[News Focus] Why do Korean doctors oppose having more physicians?

A doctor leaves the hospital holding a white coat, Tuesday morning. (Yonhap)

Thousands of medical doctors, the essential force for the care and treatment of critical patients, left their hospitals Tuesday in protest of the government’s policy to expand the number of medical school students.

South Korea’s medical landscape has been gripped with the fear of a major health care crisis, with doctors leaving their patients, claiming that the nation does not need more doctors because it has enough already and that the policy change will lower the quality of medical services in the future.

They argue that the increase is needless due to a decreasing population and the country’s already easy access to medical care. Outpatient care per person was 14.7 times a year here, higher than the Organization for Economic Cooperation and Development average of 5.9, according to the 2020 statistics.

They have also been calling for the government to seek other ways to better allocate doctors to “unpopular medical departments” such as pediatric care, obstetrics and gynecology, as well as to boost compensation.

They assert that doctors abandoned these less popular departments because the medical services they offer are significantly undervalued compared to those in “popular departments” like dermatology and plastic surgery, where medical costs are not regulated by the health insurance system, but are set arbitrarily by the doctors themselves. They argue that a system allowing the cost of childbirth by a gynecologist, for instance, to be much lower than a simple laser skin treatment by a dermatologist has led many to opt for the latter profession.

Responding to the demands, the government said necessary medical fields incompatible with the fee-for-service system would benefit from the public policy fee under the health insurance policy it announced earlier this month.

Under the scheme, pediatrics, critical care, mental health and infectious disease sectors will receive payments depending on the urgency of the procedures and the difficulties and risks of the services not reflected in the fee-for-service system.

Doctors, however, have asserted that the government lifting enrollments in medical school will not help to fill the workforce gap in essential care departments and will rather increase competition for training positions in popular departments, particularly in Seoul hospitals.

“What’s more problematic is that (the government) is trying to dismiss such problems by lifting enrollments in medical schools,” it said in a statement Tuesday.

For the Yoon Suk Yeol government, having more doctors is crucial for coping with a rapidly aging society and regional disparity. It is the first time that the government is raising the medical school enrollment quota in 27 years.

The limit was capped at 3,058 enrollments per year in 2006, down from 3,507 to assuage doctors protesting the policy of separating the prescribing and dispensing of drugs at that time. The government is to expand the cap by 2,000 starting next year.

The calculation is based on the prospect that the country will fall short by 15,000 doctors in 2035 to meet the demands of demographic change. The country needs more physicians to prepare for a “superaged society” where senior citizens make up 20 percent of the population by 2025 and 30 percent by 2035, it added.

According to the government, the number of doctors for every 1,000 people stands at 2.2, which is far below the average of 3.7 posted by OECD member countries, citing the organization’s data on health statistics last year.

The government added that the figure was 4.5 in Germany, 3.2 in France and 2.6 in Japan, noting that countries with more doctors per capita than Korea have increased their quotas.

The ministry also noted that France raised its medical school enrollment quota from 3,850 in 2000 to around 10,000 in 2020, while Japan increased the number of spaces in medical schools by 9,384 in 2023 from 7,625 in 2007. In addition, Germany, which already boasts a high medical school enrollment of more than 9,000, has recently decided to lift the number of its seats by 5,000, and the UK hopes to add 15,000 more medical students by 2031.

The ministry anticipates the planned hike will partially relieve the shortage of doctors, explaining that 2,000 more medical school students would graduate in 2031 after completing their six-year courses.

What critics say

Experts say doctors oppose the expansion plan because many hospitals, mostly private, operate under a profit-oriented structure.

“Public hospitals take up more than 50 percent of medical institutions in Western countries, so doctors welcome the decision to have more peers because it would reduce their workload, and they are still paid the same amount,” Jeong Hyoung-sun, a professor of health administration at Yonsei University, told The Korea Herald.

“But many of the doctors in Korea operate their own clinics, so if they have more competitors in the future, they won’t be able to earn more money. It’s a turf war for profit gain,” the professor noted.

Lee Ju-yul, a professor at the Department of Health Administration at Namseoul University, pointed to the fee-for-service system as a trigger for competition between doctors.

“Under the scheme, doctors charge separately for each service they perform. But the slice of the pie becomes smaller if we have more doctors,” Lee told The Korea Herald.

“That’s why the so-called ‘three-minute treatment’ emerged where doctors only spend three minutes per patient to increase the number of medical services in exchange for greater profit,” Lee said.

Not the same

This is not the first time that doctors are protesting against the quota expansion plan.

The previous Moon Jae-in administration, in July 2020, also attempted to expand medical school admissions but in much smaller increments -- by 4,000 over a 10-year period beginning in the 2022 school year. The plan was also confronted with two-week-long strikes by doctors from Aug. 21 until Sept. 8 at a time when the country grappled with the COVID-19 pandemic. But the number of doctors participating in the protests was low, as many stood by patients amid the pandemic, which led the public to sympathize with their hard work and efforts to save lives in the uncertain times, according to observers. The then government withdrew the plan as the pandemic escalated.

The public sentiment, so far this time, appears to be not the same.

A survey conducted by the Korean Health and Medical Workers Union in December 2023 showed that 89.3 percent of the public said they support increasing the medical school enrollment quota. This is nearly a 20 percent increase from 2022, when only 69.6 percent of the public agreed to have more doctors, according to a report released by Rep. Kim Woni of the Democratic Party of Korea.

Last week, a speech by a junior doctor during a rally went viral, in which she stated she would prioritize herself over patients in response to the government's plea to put patients first. The speech, which made headlines, sparked negative comments, with many calling it arrogant and privileged.

By Park Jun-hee(junheee@heraldcorp.com)