A mass strike by doctors in South Korea has been going on for a week, but the situation is still intensifying. On the first weekend after the strike, at two p.m. local time on February 25, the Emergency Countermeasures Committee of the Korean Medical Doctors Association (KMA), the largest medical industry organization in South Korea, held an expanded meeting of delegates in Seoul. After the meeting, at 5 p.m., representatives of doctors from all over the country began to march in a long line, which the Emergency Countermeasures Committee said was the largest number of people compared to previous gatherings held in recent years. The anger of the doctors is directed at the medical school expansion plan proposed on February 6From 2025, the number of medical schools nationwide will be expanded by 2,000 per year, from the current 3,058 to 5,058 studentsThe increase will be 65 percent for five years, which means that there will be a total of 10,000 more doctors in South Korean hospitals。The reason given is that as South Korea's society ages, there will be a greater shortage of doctors, and it is necessary to prepare for a rainy day. Most doctors disagree with this logic, arguing that the fundamental problem of South Korea's healthcare system is a structural shortage caused by the extremely uneven distribution of resources. In order to force ** to withdraw the plan, South Korea's first resident doctors submitted their resignation letters on February 19, and now, a widespread "resignation wave" has spread to specialists。According to a survey of 100 major hospitals in South Korea, as of the evening of February 23, more than 80 percent of residents have resigned, more than 10,000 people. February 23rd,For the first time in South Korea's history, South Korea has raised its medical crisis alert level from "alert" to the highest level of "severe."。On February 27, local time, South Korea's ** Yoon Suk-yeol made a statement on the recent intensification of the resignation of doctors in South Korea, he saidThere will be no negotiations on health care reform, and there will be no compromise on such reforms. South Korea's Ministry of Health and Welfare said on the 27th that it will adjust the business scope of ** from now on and undertake part of the doctor's business. Some experts believe that entering March, South Korea may fall into a real medical crisis. 
On February 15, in Daegu, South Korea, some doctors took off their white coats at a condemnation meeting to implement a policy of expanding the enrollment of medical schools. Figure Visual China.
Is there a shortage of doctors in South Korea? At two o'clock in the morning, Jehong, a former Overwatch professional gamer and South Korean webcamer who suffered a serious car accident, was admitted to the emergency room of a hospital, but in despair he found that there was no doctor on call. Subsequently, Jehong urgently called about twenty or thirty hospitals, and received the same reply "no doctor", and it was not until eight hours later that he finally entered the operating room, at 10 o'clock in the morning of the 21st, and if it was any later, it was likely to be life-threatening. It was the second day of a strike by doctors in South Korea. Just 12 hours after Jehong entered the operating room, data from the Ministry of Health and Welfare showed that a total of 9,275 residents resigned from 100 hospitals, or 74 percent of the group4, of which 8,024 have left their posts. The first strikers mainly came from the "Big Five" general hospitals in Seoul, including Seoul National University Hospital, Severance Hospital, Samsung Seoul Hospital, Seoul Asan Hospital and Seoul St. Mary's Hospital. The staffing of Korean hospitals is relatively deformed, and the over-reliance on resident doctors has been criticized for many years. A Korean medical student's long academic career consists of six years, the first two years are preparatory courses, the last four years are undergraduates, and in the third year, they will start an internship in the hospital and prepare for the medical qualification exam, and after passing the examination, they can enter the hospital, first as an intern for one year, and then as a resident doctor for three or four years, which is the only way for every medical student to become a specialist. According to the Korea Health Insurance Review and Evaluation Service, the proportion of resident physicians in the "Big Five" hospitals is about 40 in the total number of doctors. A survey conducted by the Korean Medical Association found that residents work up to 80 hours a week, nearly 30 hours more than most doctors, but on the other hand, their average monthly salary is much lower than that of general specialists. Therefore, this is why every time Korean doctors go on strike, starting with the resident doctors, the key front-line medical personnel are the first to leave, which exerts a lot of pressure on the first place, but at the same time brings a bad result: the rapid collapse of the medical order. Jehong was lucky. On 23 February, a woman in her 80s died after cardiac arrest and was transferred to seven hospitals where she was not admitted, not the first case of a delay in treatment during the strike. In Daejeon City, the ambulance transfer time has been extended to 2 hours, and the Daejeon City Fire Headquarters said that from the 20th to the 25th, there were 23 ambulance transfer delays, and in Busan, there were also 42 delays during the same period. The focus of the contradiction between the medical community and ** on the expansion of enrollment is: Is there a shortage of doctors in South Korea? Yoon Suk-yeol** believes that an aging population will lead to a significant increase in medical demand. Park Min-so, second vice minister of the Ministry of Health and Welfare, said on the 22nd that according to **, by 2035, the number of elderly people over 65 years old in South Korea will increase by 70 compared with now, and accordingly, the number of days of hospitalization and outpatient will increase respectively. According to estimates by the Korea Institute of Health and Social Affairs, if no action is taken, South Korea is expected to face 1There is a shortage of 50,000 doctors. Another frequently cited statistic is that the OECD (OECD) released a report in November 2023 that on the one hand, South Korea has only 2. per 1,000 people6 doctors, 37 places on average, the lowest among developed countries; But on the other hand, the number of outpatient visits per capita in South Korea is 157 times, but it can be ranked first among the member states, and there is a big contrast between the twoHighlight the contradiction between medical supply and demand。Therefore, the annual expansion of 2,000 people is "the minimum number determined according to medical supply and demand, not the number of negotiations", South Korean Minister of Health and Welfare Cho Gyuhong emphasized in a news program on the 23rd. Zhu Xiuhu, chairman of the Public Relations Committee of the Emergency Countermeasures Committee of the Korean Medical Association and former president of the Medical Association, told China News Weekly that ** quoted OECD data, saying that South Korea has fewer doctors per 1,000 people, but the medical system in South Korea and other OECD countries is different, and doctors in many OECD member countries are equivalent to "civil servants", receiving salaries from the state, and the work intensity is also lowSouth Korea is dominated by private hospitals, and doctors work a lot of work and need to work long hours to make money。"Therefore, we do not think that such a comparison is meaningless. He also noted that although South Korea has fewer doctors than other OECD countries, there is a lot of evidence that Korea is "a more convenient place to seek medical care" than any other country. First, the number of hospital visits per capita per year in South Korea is 2 percent of the national average for OECD6 times, one of the most in the world. Second, South Korea is second only to Japan in terms of average length of stay per patient per year. In addition to adequate access to medical care, South Korea's three indicators of national health, namely life expectancy, infant mortality and avoidable mortality, are among the highest in the world and above the OECD average, especially the last one, where the avoidable mortality rate is 142 per 100,000 people, compared to the OECD average of 239. "If there is a real shortage of doctors, will this happen? Therefore, we believe that this point of **'s claim is incorrect. Zhu Xiuhu said. According to a study published in December 2020 by the Medical Policy Research Institute of the Korean Medical Doctor Association, as the birth rate further declines, South Korea is expected to experience an oversupply of doctors from 2027 onwards, and the surplus number could reach 7,043 in 2035. "* misjudged the cause at the beginning and proposed the wrong solution, soThe Korean Medical Association hopes to reconsider this issue from the source。Zhu Xiuhu further emphasized. The problem of the shortage of doctors seems to have become "Schrödinger's cat", also in the context of an aging population, and the medical community has come to the opposite conclusion. But others have pointed out that doctors may be so angry because the expansion affects their vital interests. Kwon Soon-man, a professor of public health at Seoul National University, said frankly", ".More doctors means more competition, and doctors are likely to earn less in the future。"In South Korea, the group of doctors belongs to the upper part of the social elite, and the 2022 OECD data shows that Korean doctors are one of the highest-paid groups of doctors in the world, and the annual income of specialists in large general hospitals in South Korea is about 200,000 US dollars, or about 143840,000 RMB, more than 6 times the per capita income of South Korea, ranking first among OECD member countries. Therefore, under the influence of meritocracy,Doctors have topped the list of the most wanted professions for Korean teenagers for many years, and in front of medical schools, South Korea "sky".(Acronyms for Seoul National University, Korea University, Yonsei University)The signboard of the famous school is no longer shiny。But at the same time, it is really difficult for Koreans to become doctors. In fact, after the announcement of the expansion of enrollment in early February, many large cram schools immediately added night classes to migrant workers, specializing in medical school. Jongno College, Seoul's most well-known large-scale education and training institution, held a medical school admission information session, which was attended by about 4,000 people. Jongno College estimates that about 9,500 students will want to enter medical school in 2024, and the number will increase to 15,800 in 2025. As many fear, the expansion of the number of medical students each year will exacerbate the already serious "medical school black hole" phenomenon, and some experts worry that it will lead to a decline in the quality of medical education. In this regard, Zhu Xiuhu said pessimistically: "Now the medical industry in South Korea is collapsing, if the number of doctors increases, it will exacerbate the medical collapse and the increase in medical expenses, doctors will think that it is too difficult to work in this medical environment, and many doctors will give up the ...... of this profession."The unimaginable can happen. He insisted that his opposition to the expansion was not "to save his job," but that he believed that if it continued, South Korea's national health would suffer. "We're just fighting against the wrong policy of **. ”Structural "gaps" in the healthcare systemLeaving aside the question of whether there is a shortage of doctors in absolute numbers,At least, there is a consensus among the medical community on one point: there are big problems with the Korean healthcare system, and there are obvious structural shortages. On the evening of February 20, in the "100-minute debate" program of South Korea's MBC TV, ** and the medical community launched a heated debate around their respective positions. Yoo Jung-min, head of the strategy team at the Disaster Safety Countermeasures Headquarters in South Korea, mentioned that there is a big shortage of doctors in some areas. Zheng Jae-hoon, a professor of preventive medicine at Gachon University, believes that the so-called "shortage" is more due to uneven distribution than the overall shortage of doctors. In other words, this is essentially a structural problem, and the expansion of medical school enrollment is not a cure. Yoo Jung-min also acknowledged that there are indeed two obvious uneven distribution of medical resources: first, doctors are mainly concentrated in the metropolitan area (Seoul, Gyeonggi Province, Incheon);Second, there is a huge gap between different departments. In terms of regional distribution, a report released by the National Medical Center of South Korea in 2022 shows that Seoul has 899 of residents have access to emergency medical services within 30 minutes, followed by their western neighbor Incheon at 809％。However, in Gangwon-do, Gyeongsangbuk-do, and Jeollanam-do, the proportion is less than 45. Another bigger crisis facing South Korea's healthcare system is the shortage of doctors in the basic health care sector, which is the most critical and difficult "gap" to solve. More than 90% of medical care in South Korea is private, but at the same time, South Korea's national health insurance coverage is extremely high, and it is almost universal health insurance. As a result, the income of basic medical specialties such as pediatrics and adolescents, obstetrics and gynecology, emergency department, surgery and other departments with high reimbursement rate is relatively limited, and the income of "skin and eye surgery (** department, ophthalmology and plastic surgery)" with many self-funded items is high, which has become a department that young doctors flock to, and it is also the main profit body of the hospital. According to a survey by the Ministry of Health and Welfare, as of 2020, the average annual salary of ophthalmologists in South Korea is about 45.8 billion won, about 3 million yuan, ** The average annual salary of a doctor is 30.3 billion won, about 2 million yuan, which is higher than the average annual salary of doctors as a whole. The annual salary of the Department of Pediatrics and Adolescent Medicine is only about 100 million won, and it is the only department whose annual salary has decreased compared to 10 years ago. As of 2022, the number of plastic surgeons in South Korea has almost doubled in the past decade, and the number of doctors has increased by about 40, according to statistics from the Ministry of Health and Welfare and the National Health Insurance Agency. However, pediatrics, obstetrics and gynecology, and surgery, which are closely related to the basic life and health of the people, are facing a "labor shortage". According to a survey conducted by the Ministry of Health and Welfare on the recruitment of residents in 2022, the application rate for plastic surgery is 1806, * 184 for the family1, but the pediatric and adolescent department is only about 25, far from full. In addition, there is a higher risk in the primary medical field, which also increases the avoidance psychology of young doctors. According to international standards, only doctors who commit intentional or gross negligence can be sentenced, but in South Korea, even "minor negligence" can lead to criminal proceedings, and there are cases of detention (actual sentence) in the court of first instance, according to Zhu Xiuhu. Jeon Sung-hoon, head of the legal department of the Korean Medical Doctor Association, said that the biggest reason why doctors are reluctant to engage in basic medical care is the burden of medical litigation. "There are fewer and fewer doctors willing to see patients who are dying at risk. In Zhu Xiuhu's view, this is the problem that needs to be solved urgently, "In the past, doctors didn't like to work in these departments, because it was very hard, but at least they didn't attract dissatisfaction as now." These basic medical departments are barely staffed at the moment, but they could collapse at any moment." He believes that if the medical system does not change, the situation will get worse. More importantly, it is necessary to create "a reason, confidence, and institutional environment for doctors to engage in basic medical services", otherwise no amount of recruitment will solve the fundamental problem. The political game behind South Korea's healthcare reformIf the expansion plan is successfully implemented, it will be the first time since 1998 that a Korean medical school will expand its enrollment. In fact, the number of students enrolled in Korean medical schools has not increased for 27 years, but has shrunk from 3,273 to 3,058 during 2000 and 2006, and has remained unchanged since then. For years, South Korea** has been seeking to expand medical school enrollment as a key starting point for medical reform, but it has repeatedly failed. In 2000, South Korea agreed to reduce the recruitment of medical students, which led to a large-scale strike of doctors that lasted for five months after the reform of medical separation was proposed, and finally agreed to reduce the enrollment of medical students by 10 in order to appease the medical community. South Korea's last doctors' strike occurred in 2020, when Moon Jae-in** also proposed to expand the enrollment and plan to increase the number of medical students by 400 per year, which was also fiercely opposed by the medical community, and was later forced to continue to promote it due to the pressure of the new crown epidemic. From the perspective of the Korean Medical Doctor Association, Zhu Xiuhu analyzed that since 2000, South Korea's previous medical reforms have been bent on going their own way and not listening to the voices of doctors. He also pointed out that doctors are the group with the highest rate of support for Yoon Suk-yeol's election. However, after Yoon Suk-yeol was elected, he thought that he would respect the freedom and autonomy of doctors, but he did not expect to intensify his efforts on the issue of expanding enrollment this time, so the doctors felt "betrayed" and were very angry. Some critics have pointed out that South Korea has been carrying out medical reform in the past, but they have lacked enough bold action. There are also comments that what the previous South Koreans lacked was not courage, but sincerity. In South Korea, every time the medical reform triggers a doctor's strike and provokes conflicts between doctors and patients, the support rate of the "patient" is boosted, which makes the reform a "ballot action" and will also be chosen to stir up the topic during the election season. In April this year, South Korea will hold parliamentary elections, and Yoon Suk-yeol's National Power Party is regarded as "inevitable defeat" by major polls. In this context, Yoon Suk-yeol**'s attitude is particularly tough this time. According to the results of a poll released by Gallup Korea on February 23, Yoon Suk-yeol's approval rating for his administration was 34, an increase of 1 percentage point from the previous survey, and the negative rating was 58, the same as the previous survey. Among the reasons for the highest percentage of praise, the policy of expanding the enrollment of medical students ranked second. On February 26, the Ministry of Disaster Safety Countermeasures issued the "Last Maginot Line": doctors must return to work by the 29th, and those who do not return to work by March will face judicial proceedings such as investigation, prosecution, or may have their licenses revoked for at least three months. On the same day, the Emergency Countermeasures Committee of the Korean Medical Association announced that a three-day national gathering of doctors will be held on the 3rd of next month, and "this will not be the end, but the beginning of a long journey."