The conflict over the proposed increase in medical student quotas in South Korea has persisted for more than nine months. - Photo: AFP
SEOUL: It used to be that when Park Ji-sun, a 45-year-old office worker, thought of a Korean doctor, it was the 2020 tvN drama series Hospital Playlist that first came to her mind.
The series became an instant hit in South Korea, depicting the lives of five doctors battling to save lives together. It was so successful that it was renewed for a second season, which is rare for a Korean drama.
“They were heroes with white gowns during the day, sometimes sacrificing their private lives in emergency rooms at night. But at the end of the day, they were human beings with warm hearts who could connect emotionally with their patients,” she said.
“That was, until this year.”
For the last nine months, since February, Park found herself reevaluating the profession, as thousands of junior doctors refused to work in protest against the decision to increase enrollment at medical schools by 2,000 students, up from the current 3,058.
The new policy, with which the government aims to increase the number of doctors in core medical fields and enhance regional health care, is set to take effect next year.
Not only junior doctors, but medical professors, joined the protest, not to mention the Korean Medical Association (KMA), the largest group of doctors which claims to have more than 140,000 members, holding intermittent sit-in protests away from hospitals.
The conflict over the proposed increase in medical student quotas, which has persisted for more than nine months, continues to disrupt medical services nationwide.
Despite ongoing discussions, doctors and the government have yet to find common ground. The ruling party’s proposal for a four-way negotiation remains untouched, with no formal dialogue having taken place.
While the confrontation went on, Park felt her understanding of a doctor as a profession changing.
“I had thought of them as selfless heroes dedicated to public health, but now I see them as a privileged group driven by self-interest.”
Park is not the only one who questions the profession’s long-standing reputation for public service.
“The latest tension between doctors and the government has given the public impression that they are a selfish and (an exclusive group) that requires negotiations for everything,” said Lee Ju-yul, a professor at the Department of Health Administration at Namseoul University.
Patients feel betrayed by doctors, with some lamenting that they have been treated as bargaining chips.
“Patients felt stung by the behavior shown by medical practitioners. Patients have reached a point of despair because this won’t end soon,” Kim Sung-joo, a 60-year-old who is battling against esophageal cancer said.
The Korea Severe Disease Association, a group representing severely ill patients, released a statement in June framing doctors as “privileged” with no respect for the law.
“The government has worsened the situation with its lukewarm responses. This has made the doctors a privileged class that (undermines) the government and the people,” the association said.
Nurses, the group working most closely with doctors, say they have suffered some of the worst consequences of the prolonged protest.
Bang, a 40-something nurse at an emergency intensive care unit at a university hospital in Seoul, saw many doctors abandoning their ethics.
“I tend to see patients who are given only a short amount of time to live, and at the moment, some doctors deal with such patients only through videos and photos,” she pointed out.
“It’s painful to see some doctors encourage guardians to withdraw life-sustaining treatment for terminally ill patients (despite their lack of in-person interactions with them).”
Another nurse said that despite having to perform duties outside their job descriptions under the current service vacuum, thus putting them in a legally vulnerable position, they were shocked to see doctors’ groups opposing the recent passage of the nursing act.
“Doctors are asking for help and support to oppose the quota hike, but they had been furious about the nursing act that allowed us to take on greater roles to fill the medical vacuum. It’s actually for them, not us,” a 40-something nurse surnamed Kim, who works at a university hospital in Gyeonggi Province, told The Korea Herald.
The nursing act was passed by the National Assembly in late August 2024, despite the public having been sharply divided over the legislation.
It distinguishes the roles and responsibilities of nurses and nursing assistants from other health professionals medical doctors, dentists and Korean medicine doctors depicted in the Medical Service Act. Doctors’ groups claimed that the law could potentially allow nurses to open and operate their own clinics without their supervision.
Biggest, but not the first
This is not the first time that doctors have gone on a strike against the government’s policy moves. There were major strikes in 2000, 2014 and 2020 against government policies that aimed to overhaul the medical system.
For example, in 2020, the Moon administration, which tried to adopt a similar medical admissions quota policy that sought to increase the number of medical students by 4,000 over 10 years - 400 a year - scrapped their plans after a month-long protest from physicians, trainee doctors and medical school students.
The latest strike is the longest in Korea’s history. Tensions among doctors, patients and the government are believed to be more intense compared with the previous strikes. Doctors, for their part, claim they are being vilified by the current administration which has left the public more hesitant to take sides with the doctors.
The KMA launched a full-scale, one-day strike on June 18, which was a Tuesday, despite the government’s order to return to work and patient groups’ requests to stay beside them.
Medical professors, who also act as senior physicians, said they would take days off and reduce treatment as they were struggling to cope with filling the gap left by absent junior doctors. Some even resigned, putting the country’s health care system at greater risk.
The situation took a turn for the worse when the presidential committee on medical reform, aimed at opening a dialogue for South Korea’s medical reform, kicked off in late April. It was boycotted by doctors, who demanded the expansion plan be scrapped and the increase in the quota be reconsidered from the outset.
Amid intensifying confrontation, the government has taken further steps to ring the changes in the medical system. But doctors’ positions only became more extreme, vowing to resist any decision the government made.
More than 10,000 junior doctors and a similar number of medical students have walked out of their worksites and classrooms since February, with most of them refusing to respond to requests for them to return.
“The latest conflict has shown that the victims are always the patients and the weakest in the social pyramid. Doctors are a powerful group of people, which is why they had the power to drag (the conflict) out to this length,” Heo Chang-deok, a sociology professor at Yeungnam University said.
Why quota expansion
The Yoon administration’s main aim for the plan is to increase the provision of “essential” treatment and enhance regional health care.
The government argues that the current cap on the number of new doctors has left South Korea short of physicians who perform and provide higher-risk surgeries, pediatrics and emergency care.
Many doctors opt for other fields that offer better financial opportunities and work-life balance, such as dermatology and plastic surgery.
A key issue is that fields like emergency care and heart surgery have to be carried out within major hospitals, where fees are restricted by the national insurance system - to the extent that providers say they sometimes do not cover costs.
Doctors in other fields can set up their own clinics, and more easily charge high fees for optional services that fall outside the price controls of the national insurance system.
The introduction two decades ago of new private insurance products that cover such services, but not other treatments such as heart surgery, fueled demand for such services making independent clinics more profitable.
The number of new businesses opened by general practitioners from Jan 1 to July 2024 came to 129, with 104 or 80.6 per cent registered as dermatologist clinics, according to data by the state-affiliated Health Insurance Review & Assessment Service submitted to Democratic Party of Korea Representative Jeon Jin-sook.
Of the total, 48 were internal medicine clinics, while 34 dealt with family medicine. Obstetrics and gynecology clinics came to 22, while those opened by pediatricians came to only 9. Plastic surgery clinics came to 33.
Overall, the number of doctors for every 1,000 people stands at 2.2 -- below the average of 3.7 posted by the member countries of the Organisation for Economic Cooperation and Development (OECD), according to the organisation’s data on health statistics in 2023.
In addition, the staffing problem is likely to worsen, with the ministry estimating that, by 2035, the country will fall 15,000 doctors short of the number needed to meet the demand brought by demographic changes, Health Minister Cho Kyoo-hong said in a televised briefing on Feb 6 as he announced the expansion plan.
Yet doctors rolled out the same rationale as they did before to oppose the quota hike: Increasing the quota isn’t the solution to having more doctors in medical deserts outside Seoul and will not lure to-be doctors into unpopular medical specialties.
They have cited that Korea already has high access to outpatient care compared to its 37 other OECD peers.
Koreans attended an average of 14.7 outpatient care appointments per year, noticeably higher than the OECD average of 5.9, according to 2020 data released by the Paris-based organisation.
The World Health Organisation, when asked about the months-long medical standoff in South Korea, said earlier this month that the primary health care workforce -- local-level provisions such as general practice, physiotherapy and community health centers -- needs to be bolstered in general to cope with future challenges.
A 2020 OECD report said only 6 per cent of Korean doctors were general practitioners, as opposed to the OECD average of 23 per cent.
“Challenges of the future -- including aging, the prevalence of non-communicable diseases and new patterns of accessing health services -- require expanding the supply of services, particularly at primary health care settings, where most health needs should be addressed,” said the UN agency’s Regional Office for the Western Pacific in an email response to The Korea Herald.
Doctors’ demurral
In response to accusations that they are using patients as leverage, doctors have pointed out their sacrifices during the Covid-19 pandemic and said that the Hippocratic Oath stays with them.
Leaving their families and the fear of being infected behind, doctors were at the front line in the battle against the outbreak, treating patients under challenging conditions and pressure.
South Korea was relatively successful in detecting, containing and treating the virus compared to its global peers. People lauded the doctors as “protectors”, thanking them for their efforts to be in between life and death.
Public sentiment toward doctors, however, has soured since February.
Still, doctors say they will continue to take the time to say no to a set of reform policies that they claim could lead to a collapse in the health care system, even if it costs them their reputation.
Dr Ihm Jin-soo, 32, is one of them.
Being a beacon of hope in a patient’s darkest hour motivated Ihm to become a surgeon.
Leaving little time for personal self-care, he found joy in helping patients heal in operating rooms despite enduring 36-hour shifts as a first-year resident doctor at Kangdong Sacred Heart Hospital in Seoul.
But his hopes shattered the day the government announced the quota hike, and he had no choice but to resign - even if it seemed like a loss.
“How painful it must be (for doctors) to let go of years of dedication, hard work and genuine commitment to patient care? But the government rolled out policies that ruin doctors and healthcare, instead of coming up with plans to appreciate doctors, and throw shame at us.
“Does the public have the right to demand social responsibility from ordinary individuals by trampling on our pride? That only hurts our feelings and delays our return,” Dr Ihm said.
Medical professor Kang Hee-gyung, who specialises in pediatric kidney transplantation, echoed that doctors sound off to solve the problems that could lead to a no-way-back crisis and persuade the public with little lived experience in medicine.
“People think doctors are just ‘saying no’ to the quota hike, but we actually don’t,” explained Prof Kang, who heads emergency committee of medical professors at Seoul National University and Seoul National University Hospital.
“Raising the medical school admissions by 2,000 seats could be possible if there are justifiable reasons. However, the government abruptly made the decision by breaking the Sept 4 agreement signed in 2020.”
The professor was referring to the agreement made by the previous administration and the KMA, which stipulated that the Health Ministry would not make any attempt to push forward the expansion plan and will discuss the plan through a government-doctor committee after Covid-19 subsidies.
“For example, having more doctors means a rise in the cost of medical services for the public. But the government is trying to solve the problem unreasonably, which is difficult for doctors to accept,” Prof Kang said.
Prof Kang and other doctors have reasoned that salaries ultimately have to be paid for out of medical fees, so an increase in doctors will involve an increased fee burden and unnecessary treatment.
However, critics including the government have argued that recent increases in demand are due to the aging population, and that cost burdens are rising more quickly than ever, despite the slowing growth in the number of doctors.
The waning trust deficit in doctors has also left an indelible mark on her as she feels the standing and credibility of doctors are declining.
“Pride is the most important reason for doctors’ existence, but that has completely disappeared. Many doctors in medical fields where medical accidents can occur say they have no reason to stay anymore. They are staying because their contracts have not ended or because their patients are still undergoing treatment,” Prof Kang said.
Dr Choi Anna, a fertility doctor who acts as spokesperson for the KMA, said doctors are being vilified to an unusual degree because the government framed doctors as demons.
“The government said doctors only care about money and exclusivity and raised a turn war for profit gain,” Dr Choi told The Korea Herald.
“But the health care system is for the people, and doctors are also patients and guardians. Thankfully, the public is slowly recognising that the government’s medical reform policies are reckless, and it’s time for us to rebuild our health care,” she said.
Also, Dr Choi added that doctors are always there for their patients.
“A doctor wishes their patients a fast recovery. As a fertility doctor, I hope that my patient will get pregnant soon, and that’s what a doctor should and must do. Not a single doctor wants to see their patient die.” - The Korea Herald/ANN
