Start with increasing the quota by 1,000

The quota should be increased by at least 1,000 and then 2,000 to 3,000 more should be increased gradually.

Kim YoonThe author is a professor of health policy and management at the Seoul National University College of Medicine. “Many people cannot receive timely medical treatments because the supply of doctors in key medical fields such as pediatrics and obstetrics and gynecology is lacking, and the medical care system, directly linked to people’s health and lives, is collapsing,” President Yoon Suk Yeol said on Oct. 10. “In order to revive local medical care systems and prepare for a super-aged society, it’s crucial to expand medical manpower and educate talented people.”

If the Yoon administration does increase the medical school enrollment quota as promised, his government will be remembered as the first administration to accomplish something that no other government in the past two decades could do due to the fierce protests of the established cartel of medical doctors. Regrettably, the government did not announce the finalized number. But the government could be taking a step back, given the strong resistance from the Korea Medical Association (KMA). If the doctors at local clinics as well as doctors at university hospitals go on strike just like they did in 2020, many people will have to suffer.

President Yoon also promised policies to ensure that newly graduated doctors choose essential medical fields instead of beauty and plastic surgery, and that medical students from schools outside Seoul work in their own region without moving to the capital city. The president promised to encourage more doctors to work in key medical fields such as obstetrics and gynecology and pediatrics by lowering legal risks, increasing insurance premiums, and normalizing the medical system. To prevent the collapse of regional medical care systems, the president promised to support national university hospitals to become the backbone of the system and place them under the supervision of the Ministry of Health and Welfare, not the Ministry of Education.

This is a step in the right direction. If increasing the medical school enrollment quota is a “necessary measure” to prevent the collapse of essential and regional medical care systems, supporting essential medical fields and strengthening the regional medical system centered on national university hospitals are “sufficient measures.” These policies should be implemented in conjunction with increasing the number of medical students to prevent the influx of doctors into the cosmetic and plastic surgery fields, and metropolitan areas. Yoon’s policies included most of the demands made by the KMA, which argued that those demands be resolved first because increasing the quota alone will not resolve the current situation.

But if national university hospitals decide to use the increased enrollment quota to expand the professors and doctors of their own hospitals, the perennial problem of Korea’s medical system, where the patients only want to be treated at major hospitals, will be worsened. Other hospitals affiliated with private universities and small-and medium-sized hospitals around the country will also avoid cooperating with national university hospitals.

No matter how excellent national university hospitals become, they cannot be responsible for the entire region’s essential medical care alone. City and provincial governments must organize networks of hospitals that provide essential care and utilize the increased number of doctors in the region. Instead of only utilizing the increased number of doctors, the system should be changed to give health insurance premiums and administrative incentives to the hospitals in the essential medical institution network only when they work together. The medical system of infinite competition and self-survival must be transformed into a medical ecosystem of mutual benefits and cooperation.

Opening new medical schools in different regions will take more time and money than increasing the enrollment quota of the existing schools. Furthermore, it comes with a difficult task of making excellent universities and hospitals. Of course, opening new medical schools is a good alternative because it will help develop the community, economy, education and culture of the provincial areas, as the populations outside the capital region are rapidly decreasing. But this time, the government must focus on increasing the medical school enrollment quota. Only then will it have the opportunity to talk about opening new schools.

The percentage increase is also important. If the government conceded to the doctors and increased the quota by 300 to 500 — as the KMA quietly pressures — it will not help resolve the lack of emergency room capacities, long waits at pediatric clinics, and a shortage of doctors in rural areas. A 10 percent increase in doctors in 10 years will not resolve the collapse of the essential medical care and regional medical care programs. The quota should be increased by at least 1,000 and then 2,000 to 3,000 more should be increased gradually.

The KMA said on Oct. 18 that the country may face a more unfortunate situation than the medical strike in 2020. This sounds like a threat, taking hostage of the patients’ lives to protect their vested interest. But this is not something we want to hear from the doctors of a country, who earn the highest incomes among OECD member countries.