This article was written by origami
What happens when doctors in 5 hospitals in a city decide to submit their resignation letters at the same time?
Recently, South Korea's plan to expand medical school enrollment in the 2025 academic year has sparked a rush in the medical community. In order to oppose the expansion, more than 2,700 interns and residents from Seoul, South Korea, decided to submit their resignation letters en masse and stopped working at 6 a.m. on Tuesday 20th. [1]
With the slogan "Medical Prison is Coming Up", these doctors took to the stage.
This massive collective strike stems from a plan to reform medical education.
On February 6, South Korea** announced a transformative plan for medical education: expanding medical school enrollment from the current 3,058 to 5,058 students (+2,000, +65%) by the 2025 academic year, ultimately adding 15,000 doctors to South Korea by 2035. [1]
According to South Korea's statistics, the doctors are all from the top five most well-known hospitals in Seoul. The size of the strike is 37% of the total number of doctors in South Korean hospitals. [1]In addition, these doctors are also the core of the current emergency front line of the hospital. The Korea Association of Interns and Residents (KIRA) said the labor action could lead to the disruption of large-scale surgeries.
The history is similar. In 2020, a large-scale strike movement also broke out in the medical sector in South Korea as part of the reform of the healthcare system in South Korea at that time. The three-day strike was organized by the Korean Medical Association (KMA), which has about 130,000 members. They oppose the **plan to add 4000 medical students over the next 10 years, with about three-quarters of those doctors going to be sent to rural areas of the country for at least 10 years.
At that time, the South Korean public feared that the doctors' strike during the coronavirus pandemic would cause a shortage of medical care, and the plan was eventually withdrawn.
But this time, South Korea's performance seems to be extremely tough, saying that this time the expansion of medical students will be irreversibleIf doctors do do so, they will face severe penalties, including the revocation of their medical licenses.
The response of the Korean medical community to this is that medical students also joined the ** event to announce a strike. Student representatives from 35 of South Korea's 40 medical schools approved a mass strike, according to the Association of Korean Medical Colleges (KAMAC), at an extraordinary emergency committee meeting held on Friday. [3]
**: Only the expansion of enrollment can save Korean medical care
Behind the tension between the two sides is an 18-year enrollment plan.
A foreign propagandist in South Korea told him that the reason why he wants to promote the expansion of medical student enrollment is to reverse the current shortage of doctors with sufficient doctor labor, and the number of medical students enrolled in South Korea has not changed for 18 years, and it has remained at the level of 3,058 students every year. 」
According to official data in 2021, the number of doctors per 1,000 people in South Korea is 26, which is lower than the OECD average of 3Level of 7 people. [4] In the same year, China's "2021 Statistical Communiqué on the Development of China's Health Undertakings" stated that China's practicing (assistant) physicians per 1,000 population in 2021 were 304 people. [5]
Source: Reference 4
Statistically, the number of doctors per 1,000 population in South Korea has not reached the point of extreme shortage. However, Dr. Kang Won-do (pseudonym), a former Korean obstetrician and gynecologist, saidThe real problem with Korean doctors is that they are extremely unevenly distributed, and if I were to average my income with the head of Samsung, I would also be a billionaire. 」
The unevenness is reflected in two dimensions: regional differences and specialty differences.
According to statistics from the Korea Health Insurance Review and Assessment Service in 2020[6], the distribution of doctors varies greatly among districts and counties in South Korea, with the number of doctors per 1,000 population in Goseong-gun, Gangwon Province, which ranks at the bottom, being only 045, but the number of doctors per 1,000 population in Jongno-gu, Seoul, ranked first, is as high as 1629 people.
Among the 250 districts and counties in South Korea, there are 45 districts such as Goseong-gun with less than 1 doctor per 1,000 population, accounting for 18%; In areas where the number of doctors per 1,000 population is below average, there are as many as 192, accounting for 768%。
In addition, the distribution of advanced medical resources between urban and rural areas in South Korea is also very uneven. There are studies that suggest thatAll disciplines in South Korea show a concentration of specialists in densely populated large cities, and the number of specialists in a low-density, economically underdeveloped county is even lower than the number of specialists in a residential community in Seoul.
In the case of urgent needs of residents, there will also be a huge gap in the probability of treatment between urban and rural residents due to objective conditions. According to the Ministry of Health and Welfare, from 2015 to 2017, the emergency disease death ratio in the southern region of Gangwon Province was 209, the southeast area of Seoul is only 085, the former is the 2 of the latter5 times. [8]
Another problem is the mismatch between the areas where doctors are needed and the actual workforce. Dr. Kang said that due to the abundant business prospects and better social status, medical disciplines such as ** medicine, ophthalmology, plastic surgery, and orthopedics are a must-do for all Korean doctors. In contrast, pediatrics, cardiothoracic surgery, general surgery, obstetrics and gynecology, and other disciplines known as basic medical care in South Korea, have a chronic shortage of doctors.
On the one hand, the working environment is not as glamorous as ophthalmology and ** department, on the other hand, the diagnosis and treatment fees of obstetrics and gynecology are low, the cost of medical insurance is less, and doctors do not earn as much as other peers. 」
Park Baek-ho (pseudonym), another M.D. student at Yonsei University in South Korea, believes that the uneven distribution of disciplines may also be due to fear of accountability, with young doctors feeling that specialties such as obstetrics and gynecology and thoracic surgery are more likely to cause medical disputes and lawsuits. In South Korea, the high amount of compensation resulting from medical lawsuits can lead to outright bankruptcy of doctors, so many doctors will actively avoid these disciplines.
In the face of this series of problems, South Korea believes that the expansion of enrollment is a threshold that must be crossed to improve medical care.
In this reform, the South Korean health ministry noted that an increase of 150,000 doctors to meet the growing needs of the country's rapidly aging population and other factors, and to ensure that more doctors have access to essential health care amid growing regional disparities. [9]
However, on the same issue, South Korean doctors think almost exactly the opposite.
Doctor: Expanding enrollment will ruin the entire Korean medical system
In the past few days, I have felt like a knife in my heart, and February 6 (referring to the announcement of the expansion of enrollment reform) is a death sentence for the Korean health care system. [10] Kim Taek-woo, president of the Gangwon-do branch of the Korean Medical Association, delivered an enthusiastic speech at a rally to expand the enrollment of medical students.
At the rally, more than 120 doctors** carried various slogans:
Rapidly increasing medical school enrollment will erode high-quality health care. Koreans are victims of an unwarranted increase in the number of doctors. Medical prisons are on the horizon. 」
During this period, similar events were being held in medical associations across Korea. In response to the complicated topics of the speech, some South Koreans summarized the speeches of the conference, believing that most of the doctors' statements are refuting the logic of expanding enrollment proposed by South Korea.
The Korea Institute of Health and Social Affairs estimates that South Korea will face a shortage of 27,000 doctors by 2035. However, according to the Korean Medical Association (KMA), although the number of doctors per 1,000 population in South Korea is currently below average, it is showing a particularly rapid growth, and there is no shortage of doctors in South Korea. A survey of 27,000 members of the Korean Medical Association showed that 95% of physicians disagreed with the idea that there is a shortage of doctors in Korea. [11]
For example, the president of the Chuncheon Medical Association branch of South Korea saidEven if the enrollment ceiling is not raised, South Korea will have a surplus of doctors due to negative population growth and rapid agingI don't know what we want to achieve with 2,000 more medical students enrolled each year. 」[10]
On the issue of uneven distribution of medical resources, the South Korean medical community also has its own logic, and they believe that the root cause is the lack of medical financial expenditure: South Korea implements universal medical insurance, and the people only bear a lower proportion of medical expenses. However, most of South Korea's medical insurance is financed by the insurance premiums paid by the people, and the subsidy accounts for less than 20%, and it has been in a state of loss for many years.
According to Dr. Jiang's analysis, this is an inevitable result of market regulation. With only 10% of South Korea's public hospitals and 90% of hospitals run by doctors or capitalists, it is inevitable that private hospitals will naturally pursue profitability. In the case of continuous losses in medical insurance and insufficient subsidies, South Korea's medical resources will naturally tend to be in large cities with developed economies and strong consumption power, and avoid less profitable disciplines such as obstetrics and gynecology. 」
Compared with **, who thinks that recruiting more people will lead to people to go to the countryside and to the chest of women and children, the idea of Korean doctors is that as long as the money is in place, the doctors themselves will be diverted to the countryside and to the chest of women and children.
There is a shortage of doctors in the field of pediatrics, there is a shortage of doctors in the countryside, and it is not a problem with the number of doctors, but a problem with policy. The president of the Woncheon Medical Association in Korea told ** that simply issuing more medical licenses will not change the preference of medical students for certain specialties. To prevent the collapse of pediatrics and other essential disciplines, South Korea should raise the cost of basic hospital services. [10]
However, some scholars feel that the views of the doctors' association are not as selfless as they say. Gao Pengxian (pseudonym), a doctor of health economics in a developed country, commented that the behavior of South Korean doctors is somewhat suspicious of safeguarding their elite status and corresponding interests.
After all, there are data that show that Korean doctors are the absolute elite of South Korea, with an average income of 6 of the domestic wage earners8 times. [12] If the pool of doctors expands, the cake of vested interests will become smaller. 」
Dr. Kang, a Korean doctor who used to work in obstetrics and gynecology, offered another perspective, saying that this time the strike was different because medical students were also involved, suggesting that they may not be simply for the loss of money, but for the fear of change and variability. For a profession, when financial freedom can be achieved by simply following the step-by-step process, any variable that could break the step-by-step process is dangerous. 」
Immortal fighting method, what is the patient?
Standing on different sides of interests, all parties in the medical reform have their own thoughts, and the eight immortals cross the sea and show their magical powers. However, in this war of words, the patients whose vital interests are most concerned seem to have been forced to remain invisible.
In March 2023, a South Korean teenage girl fell from a tall building, and multiple hospitals drove away the ambulance that transported her due to a lack of doctors, and the teenage girl died in the ambulance. In May, a 5-year-old child with a high fever died a few days later after being rejected by four hospitals for lack of pediatricians. In the same month, a South Korean man in his 70s was run over by a car and was denied admission by 10 hospitals while being taken to the hospital, eventually dying in an ambulance two hours later.
According to statistics, from 2018 to 2022, there were as many as 37,000 cases of ambulance refusal in Korean hospitals, and one-third of them were due to the lack of relevant doctors.
In fact, from the perspective of the people, everyone is in favor of expanding enrollment. According to the results of a poll released by polling agency Gallup Korea, 76% of respondents gave a positive evaluation of the policy of expanding the enrollment of medical students. [14] On the South Korean internet, the public has shown intolerable voices about the continuous occurrence of medical malpractice in 2023.
Dr. Kang said he hoped that the Korean health care reform would achieve some results. But when asked what results you think will benefit patients, he thought for a moment and said, "I don't know." 」
References: 1].
12].Korean Nation** "The highest monthly salary of Korean doctors in OECD......is 4 7 times that of the average wage earner".
13].HK01 "Four Years Ago - The Great Strike of Doctors - Or a Repeat - South Korea's Massive Increase in Medical Students Threatens to Detonate the Medical Crisis".