A country crammed with aspiring doctors has no future

The grim reality only helps justify the crazy education system.

Hyuncheol Bryant KimThe author, a medical doctor, is a professor of economy and public policy at Hong Kong University of Science and Technology. I recently had lunch with a new Korean professor at my university. After earning a Ph.D in economics at Princeton University in the United States, he came to Hong Kong University of Science and Technology to teach financial theories. As you guessed, financial theories are a field that require high-level mathematics. If the professor has trouble solving a math problem, he asks for help from his high school friend in Seoul. Surprisingly, he is a medical doctor at a university hospital. A mathematical genius, he swept the math Olympiads during his middle and high school days and entered a college of medicine simply because he didn’t want to “waste” his near perfect College Scholastic Aptitude Test (CSAT) score.

When I heard that story from the new professor, I felt that the widespread rumor — that a group of excellent high school students from the top scorer to the 3,058th place in the test among those who chose natural sciences for their curriculum track apply for colleges of medicine — could be true. As the enrollment quota for medical colleges increases by 1,509 next year, 4,487 students from the top score down will surely apply to colleges of medicine in December.

You cannot find such a bias elsewhere. Why don’t top Korean students choose other majors they probably like and excel in? In my earlier column, I singled out the excessive income gap between medical doctors and other professionals as the primary reason for the extreme rush to medical colleges. To tell the truth, only medical doctors can earn a high income for a long time in Korea without worrying about retirement.

Until the 1997-98 Asian financial crisis, top-class high school students mostly went to colleges of engineering and natural sciences. They elevated Korea’s manufacturing industry to the ranks of advanced economies. But the infatuation with medical schools only deepened over the past 20 years. It will be good if the hospital industry can create national wealth to turn the country into a genuinely advanced one. But the healthcare industry is more reliant on domestic demand than the manufacturing sector or tech companies — and less effective in enriching the country. For instance, it will be the best scenario if a medical doctor can land a job at a large general hospital. But if our science and technology can be commercialized, the world will become our stage for further growth, our exports will increase, and the nation’s coffers can be fattened.

If a country is to have competitiveness, top-caliber students must go to colleges of engineering and natural sciences. A state has no future if it is crammed with medical doctor-aspirants. If the question is about narrowing the income gap between doctors and other professionals, there are two options. One is to raise the income of the graduates from engineering and natural science colleges, and the other is to lower doctors’ income. Of course, the first is better. But that’s not easy, as it requires boosting productivity through technological innovations and building powerful, cutting-edge industry. Nevertheless, the alarming brain drain to the medical field quickly depletes human resources for engineering and natural sciences. That accentuates the need for the second option, as doctors’ income grew largely thanks to policy failures, not technology advances. But the idea of arbitrarily lowering a certain profession’s income will certainly backfire. What are effective solutions then?

First of all, raising the medical school admissions quota is a necessary condition for medical reforms. So far, discussions on the quota increase were mostly confined to satisfying the future demand for increased medical services rather than looking at the big picture of the country. Since the introduction of law schools in 2009, the number of lawyers has increased by more than 2.5 times. Thanks to the development, ordinary citizens can access legal services more easily than before while law practitioners’ average income decreased. Such changes are needed for the medical community as well.

Medical circles worry about the impact on the quality of medical education and services from the sudden increase in medical students. Increasing the enrollment quota by 1,500 from next year certainly went overboard. It could be even better to incrementally raise the quota between 500 and 1,000 per year.

It is not that all Korean doctors’ income increased much. Rather, the income gap grew bigger according to their specialties. The main culprit is the now-popular indemnity insurance. Thanks to that insurance, 40 million subscribers, accounting for nearly 80 percent of the entire population, can reduce their own financial burden and use medical services not covered by the National Health Insurance. Citizens are competitively making insurance claims by visiting hospitals even for minor symptoms. Despite such an explosive use of unnecessary medical services, the government has been sitting on its hands for the past 20 years.

Doctors’ income also varied greatly depending on whether or not patients took out an indemnity insurance policy. According to a 2021 survey, the average annual income of dermatologists, ophthalmologists, orthopedists and physiatrists — popular specialties in Korea — was 385.8 million won ($279,093) as of 2020, while that of physicians, surgeons, OB-GYNs and pediatricians dealing with “essential medicines” was only 234 million won. The income mismatch grew even bigger over the past 10 years. For example, while the income of those popular doctors has more than doubled since 2010, that of pediatricians has decreased 16 percent.

The current medical system also encourages doctors to avoid such essential medicines and choose dermatology, plastic surgery and other categories not covered by the National Medical Insurance. Such a problem was caused by government policy failures. In other words, the government failed to properly manage the indemnity insurance and medical treatment not covered by the national insurance policy, not to mention its failure to aggressively raise the coverage rate for essential medicines.

We need to colossally revamp the indemnity insurance, including raising the portion of self-pay for medical costs up to 50 percent. At the same time, we need to reduce the income of doctors who make disproportionately more money than their peers dealing with essential medicines. For instance, the government needs to find effective ways to allow experts other than doctors to legitimately conduct tattooing if they have separate certificates in skin care.

While pushing for the quota hike, the government proposed fiscal support for essential medicines, which is currently being discussed by the Special Committee on Medical Reform. The proposal for essential medicine development includes increasing the number of doctors in vital medicines, streamlining the medical service delivery system, investing in revitalizing the regional medical system, alleviating doctors’ legal risks in medical practice, bolstering compensation systems for essential medicines, and improving the management of indemnity insurance and skin care. The developments are a step in the right direction. But the problem is that the medical support package still lacks details.

Frankly, it is not appropriate for doctors to refuse to participate in the special medical reform committee, citing “a relatively smaller number of doctors in the committee than other groups.” Doctors must join the committee and raise their voice proactively. The government must make final policy decisions by listening to doctors’ views and carefully weighing their impact on public health and the economy.

Let’s go back to the immoderate gap in labor markets. The widening income gap among doctors has caused a serious setback for essential medicines. The sharp income disparity between doctors and engineers engendered the rush to medical schools to endanger the stable supply of experts in science and technology. The grim reality only helps justify the crazy education system plagued with cut-throat competition and the extortionate cost of private education.

In a recent paper that ran in the prestigious American Economic Review, Sejong University Prof. Kim Seong-eun and University of Southampton Prof. Yum Min-chul wrote that the overheated competition and excessive private education costs lowered Korea’s fertility rate by a whopping 28 percent. In other words, the country’s birthrate could have risen to 1.0 from its pitiful 0.7 without such brutal competition.

The exorbitant discrepancy torments our society. What college you graduated from still holds the key to determining your economic future in this country. If just a small difference in CSAT scores can create such an alarming income gap for the rest of your life, that’s not fair. If we can’t fix it, the country is doomed.

Translation by the Korea JoongAng Daily staff.