The Causes Behind the South Korean Medical Resident Strike

Masahiro Kami, M.D., Ph.D. President, Medical Governance Research Institute, Tokyo, Japan

The collective strike by medical residents in South Korea has become a topic of global discussion. Not only has it been covered by our national media, but on April 4th, the "New York Times" in the United States also published an extensive explanatory article. Why has such a situation arisen in South Korea? This paper aims to discuss the background.

Increasing Medical Demand in South Korea

The medical circumstances in South Korea and Japan are similar. South Korea's total fertility rate was 0.78 in 2022, lower than Japan's 1.26, and the aging rate (percentage of the population over 65) was 17.4% in 2023, expected to reach 24% by 2030. Although not as high as Japan’s 29.1% in 2023, the progression of aging is severe.

With the aging population, medical demand increases. However, South Korea has fewer doctors. The doctor per 1,000 people ratio was 2.6 in 2022, significantly below the OECD average of 3.7, similar to Mexico (1.8), Chile (2.2), and Turkey and Poland (both 2.4), making it one of the countries with a doctor shortage.

The regional disparity is also severe, with Seoul having 3.5 doctors per 1,000 people, almost the same level as Tokyo. In contrast, Gyeonggi-do has only about half that number, 1.8. This situation is unlikely to be resolved soon, primarily because South Korea has fewer medical graduates. As of 2021, the number of medical school graduates per 100,000 population was 7.3, among the lowest in OECD countries.

South Korea should have increased the number of medical trainees. Like our country, the training of doctors in South Korea is under government control, but the government has continued without any policy. Medical school capacities have not been increased since 1998.

Of course, the government was aware of the issue. Under the Moon Jae-in administration until May 2022, the establishment of a national public health medical university was considered. Managed by the Ministry of Health and Welfare, which corresponds to Japan's Ministry of Health, Labour and Welfare, the training institution would offer free tuition. However, in exchange, after obtaining a medical license, doctors must work as civil servants in regional areas for ten years.

This system is similar to Japan’s Jichi Medical University and medical school regional quotas, likely serving as a reference. If doctor shortages and disparities become issues, the actions taken by countries tend to be similar. However, such measures alone will not resolve the shortage of doctors in South Korea. When I asked a journalist friend from the South Korean media, the response was, "It’s a case of six of one, half a dozen of the other."

Doctors' Opposition to the "Quadruple Increase" Policy of the Previous Administration

The establishment of new medical schools was interrupted by the onset of the COVID-19 pandemic. With all hands on deck for coronavirus response, setting up new medical schools was not feasible. However, the pandemic exacerbated the medical crisis in South Korea, especially highlighting the severe shortage of medical services in rural areas.

As a result, discussions to increase medical school capacities beginning with the 2023 academic year started, proposing to increase the current capacity (about 3,000 students) by approximately 500. However, strong political forces such as the Korean Medical Association opposed the expansion, and the medical school capacities remained unchanged. This situation resembles the opposition by the Japan Medical Association to increasing medical school capacities. Considering the needs of the South Korean people, the number of trained doctors must be increased. However, vested interests in South Korea hold veto power, much like in Japan.

In the midst of these wandering discussions, in February, the South Korean government announced plans to increase medical school capacities from 3,058 to 5,058 starting the next year, aiming to reach up to 15,000 by 2035. Given that this represents a quadruple increase compared to the previous administration, it was an untenable proposal.

As expected, the medical community strongly opposed this. In early March, medical residents across the country submitted their resignations en masse, with about 12,000, or 90% of all residents, leaving their jobs.

Medical residents primarily work in regional core hospitals. In South Korea, residents make up about 40% of the medical staff in these hospitals. The simultaneous departure of residents plunged the medical scene into chaos.

The remaining doctors were burdened significantly. On March 24th, a 40-year-old professor from Busan University Hospital, who had taken over the clinical duties of residents, died of a cerebral hemorrhage. The Korean media reported, "The professor had been handling outpatient visits, overnight duties, and emergency surgeries since the mass resignation of residents last month and had expressed his fatigue to those around him," (Chosun Ilbo, March 25th), indicating a potential death from overwork. On March 25th, over 3,000 medical faculty members collectively submitted their resignations, further escalating the chaos. Medical students also followed suit, with a mass refusal to take the national medical examination and announcements of leaves of absence.

Despite the chaos in South Korea's medical scene, the government did not retract its policy. At the end of February, it sent warning letters to the homes of striking doctors, implementing disciplinary actions such as license suspensions for three months starting in March. On March 20th, the government announced its decision to stick to its original plan and increase the medical school capacities outside of Seoul by about 2,000 starting the next year.

The "Medical Capacity Increase" Used as a Political Tool

In our country, the cabinet decision to increase medical school capacities was made in 2009. That year, the Liberal Democratic Party's popularity was low, and the Democratic Party took over the government in the general election. Even though the Japan Medical Association opposed it, increasing medical school capacities appeared as an attractive policy to the then Aso administration to boost its popularity.

Doctors are seen as social elites. Even if they are somewhat neglected, they do not face backlash from the public. This tendency is especially pronounced in South Korea. According to OECD statistics from 2021, the average annual income of doctors in South Korea was $192,000 (based on purchasing power parity), the highest, surpassing Germany and the Netherlands. This is why, even if medical residents and university professors collectively oppose it, the government proceeded with the increase in medical school capacities.

The number of trained doctors in South Korea will increase under government leadership. Patient-centered care will take a back seat to political convenience. The medical scene will likely become increasingly chaotic. What should we learn from South Korea? I believe that doctors, as traditional professionals, should prioritize patient benefits. The shortage of doctors in South Korea is clear. Why was the collapse of regional medical services ignored? Proposals to increase medical capacities should have come earlier from the doctors themselves. If they had led the discussion, they could have better protected the interests of both patients and doctors.

This article is Osaka Health Insurance Newspaper published on May 25, 2024