravitate toward a select few lucrative specialties,” he remarked.

Moreover, a number of experts, Kim included, have challenged the KMA’s forecast of a potential doctor oversupply in South Korea, attributed to the country’s declining birth rate. These experts argue that the KMA’s projections might not fully account for the burgeoning medical needs of an aging populace and increasing life expectancies.

FUTURE IMPLICATIONS

The South Korean public, in general, seems receptive to the proposed increase in medical school quotas, presenting a viewpoint differing from the KMA’s stance.

With the possibility of more accessible medical school admissions on the horizon, a rising number of students are expressing interest in the medical field, drawn by the combination of competitive compensation and job stability. This shift is manifest in the uptick in applications to specialized medical prep schools.

“Currently, we are hosting information sessions for our winter holiday course designed for medical school preparation. Previously, these sessions attracted around 2,000 attendees. But after the government’s announcement, the figure has risen to approximately 5,000,” Lim Sung-ho, the CEO of Jongro Academy, a leading tutoring franchise, told Korea Pro.

Lim also highlighted the increased web traffic to their informational videos, suggesting a growing curiosity about medical education.

However, there’s a broader debate emerging from this trend. Some argue that the enlarged quotas might inadvertently direct more students toward medicine, potentially sidelining other vital fields.

Recent data indicates an increasing number of university students, especially those from top-tier institutions majoring in scientific disciplines like engineering, are considering pivoting to medicine. Such shifts, incentivized by the proposed quotas, could become more pronounced in the future.

Further, this aspiration isn’t limited to younger students. Individuals in their 30s, many of whom are currently employed, are enrolling in prep classes, likely hoping to transition to a more lucrative and stable profession.

While filling the medical personnel gap is crucial, there’s a parallel concern: siphoning off talent from diverse sectors, especially fields like engineering, might narrow the country’s talent pool. Such a scenario could challenge South Korea’s diverse competencies, potentially influencing its global standing in various sectors.

Edited by John Lee