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Why Doctors Are Against South Korea’s Expansion of Medical School Admissions

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Why Doctors Are Against South Korea’s Expansion of Medical School Admissions

A KMA spokesperson weighs in on the ongoing strike and South Korea’s medical crisis.

Why Doctors Are Against South Korea’s Expansion of Medical School Admissions

Members of The Korea Medical Association stage a rally calling for the government to scrap the medial reform plan in Seoul, South Korea, May 30, 2024. The banners read “The National health death.”

Credit: AP Photo/Ahn Young-joon

In May, the Seoul High Court dismissed an appeal lodged by doctors and other dissenters to overturn the South Korean government’s plan to boost medical school admissions.

Following the government’s latest directive, medical institutions are now tasked with admitting an additional 1,509 students to their existing quota of 3,058 starting next year.

The ruling came amid South Korea’s ongoing medical crisis, triggered by nationwide doctor strikes in February opposing the policy. With a majority of residents and interns refusing to return to their posts, hospitals continue to grapple with a severe personnel shortage. 

Proponents assert that the scarcity of essential healthcare workers, rapidly aging demographics, and doctor deficits in rural areas underscore the necessity for swift action to expand intake of medical students. Opponents, led by the Korea Medical Association (KMA), claim that meaningful change remains elusive without a fundamental overhaul of the nation’s medical system. 

Past administrations have attempted similar reforms only to face staunch resistance from the KMA and healthcare providers at every turn. But this time, the Yoon Suk-yeol administration is determined to push through.

The Diplomat recently spoke with Sung Hye-young, an internist and spokesperson for the KMA, to gain more insights.

Although South Korea has a low doctor-per-capita ratio compared to other developed nations (2.1 per 1,000, while the OECD average is 3.7), Sung emphasized that a simple numerical juxtaposition overlooks broader considerations.

“Many OECD countries operate on a capitation model, whereas South Korea relies on a fee-for-service model,” Sung explained. “In a capitation system, physician’s patient loads are restricted, necessitating a larger number of doctors to meet demand.”

South Korea also boasts the highest annual outpatient treatment rate, approximately three times higher than the OECD average. 

“Even with current numbers, our country maintains exceptional healthcare accessibility. Patients here consult doctors even with minor symptoms without delay,” Sung said. 

But like its neighbor Japan, South Korea confronts a rapidly aging society. It is poised to be the world’s most-aged nation by 2044, and the government claims this demographic trend requires a bolstered workforce.

While the demographic shift is undeniable, Sung argued that the policy misses the simultaneous drop in population size. 

With South Korea experiencing a record-low fertility rate, the population as a whole is on a trajectory of steady decline. Projections indicate that by 2072, South Korea’s population will plummet to 36 million, a whopping 30 percent decrease from the current 51 million.

Therefore, the KMA and healthcare professionals contend that the primary concern isn’t the total number of doctors but their distribution. More efficient allocation of human resources, in other words, will solve the problem without having to train more physicians unnecessarily.

The Yoon administration maintains that hiking medical school enrollment will result in a trickle-down effect. Yoon’s vision is that more graduates will translate into more physicians in rural areas and understaffed medical specialties such as pediatrics and thoracic surgery.

But this assumption, Sung argued, is divorced from reality and lacks empirical evidence.

“Just because medical schools increase admissions by 60 percent, there’s no assurance that graduates will relocate from urban centers or choose to pursue less popular fields,” she asserted. “In reality, it could exacerbate the concentration of doctors in Seoul and other metropolitan cities, with more students leaning towards sought-after specializations.”

Sung warned that this scenario would only intensify the existing problem, ultimately placing the burden on patients as healthcare costs rise due to overtreatment and overprescribing. 

So, is there a better solution? Instead of hasty reforms, Sung recommended that the government address the root issues and enhance the appeal of rural areas for physicians.

“The government first and foremost must raise government-mandated medical fees for practitioners in fields with low medical costs and extensive insurance coverage,” she said. 

South Korea’s national healthcare system is designed to cover up to 80 percent of inpatient and 30-70 percent of outpatient medical services. Hospitals and local clinics generate revenue primarily by performing high-cost medical procedures or treatments not covered by insurance.

Sung highlighted a significant disparity in the government-mandated medical costs between essential and non-essential healthcare fields. On average, the former commands notably lower rates, while the latter is often not dictated by the mandate and offers a plethora of non-insured treatments. 

For this reason, essential healthcare fields confront understaffing and lower popularity among doctors compared to more popular but non-essential specializations like plastic surgery and dermatology.

Such discrepancies, Sung claimed, “have led to the closure of many local clinics as physicians have migrated toward more coveted sectors.”

“At the current mandated prices, many essential healthcare providers are paid less than the costs of delivering the service. Simply put, the more patients they see, the less money they make,” she elaborated.

As for attracting more doctors to remote locations, Sung said it requires resourcefulness and creativity from policymakers. “In the rural areas today, it’s not just hospitals that are in short supply,” she said. “Critical infrastructures are sparse, from local pharmacies to gas stations, grocery stores, and diners. 

“It’s ultimately government policy [that is needed] to rejuvenate these regions, enticing not only more medical professionals but also residents and businesses.”

With both parties in the debate over South Korea’s medical sector unwilling to concede, the standoff is anticipated to persist into the foreseeable future.

As of writing, some 10,000 medical residents and interns have yet to resume their positions since their en masse resignation in February. In the absence of renewed dialogue or an evidence-based rationale by the government concerning its initiative (a request also made by the court in May), their return seems unlikely at this point. 

In South Korea, where general hospitals heavily rely on residents, their absence has created a huge vacuum. The Yoon administration has leveled harsh condemnation against the medical community over the strike, accusing young doctors of neglecting their duty in favor of self-preservation.

While she desires to see the current crisis end, Sung said medical students and physicians have their own grievances as well.

“Our government frequently accuses us of acting solely out of self-interest. But those currently on strike – many restricted from finding new jobs and struggling to make ends meet – do so out of concern that President Yoon’s policy jeopardizes the basic pillars of South Korea’s healthcare system and erodes medical school standards,” she said.