[Issue Analysis] "Even if the number of medical school seats increases, students avoid undesirable specialties and rural areas, only raising medical costs"

Government to Increase Medical School Quotas for the First Time in 19 Years
Medical Associations Vow to Use All Means for Full Response

The government is increasing the number of medical school freshmen for the first time in 19 years. It is considering a plan to increase the nationwide medical school admission quota by more than 1,000 students starting in 2025. Medical associations are opposing this, stating that if the government adjusts the medical school quota without consultation, they will respond with all means, including strikes.

According to combined reports from the ruling party, government, and the National Assembly's Health and Welfare Committee on the 17th, the government is discussing a plan to increase the admission quota of 40 medical schools nationwide, which has been 3,058 students annually since 2006, by more than 1,000 students starting from the 2025 academic year entrance exam taken by current high school sophomores. This number is nearly double the increase initially considered by the Ministry of Health and Welfare.

Increasing the medical school quota has been a long-standing issue. Due to demands from medical associations opposing the 2000 'separation of prescribing and dispensing,' the medical school quota was reduced by 10% until 2006. Since then, the domestic medical school quota has remained at 3,058 students for 18 years. During the 2020 COVID-19 crisis, which caused a medical emergency, the Moon Jae-in administration planned to increase the medical school quota by 400 students annually for ten years, but retreated due to strong opposition from doctors. The government and medical associations agreed to form a consultative body to discuss the medical school quota issue after the COVID-19 situation stabilized. Earlier this year, the government and medical associations resumed discussions in the Medical Issues Consultative Body.

Shortage vs Sufficiency of Doctors

The government judged that expanding the medical school quota is necessary to address essential medical service collapses in pediatrics and obstetrics, shortages of medical personnel in rural areas, and issues caused by aging populations. According to Ministry of Health and Welfare data, in 2020, the number of medical school graduates per 100,000 people in Korea was 7.2, which is 56% of the OECD average of 13.6. Even with a drastic increase of 1,000 students annually starting next year, by 2035, the number of doctors per 1,000 people is expected to be only 2.88, which is 64% of the OECD average of 4.5. A government official explained, "As the aging population, which increases medical demand, progresses further, essential medical services will deteriorate uncontrollably. This is the background for increasing the medical school quota, which previous administrations have not dared to touch."

The stance of medical associations differs. The Korea Institute for Health and Social Affairs stated, "Even if the current medical school quota is maintained, considering doctor output and demographic changes, Korea's number of doctors per 1,000 people will quickly catch up to the OECD average." They added, "Although Korea's current number of practicing doctors per 1,000 people is lower than the OECD average, the rate of increase in Korea's practicing doctors per 1,000 people is higher than the OECD average." They claim that by 2040, Korea will have 3.85 doctors per 1,000 people, while the OECD average will be 4.83, narrowing the gap to 0.98 doctors, less than one. The institute further analyzed that by 2055, Korea will have 5.34 doctors per 1,000 people compared to the OECD average of 5.83, reducing the gap to 0.49, and by 2063, Korea (6.49) will surpass the OECD average (6.43). Professor Nam Ju-yeol of Namseoul University's Department of Health Administration said, "Currently, Koreans use medical services about three times more per capita than major OECD countries. When expanding the medical school quota, the socioeconomic costs of oversupplying doctors must also be considered."

Unresolved Avoidance Departments vs Strong Incentives

Medical associations believe that increasing the number of doctors will lead to higher medical costs. They argue that increased medical costs due to more doctors will result in higher national health insurance premiums, burdening the public. Between 2005 and 2020, the medical care expenses per doctor in Korea were 237.783 million KRW in 2005, 351.905 million KRW in 2010, 422.971 million KRW in 2015, and 565.886 million KRW in 2020.

According to the Korean Medical Association, assuming the current medical school quota is maintained and applying this to future medical care expense projections, total medical care expenses in 2025 will be 123.3757 trillion KRW, with medical care expenses at 86.1636 trillion KRW; in 2040, total medical care expenses will be 333.6472 trillion KRW, with medical care expenses at 232.4186 trillion KRW. Assuming an increase of 350 medical school students, total medical care expenses in 2040 would increase by about 6 trillion KRW compared to maintaining the status quo. If the quota increases by 1,000 students, total medical care expenses in 2040 are estimated to rise by about 17 trillion KRW. A Korean Medical Association official criticized, "It is naive to think that surplus doctors will move into essential medical fields if doctors are produced in sufficient numbers."

The government plans to introduce incentives to attract doctors to essential medical fields alongside increasing the number of doctors. Minister of Health and Welfare Cho Kyu-hong said at a parliamentary audit, "Medical imbalance between regions is due to medical fees, infrastructure, and living conditions. We will start by adjusting medical fees." The government is expected to adjust fees for essential medical fields such as surgery, pediatrics, and emergency rooms (medical fees paid to hospitals and clinics from health insurance funds). Currently, Korea operates a fee-for-service system where medical personnel receive payment based on services provided, leading to a concentration of medical personnel in metropolitan areas where many services can be offered.

The government also plans to propose removing or easing regulations on 'quota size' and 'total personnel expenses' for national university hospitals. It is known that the government is leaning toward increasing quotas mainly in regional medical schools. Even if regional medical centers outside metropolitan cities offer specialist recruitment with annual salaries of around 300 to 400 million KRW, it is difficult to find candidates. Recently, a general hospital in Cheongju posted two specialist recruitment notices with an unprecedented annual salary of 1 billion KRW, but there were zero applicants.

Willing to Strike vs Public Opinion Supports Increase

Medical associations have stated that they are willing to go on a general strike if the plan to increase the medical school quota is announced. The Korean Medical Association plans to hold a nationwide doctors' representatives meeting in the afternoon to discuss responses to the recent medical school quota expansion issue. Public opinion is cold. According to a 'National Medical Issues Survey' released by Kim Won-yi, a member of the National Assembly's Health and Welfare Committee from the Democratic Party, the majority of the public believes the medical school quota should be increased by 300 to 1,000 students. Among them, 24.0% responded that the quota should be increased by more than 1,000 students.

Earlier, in a public opinion survey by the National Health and Medical Industry Labor Union, more than half of the public thought there was a shortage of doctors, and 7 out of 10 supported increasing the quota. The Health and Medical Labor Union commissioned 'Southern Post,' a public opinion research agency, to conduct a 'National Public Opinion Survey on Health and Medical Workforce Status and Expansion' from March 21 to 28, targeting 1,000 adults aged 19 and over across 17 cities and provinces nationwide. The survey found that 58.4% of respondents said there is a shortage of doctors. By region, Jeonnam had the highest response rate for doctor shortage at 81.3%, followed by Ulsan at 69.7%, Jeonbuk at 69.4%, Chungnam at 68.7%, and Daejeon at 65.7%. The biggest inconveniences caused by doctor shortages (multiple responses allowed) were long waiting times for treatment (69.7%), difficulty making appointments (57.9%), insufficient consultation time (50.0%), and inadequate explanations about treatment and tests (37.1%). Support for expanding the medical school quota to solve the doctor shortage was 66.7%, 23.5% were unsure, and 9.8% opposed.

The Health and Medical Labor Union stated, "This survey clearly confirmed public opinion that health and medical personnel should be expanded and appropriate medical personnel standards established," and urged, "The government should not delay any longer and must take action to eradicate illegal medical practices, expand the medical school quota, and establish appropriate medical personnel standards."