Is this the extent of the shortage of doctors in Korea?
Not all departments are short of doctors
Organization for Economic Co-operation and Development data from 2017 show that South Korea has an average of 2.3 doctors per 1,000 people, well below the OECD member country's average of 3.4. South Korea's Health and Welfare Minister Park Yeong-hou previously revealed that Seoul has an average of 3 doctors per 1,000 people, while Gyeongsangbuk-do, another economic center, has only 1.4.
In response, the South Korean government recently launched a medical student expansion plan that would increase the annual enrollment quota of 3,058 required for medical schools by about 400 over the next 10 years, while giving incentives to students majoring in lower-paying specialties such as epidemiology and medical students volunteering to go to rural areas to work in public **** health in order to better respond to public **** health emergencies.
However, the announcement of the program led to an instant "explosion" and a mass walkout in South Korea's medical community.
Song Kyung-young, a professor of surgery at St. Mary's Hospital, who is opposed to the South Korean government's plan, argued that the South Korean government does not have an accurate grasp of the doctor shortage. "More accurately, what Korea is short of is not all doctors, but general surgeons and cardiothoracic surgeons."
According to Korean media reports, most medical students and clinical interns in South Korea are willing to learn in-depth surgical skills even if they are interested in surgery after completing their medical education and training, and do not want to work as general surgeons.
On the one hand, general surgery is inherently unpopular in South Korean medical circles.
A medical student at the Seoul National University College of Medicine said the most "sought-after" fields at the college are dermatology, plastic surgery, radiology, rehabilitation medicine and orthopedics, while cardiothoracic surgery and general surgery are the least popular fields.
Seoul National University College of Medicine conducted a survey of more than 12,000 medical students and found that internal medicine, psychiatry, pediatrics and orthopedic surgery are the most preferred practice areas for medical students after graduation, and undergraduate medical students preferred non-clinical practice areas.
Park Ji-hyun, chairman of the Emergency Countermeasures Committee of the Korea Association of Internists, said specialists, including general surgeons, often have difficulty finding suitable hospitals, and unrealistic hospital medical fees make it difficult for hospitals to make ends meet, resulting in many internists choosing to take up jobs in other departments not covered by health insurance, such as dermatology and plastic surgery.
On the other hand, general surgeons earn less than plastic surgeons.
Under South Korea's health insurance reimbursement system, more surgeries for patients means more financial losses for hospitals.
When it comes to non-Medicare-covered surgical services, such as plastic surgery, both hospitals and doctors earn more.
Song Kyung-yeong cited the example of a gastrectomy, which requires at least one surgeon, one anesthesiologist and one nurse. However, health insurance reimbursement for gastrectomies is too low compared to labor and surgical costs, amounting to 100 won for the surgery while the hospital gets only 70 won, before factoring in labor costs. No hospital is willing to make such a low-margin "deal".
Song Kyung-young said this is why hospitals are unable to make a profit from critically ill patients, and a major reason why Korean medical students and interns are reluctant to become general surgeons. "Unless health insurance reimbursement for surgery improves, few future specialists will choose general surgery."
Song Kyung-young argued that this "distorted system" in South Korea is gradually reducing the number of large hospitals that can serve critically ill patients.
Even expansion will hardly work
Song Kyung-young said he has been raising the issue for a long time and has emphasized the fact that surgical departments would attract more doctors if they were properly reimbursed, but nothing has changed. "The government hasn't even discussed reimbursement, instead focusing on increasing the number of doctors."
Now, the South Korean authorities are again dealing with the problems facing the public **** health sector in the same way, but in Song Kyung-yeong's view, more doctors don't lead to a better public **** health system; it's the infrastructure that needs to be sound.
Like public ****health, increasing the number of general surgeons also requires strengthening hospital infrastructure. According to Song Jingying, general surgeons often do not choose to go to hospitals that lack infrastructure such as operating rooms and surgical equipment, "They prefer hospitals where patients are willing to undergo surgery."
"Most of the smaller hospitals or provincial medical institutions are under-equipped. As a result, surgeons at these hospitals perform only simple operations or even see only outpatients, while in rural areas, patients with serious illnesses that require surgical treatment are more likely to visit large hospitals in Seoul. Even if the government arranges for more doctors in public hospitals, if adequate infrastructure is not established, it will cause patients to 'avoid' public medical institutions." Song Kyung-young said.
Also, the South Korean government's plans to expand medical school enrollment and establish a public medical school may not work.
Song Kyung-young said that while South Korea is in dire need of general surgeons, it will take more than 15 years to fill the vacancies by increasing medical school enrollment and establishing a public medical school. Take becoming a surgical specialist, for example. "After graduating from a six-year medical school, one must spend five years on internship and residency training and another two years on specialty training, while male doctors are also required to serve three years in the military."
He doesn't think the Korean government's plan will attract more medical students to choose surgery. "No matter how many more doctors are added, the number of general surgeons in Korea will not go up unless this reimbursement system, where more surgery means more financial losses, is changed."
Song Kyung-young revealed that Korean medical students and interns have lost confidence in the future of general surgeons because of the low reimbursement they receive.
References:
1.KoreaBiomedicalReview:" whyaremedicalschoolstudentsreluctanttobecomesurgeons?"
2. Reuters: SouthKoreanmedicalstudentsrevoltovergovernmenthealthreformplans
3.NCBI: FactorsassociatedwiththespecialtychoiceofKoreanmedicalstudents:across-sectionalsurvey