[Public Voices] Can Expanding Medical School Admissions Prevent the Collapse of Essential Medical Services?

"We will increase the number of medical school admissions by more than 1,000."

The sudden announcement that emerged after the ruling party lost the by-election for the Gangseo District Office was a black hole declaration that overshadowed other news. As expected, public interest and support were tremendous.

In 2020, when the Democratic Party of Korea was the ruling party, efforts to expand medical school admissions, establish public medical schools, and introduce a regional doctor system lost momentum due to medical sector strikes during the COVID-19 pandemic. Now, as the card of expanding medical school admissions is raised again, the public watches with mixed feelings, wondering if it will succeed this time.

South Korea’s medical technology is world-class, medical costs are relatively low, and patient accessibility is good. For these reasons, it is regarded as a "medical advanced country," greatly contributing to public health. However, recent worsening of emergency room cycling and pediatric department open-run incidents have made the public experience the seriousness of medical service gaps in rural and vulnerable areas. In other words, due to the "collapse of essential medical services," public interest in the healthcare system has increased, making it a priority in livelihood policies. As a result, a consensus on expanding medical school admissions has formed.

However, the reality is not easy. The crisis of essential medical service collapse is deepening, starting with obstetrics and gynecology, thoracic surgery, pediatrics, surgery, and emergency medicine. Yoon Han-duk, director of the Central Emergency Medical Center, died suddenly from overwork at his office desk during Lunar New Year duty. Professor Song Joo-han of the respiratory medicine department at Severance Hospital, who was in charge of critical patients, suffered a cerebral hemorrhage during a seminar but was mistaken for dozing off, delaying response; he remained in a prolonged coma and eventually passed away. Professor Joo Seok-jung, a thoracic surgeon at Asan Medical Center who waited at his home near the hospital to respond immediately to emergency surgeries, died in a traffic accident in front of the hospital, causing much sorrow. Every year, 3,058 newly graduated doctors tend to choose popular specialties with less labor intensity and higher income, such as so-called "PiAnSeongJeongJaeYoung" (Dermatology, Ophthalmology, Plastic Surgery, Orthopedics, Rehabilitation Medicine, Radiology), rather than essential medical fields, deepening medical polarization.

Assemblywoman Shin Hyun-young

How can we blame young doctors choosing specialties from the perspective of MZ generation (Millennials + Generation Z) labor as merely an individual problem? Even the Minister of Health and Welfare confessed during last year’s national audit that if he were a doctor, he would choose a specialty with a guaranteed income and good working conditions. This reflects the government’s recognition that the collapse of essential medical services is a national urgent issue requiring countermeasures.

If we recklessly expand medical school admissions while neglecting the harsh working conditions of essential medical services, problems such as substandard medical schools, low-quality doctors and medical practices, unnecessary medical oversupply, threats to health insurance finances, and moral hazard from medical commercialization will run rampant. The rosy hope that the essential medical service gap will be resolved automatically through a trickle-down effect is an illusion. Ten years from now, it is obvious that only administrative resources will be wasted to manage the situation. At that time, there is no guarantee that a desperate situation requiring the recruitment of foreign doctors to secure essential medical personnel will not arise.

A competent government that can properly read changes in the medical field should have first announced substantial alternatives based on evidence-based medical workforce projections for securing essential medical doctors (if expansion is necessary, there will be times to reduce), appropriate compensation systems, institutional efforts to improve the harsh 3D working conditions, safety nets against punitive medical lawsuits that increase with critical patient care, national liability insurance design, and full support and responsibility enhancement for essential medical specialty trainees before announcing popularity-driven policies like expanding admissions. If the expansion of medical school admissions had been announced as a follow-up task after that, it would have sufficiently offset the medical community’s grounds for opposition.

To prevent our society’s "doctor preference phenomenon," such as making our children doctors, elementary school medical school prep classes, and science and natural science students repeatedly attempting medical school entrance exams, from turning into populism, it is necessary to create a social atmosphere that can shift to mature discourse on "what is a good doctor, and what kind of doctor is needed in our era?" When doctors who wear the white coat not for stable jobs or high income but out of humanitarianism and concern for medical advancement and health become the mainstream, solutions and skills will be properly demonstrated amid the low birthrate and super-aged society crisis.

The 140,000 doctors who have led South Korea’s medical field to a world-class level are hoped to continue to take pride as guardians of public health. When the professionalism and social responsibility of doctors are strengthened, respect and trust from society and patients will be solidified. A national system must be established in the entire medical education cycle?from medical school entrance exams, medical education, to doctor training?that allows doctors to fully feel their social role, responsibility, pride, and fulfillment. It is earnestly hoped that 2024 will be a year when the National Assembly, government, and medical community cooperate to shift to a paradigm for proper doctor training.

Shin Hyun-young, Member of the Democratic Party of Korea