Health,  Life

Doctor Exodus in South Korea: A Crisis of Shortages, Salaries, and Systems

The “tide of resignations” among South Korean physicians commenced in late February and appears to evince no signs of abating. The rationale for this strike appears somewhat perplexing: the South Korean government’s proclamation to augment medical school admissions to address the dearth of physicians in South Korea. Since 2006, South Korea’s medical enrollment quota has remained stagnant at 3,058 students for nineteen years. Now, by expanding the intake of medical students and augmenting the cadre of physicians, would it not alleviate the strain on frontline medical personnel? This policy, ostensibly advantageous to the populace, garners support from over 70% of surveyed Koreans. However, it encounters staunch opposition from Korean medical factions such as the Korean Medical Association. They contend that the expansion of admissions policy fails to address the medical crisis but rather imperils the quality of education and training, precipitating the collapse of the healthcare system.

This rare occurrence of a doctor’s strike on a global scale has escalated the standoff between the government and the medical fraternity. Presently, patients are being denied medical care due to insufficient healthcare capacity, with some even being shuttled between multiple hospitals for treatment, resulting in dire instances of fatalities owing to untimely interventions. South Korean public sentiment is fraught with apprehension, fearing that without a prompt resolution, South Korea’s healthcare system may plunge into further disarray, potentially culminating in a “medical catastrophe” come March.

The response from South Korean physicians is vehement, while the government under the leadership of Yin Xiyue maintains a resolute stance, showing no inclination towards concession. How will this confrontation between the medical community and the government culminate? Is the entirety of this predicament attributable to the expansion of recruitment?

On February 6 of the current year, the Ministry of Health and Welfare and the Ministry of Education of South Korea jointly declared that commencing from the academic year 2025, South Korean medical schools would commence augmenting admissions from the current 3,058 to 5,058, constituting a 65% escalation. The objective is to bolster the physician count to 10,000 by 2035.

Upon the announcement of this plan, it promptly reverberated across the Korean medical landscape. On February 20, over 2,700 interns and residents from Seoul collectively tendered letters of resignation, precipitating a strike in protest. The ensuing day, a cumulative of 9,275 residents, accounting for 74.4% of the total, submitted resignation letters. Simultaneously, over 10,000 students from 34 medical institutions sought study suspension, representing 62.7% of the total medical student populace.

On February 22, Zhu Xiuhu, former president of the Medical Association, decried at a press briefing that the government’s encroachment upon the fundamental rights of interns and residents had reached a level of irrationality. “While national preservation of life is paramount, the basic right of physicians to choose their career path should be respected.”

In response to the doctors’ strike, South Korean authorities decreed major hospitals to refrain from acknowledging resignation submissions from doctors and issued warnings of potential revocation of medical licenses for the strikers. South Korean law enforcement also intimated the possible arrest of the strike’s “prime instigators”. Furthermore, the South Korean government mobilized medical resources such as public hospitals and military physicians, deploying them to open additional emergency facilities, alongside expanding the remit of nursing personnel to undertake some of the physicians’ duties.

However, this approach yielded limited efficacy. South Korean citizens are now grappling with the ignominy of being bereft of avenues for medical recourse when ailing. Numerous hospitals have postponed surgeries and curtailed operations. The predominant query inundating the emergency hotline is the whereabouts of medical assistance.

The crux of the conflict between the medical community and the government surrounding the admissions expansion hinges on the question: Is South Korea facing a dearth of physicians?

Projections suggest that by 2035, the demographic of individuals aged over 65 in South Korea will burgeon by 70% compared to the present. Correspondingly, hospitalization and outpatient days are projected to escalate by 45% and 13%, respectively. According to estimates from the Korea Institute of Health and Social Affairs, absent governmental intervention, South Korea is poised to confront a shortfall of 15,000 physicians by 2035.

Another datum frequently invoked by the government is a report disseminated by the Organization for Economic Co-operation and Development (OECD) in November 2023, indicating that South Korea harbors merely 2.6 doctors per 1,000 individuals, falling below the member countries’ average of 3.7. This places South Korea at the nadir among developed nations. The dearth of medical practitioners is particularly acute in remote regions. In Chungcheongnam-do and Jeollanam-do, the physician-to-population ratio stands at a mere 0.49 and 0.47, respectively.

The OECD report delineates that Korean physicians tend to treat 6,113 patients per capita annually, ranking highest among the 32 member nations and 3.4 times the OCED average (1,788 patients per capita). The average duration of initial medical consultations for South Koreans is 4.3 minutes, merely a quarter of the OECD average (16.4 minutes).

The exodus of physicians from South Korea is exacerbating, while nurses labor fervently within hospital precincts.

South Korea’s Minister of Administration and Security, Lee Sang-min, contends that the government did not unilaterally determine the admissions expansion. Extensive deliberations were purportedly conducted with various societal factions, including the medical community, before finalizing the expansion of 2,000 students.

However, Korean physicians hold a divergent perspective. A majority of physicians and medical bodies posit that the extant physician count in South Korea suffices, cautioning that augmenting admissions will intensify intra-professional competition, engender superfluous medical interventions, and strain medical insurance.

A study unveiled by the Medical Policy Research Institute of the Korean Medical Association in December 2020 postulates that as the birth rate further plummets, South Korea is poised to grapple with a physician surplus from 2027 onwards, potentially culminating in an excess of 7,043 physicians by 2035. “The government’s assessment of the predicament from its inception is flawed, thus necessitating the Korean Medical Association’s call for a renegotiation from the genesis,” underscored Zhu Xiuhu.

The quandary of physician dearth appears akin to “Schrödinger’s cat”. Against the backdrop of demographic aging, the government and the medical fraternity espouse disparate conclusions.

“It’s not a paucity of physicians, but rather suboptimal treatment, coupled with incessant apprehensions of punitive measures,” lament Korean physicians. They aver that it is the government that holds patients hostage. “Numerous physicians have confided in me, likening their predicament to that of an abused spouse, with patients portrayed as the beleaguered children and the government as the abusive spouse,” delineated a representative of the physicians’ collective.

How much do physicians truly earn?
Physicians bemoan being undercompensated. Is this a veritable assertion?

Pertinent data unveils that in 2020, the mean annual salary income of salaried physicians in South Korean medical establishments stood at US$195,463 (approximately RMB 1.37 million). The remuneration of physicians in general disciplines not only surpasses that of their British and American counterparts but also eclipses that of ordinary wage earners by a factor of 2.1, and even reaches a staggering 6.8-fold for specialists in private hospitals.

Notwithstanding, the lofty incomes of select physicians obfuscate the meager earnings of others. According to a report by the Korea Institute of Health and Social Sciences, as of 2020, the department of thoracic surgery within hospitals claimed the top spot in terms of annual income (487.99 million won), towering 4.5 times above pediatrics (108.75 million won), which occupies the bottom rung (22nd). Ophthalmology, ranking second (458.36 million won), and plastic surgery, ranking third (402.84 million won), exceed fourfold the average income of pediatrics.

The remuneration of interns and residents, who constitute the primary force in the current strike, is notably diminished. Interns and residents have emerged as the pivotal force behind the strike. Despite constituting a mere fraction of South Korea’s 140,000 physicians, they occupy approximately 30% to 40% of the workforce at select major hospitals and undertake indispensable responsibilities in critical domains such as emergency wards, intensive care units, and surgical theaters, lending vital support to senior medical personnel.

In an interview conducted by the Korea Central News Agency, Yu Hada, a participating intern, elucidated that intern doctors typically labor in excess of 100 hours per week and garner monthly earnings ranging from 2 million to 4 million won (approximately 10,000 to 20,000 yuan), inclusive of overtime remuneration. Contrastingly, the local median monthly income stands at approximately 2.35 million won (roughly RMB 12,700). However, when dissected by working hours, the hourly wage of intern doctors barely attains half of South Korea’s statutory minimum wage (9,860 won). Consequently, South Korea’s current medical framework, albeit distinguished, hinges upon subjecting apprentice doctors to relentless toil.

Jung Hyung-sun, a professor specializing in health administration at South Korea’s Yonsei University, contends that whereas public hospitals constitute over 50% of medical establishments in Western nations, in South Korea, more than 95% are privately owned medical institutions. Physicians in public hospitals aspire to bolster their ranks to alleviate workloads and preserve their remuneration, whereas their counterparts in private hospitals seek to curtail competition to safeguard their lucrative incomes. This acute scarcity has elevated Korean physicians to the status of “white aristocrats,” forming a vested interest faction imbued with a profound sense of entitlement, thereby erecting barriers to entry into their enclave. As articulated by an elder physician cited in “The Korea Herald,” “In Korea, the only individuals asserting an absence of physician shortages are physicians themselves.”

On March 6, 2024, South Korean President Yoon Seok-yue presided over a cabinet session, expressing grave concern over the collective resignation of Korean physicians, which he deemed a direct affront to the foundational tenets of the legal system, warranting decisive action.

South Korean citizen Li Qiyuan delineated that in South Korea, parents embark on targeted preparatory education, commencing from primary school, to secure their children’s admission into medical schools, underscoring the entrenched aspiration for medical careers among Korean youth.

Ultimately, the expansion of medical student enrollments is poised to intensify competition among South Korea’s fledgling physicians, a pivotal driver behind the current wave of strikes. However, the underlying impetus resides in the systemic contradictions permeating South Korea’s medical infrastructure.

South Korea’s preeminent medical resources are concentrated within the capital’s economic nexus, fostering a proclivity among local denizens to seek treatment in Seoul. This phenomenon exacerbates shortages of medical practitioners, particularly in fields such as pediatrics, obstetrics and gynecology, and internal medicine, not only in local precincts but also within Seoul’s premier hospitals. As per the “Current Status of Specialist Doctors in Various Departments in South Korea,” the projected tally of pediatricians for 2023 stands at a mere 304, less than half the 2014 figure.

Consequently, the government’s resolve to augment medical student admissions is motivated by the exigency of ameliorating regional medical deficits and rectifying specialty imbalances. Nonetheless, the efficacy of this strategy remains uncertain, as the influx of 2,000 additional physicians annually raises questions regarding their propensity to specialize in critical areas vis-à-vis cosmetic procedures, compounded by the allure of urban comforts versus rural commitments.

In essence, the reluctance to engage in primary care stems from the punitive legal environment prevailing in South Korea, wherein even minor lapses incur criminal repercussions, fostering a risk-averse mindset among budding physicians. This legal straitjacket, coupled with the paradoxical dynamics of healthcare financing, epitomizes the conundrum confronting the Korean medical landscape.

The ongoing impasse underscores a longstanding discord between the government and the medical fraternity, characterized by a history of confrontations and concessions. The government’s endeavors to effectuate medical reforms are met with resolute opposition, epitomizing a recurrent dialectic between policy imperatives and professional prerogatives.

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