THE COVID-19 pandemic has revealed, more than ever, the indispensability of doctors and those working in the healthcare industry. In response to the anticipation of more infectious disease outbreaks as well as the rapidly aging Korean population, the government has pushed for an increase in the medical school admission quota and the establishment of public medical schools. The government’s proposal addresses possible shortages of doctors in Korea—especially in rural regions—and makes an effort to implement preventive measures for future infectious disease outbreaks.

The problems

   Although Korea’s medical system is recognized across the world, many believe Korea may be on the verge of a doctor shortage. Korea’s physician density (doctors per 1,000 people) stands, as of 2018, at 2.39, lower than the OECD average of 3.51; this places Korea among the bottom seven OECD countries*. The number of consultations in hospitals in Korea does not help the case: Korea placed first in the number of doctor consultations per capita that same year with a value of 16.9, significantly higher than the average of 7.1**. Therefore, it is unsurprising that Korean doctors work 3.37 times as much as the OECD average***. Given a low doctor density paired with high doctor workload and demand, it may just be a matter of time before Korea is hit with a shortage.

   Nevertheless, in order to understand Korea’s medical scenario, it is important to take a look into the different regions within Korea—the disparities are staggering. The most recent data from 2019 shows that Seoul has the highest doctor density with a value of 3.1 doctors per 1,000 people, while the provincial areas have values that range from 1.3 to 2.0****. These variances between regions are reflected in hospital recruitments as well. According to Money Today, the “Big 5” hospitals in Seoul, Catholic Central Hospital, Seoul National University Hospital, Samsung Hospital, Seoul Asan Hospital, and Severance Hospital, were able to meet their recruitment quotas with a surplus of applications, while only five provincial training hospitals were able to fill their quotas. The remaining 78.3% faced shortages in the recruitment process. After all, it is in large hospitals in major cities where the tangible merits of being a doctor—job stability, high income, and social reputation—are more likely to be attained.

   Because doctor density is correlated with population, it is also imperative to address Korea’s aging population. In an interview with The Yonsei Annals, Dr. Hong Yun-Chul (Professor, Dept. of Preventive Medicine, Seoul National Univ.), who conducted a study on Korea’s medical resource availability, explains the imminent risks of Korea’s aging population. “As of 2020, the proportion of the elderly population aged over 65 accounts for 15% of the population, and this value is expected to reach 25% by 2030. This increase of the elderly population will come with escalating frequencies of neurodegenerative diseases such as Alzheimer’s, as well as chronic diseases.” In other words, Korea’s aging population is expected to surge the demand for medical care, and Korea’s current doctor density growth rate is worrisome to many, including Dr. Hong.

   Although the disparities have been present throughout the years, the ongoing COVID-19 pandemic and Korea’s aging population have emphasized the need to increase the availability of medical services across the entire country, with a focus in rural areas. Accordingly, in July 2020, the government announced plans to foster and reinforce Korea’s medical field based on an increase in the medical school admission quota and the development of public medical schools mainly through the reestablishment of Seonam University in 2024.

The policy

   For the first time in 14 years, the government announced plans to increase the medical admission quota, which has stood at 3,058 since 2006. The plan involves increasing the quota by 4,000 in a span of ten years—from 2022 to 2032—by admitting 3,458 every year within the given period. In efforts to address the anticipation of infectious disease outbreaks in the future, 12.5% of the additional admittees (50 every year, 500 in the span of ten years) will be allocated towards the field of epidemiology*****, in addition to severe trauma and pediatric surgery. Another 12.5% will be devoted towards basic science, pharmaceutical, and bio-applicative research, and these will be allocated in provincial, research universities******. Despite numbers being set, there is uncertainty in how the policy will materialize these changes within the current system.

   The remaining 75% (300 yearly, 3,000 total) will be allocated in efforts to send doctors to rural regions by creating a university admission track whose name roughly translates to “Local Doctor Screening.” According to The Hankyoreh, students admitted to this track will be required to work for at least ten years in provincial areas (in addition to the 11 years of medical study); if they fail to do so, they will face the threat of having their medical licenses suspended. Accordingly, the requirement to conform to nearly 20 years in a rigid system has generated insecurity from both the opposition and the supporters. Prospective students will face a decision that will define the next two decades of their lives, yet there is no concrete guideline on how they will be supported throughout the track. This lack of incentivization and security has raised questions on the long-term implementation of the policy as well as the investments that will be needed; if the admissions process faces a shortage in applicants or underperformance, the quota will have to be cancelled.

Will the policy be effective?

   When the government announced its plans to increase the quota of medical school admissions, the response from the medical community was mixed. On August 7th this year, over 10,000 medical students, intern residents, and specialists across the country took the streets to protest the government’s plans, which are being carried out “without regard of the standing medical community” and its recent efforts to fight the COVID-19 pandemic. Despite Korea’s low doctor density, Korea has a high number of beds per 1,000 people (12.4) and the highest value of outpatient care per capita (16.9), compared to the OECD’s average of 4.5 and 6.6, respectively. As a result, many argue that a low doctor density paired with low costs and good facilities is what gives Korea’s medical system its efficiency*******.

   The opposition is divided as well. While some, as previously mentioned, completely oppose the increase in quota, others agree with the increase but believe there needs to be a more rigid and clear approach to the policy. Regarding the establishment of public hospitals in Korea’s mostly privately-funded medical scenario, Dr. Hong restates the necessity to increase the supply of public hospitals but believes there have to be ways to make these public institutions cooperate with the current private medical system. Furthermore, Dr. Hong emphasizes the extended period that must be considered when implementing the policy—the years, if not decades, to train doctors and establish the necessary infrastructure—as well as the long-term monetary and personal expenditures. If there are no proper guidelines, as Dr. Hong affirms, “inaccuracies in judgement” may result in adverse societal effects following these considerable periods of time.

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   Despite various views on the policy, both supporters and the opposition agree that communication with the medical community has to improve. Infectious disease outbreaks and aging populations indiscriminately threaten society as a whole, so the active involvement of all societal stakeholders, and their differing stances, is indispensable. Although Korea already takes a reputable place in the medical industry around the world, change and adaptability may become more crucial in the coming years of both anticipated and unprecedented threats.

*OECD Statistics

**OECD Statistics

***Korea Biomedical Review

****Statistics Korea

*****Epidemiology: The study of the spread of infectious diseases

******Money Today

*******JoongAng Ilbo