At the time of writing, some 12,000 medical interns and residents have quit their hospitals in South Korea. That’s 92 percent of all medical trainees in the country. Physicians and nurses are plodding through a string of shifts without a break. Medical schools have postponed their spring term as most of their students have refused to come to class – the more they delay their return, the later they become doctors, while hamstringing the schools’ capacity to admit new medical students.
The trainees are rearing up against the government’s decision to increase the annual college quota for medical degrees by 2,000 starting from the 2025 academic year. In 2006, admission was capped at 3,058 and hasn’t budged since.
Almost 90 percent of South Koreans concur that university intakes of medical students should be increased to ensure the country will have more doctors in the future. Currently, there are 2 clinicians trained in Western medicine per 1,000 South Koreans. Compare this to the OECD average of 3.7, and it makes sense why South Korean physicians earn more than $220,000 a year. Their paltry number gives them negotiating leverage over hospitals. The medical profession has long been a lucrative career path coveted and dominated by students from high-income brackets.
That explains the current strike. Doctors don’t want more white gowns competing in the market for medical services, which they fear will drive down their wages.
“How abnormal is this?” lamented South Korea’s President Yoon Suk-yeol on March 6.
Patients bear the brunt of this “abnormality.” As I wrote in The Diplomat last year, the lack of doctors has especially taken a toll on fields crucial to saving lives such as emergency care, pediatrics, internal medicine, and other complicated surgery. Gurneys are turned away on the hospital doorstep due to shortage of physicians. People die from belated medical care. South Korea doesn’t have that many infants – the country’s ’s fertility rate is 0.72, the world’s lowest – yet pediatricians are so rare that a night-time appointment is practically impossible, forcing sick children to wait for hours for care. These instances are unacceptable for a society with such a developed economy and sophisticated infrastructure.
Making matters worse, South Korea will soon become a super-aged society where 20 percent or more of its population are aged over 65. By 2035, this share will have ballooned to 30 percent. Accordingly, the average length of a hospital stay is expected to surge by 45 percent. Different studies suggest that the country needs between 10,000 and 27,000 more doctors to care for its aged demographics by 2035. These estimates are still conservative, considering some 32,000 doctors likely to retire in 2035.
If the current plans are put in place smoothly and colleges recruit more medical students starting in 2025, South Korea will reap the full benefit only in 2036 – reflecting the time it takes for a new medical student to finish their college courses and training and become a specialist. Right now is the last gasp for South Korean healthcare. The government is right on this; South Korea cannot wait any longer to start bringing more medical students into the field. The doctors should fall in line.
Requests submitted on March 5 by South Korean colleges to the Education Ministry to unlock their admission cap showed that they were willing to train 3,400 more medical students, 70 percent more than what the government intended. Yet, now that the long-overdue healthcare reform is within reach, professors are either threatening to ditch their work or flat out resigning en masse as of March 8 in protest of increasing the number of students they have to teach.
They’ve been filling in for the striking trainees. There will be disastrous consequences once they truly abandon their patients.
The professors argue that the increased student-to-faculty ratio impairs the quality of medical education. But the average number of medical students per school in South Korea is one-third of those in Germany and the United Kingdom and half that in the United States. Each South Korean medical professor handles 1.6 students on average. This is piddling.
Even if we take at face value the claim that professors don’t have enough hands to manage lectures, research, and treat patients all at once, it’s hardly understandable why they then object to the government’s proposal to hire more medical professors.
The medical community is exclusive, stagnant, and morbidly obsessed with their vested interests. From early on in their career, medical students are browbeaten into internalizing the worldviews of their “closed-off cliques.” Interns and residents who refused to abandon their hospitals were subjected to vicious verbal abuse in an online doctors’ community with hundreds of bone-chilling comments, including “I will bash your head” and “I will knife you in the stomach.”
This sense of entitlement and elitism is all too obvious. Patients in the countryside are more likely to die than their urban counterparts due to inopportune and insufficient medical care. One of the solutions is to recruit and train more students from the countryside – they tend to stay put in and around their hometowns. The government could make their education free in exchange for a fixed amount of mandatory service in the countryside. Yet South Korean doctors oppose this possibility by advancing a ludicrous claim that the quality of treatment deteriorates unless doctors were at the top of their class. (Never mind that the Netherlands draws lots to pick their medical students, and its medical quality ranks considerably higher than South Korea’s.)
Meanwhile, South Korean specialists lashed out against the government’s reform effort because it’s being pushed by bureaucrats. Medical associations proclaim “the government can never win against doctors.” This is an unwarranted hubris.
Physicians’ privileges and respectability derive largely from the tacit social contract that gave them exclusive rights to administer treatment in return for their sacrosanct professionalism and heightened sense of ethics. The World Medical Association stipulates that patients’ health should be physicians’ highest priority, their “first consideration” and “primary duty.” And the Korea Medical Association’s ethical code dictates that physicians’ “life duty” should be to “preserve and promote human lives and health.” Under the South Korean Constitution, the state assumes responsibility for public health, and doctors should adhere to the medical service act that aspires to the same end.
Yet South Korean doctors prioritize their rights to freedom of movement and employment regardless of the national healthcare tanking day by day. They accuse the government of violating their individual liberty by mandating forceful return to work and threatening to suspend their license. They are wrong. Their profession is bound by deontological ethics, meaning they are ethical to the extent they stick to their duty. It’s in the same vein as the country’s mandatory military service that puts conscripts’ individual rights on the back burner for the sake of national defense. Soldiers are considered ethical to the extent that they protect civilians.
Doctors’ strikes are only legitimate on two conditions. First, they should leave critical services intact. Second, their cause of striking should be to prompt a systemic improvement that could save more lives in the end. Neither conditions applies to South Korean physicians’ current strike. They walked out in complete disregard of the gravity of their duty. An online community comprising doctors in favor of the government reform revealed that those on strike are “giving no consideration to how their collective action contributes to social values and improvement.”
It’s not like the Yoon administration is running roughshod over them with executive orders and police investigations for conspiring to endanger public health. The government agreed to the doctors’ demands to improve trainee working conditions and wages, to increase financial incentives for carrying out tough medical procedures, and to minimize legal ramifications of surgeries gone awry, among others. Still, they walked out of their hospitals.
Since January, the government has held 28 meetings with medical representatives. The latter had stuck firm to its demand all the time: no augmentation of their ranks.
The government has opened up military hospitals to the public, and is even considering to dispatch officer doctors to civilian hospitals should things take a turn for the worse. The legal scope of nurses’ activities has also been temporarily expanded to cover for missing doctors. Nurses and what few doctors there are left will eventually buckle. South Korea’s healthcare is at a breaking point. Doctors should return to sense and to their patients, and the Yoon administration should keep this reform momentum alive even after the April general elections.