[Initial Perspective] Medical Reform, Details Matter

Attention to Japan's Case of Establishing 'Jachi Medical College'
Medical Quality Declines Without Supporting Educational Infrastructure

"A country where phrases like 'emergency room round trips' and 'pediatric open runs' become popular cannot be called a good country."

President Yoon Suk-yeol strongly indicated his determination for medical reform at the eighth public discussion on livelihood issues held on the 1st, accelerating the expansion of medical school quotas. President Yoon reaffirmed his commitment to the policy, stating, "If the medical reform desired by the majority of the people is rolled back due to opposition or resistance from a few, it is no different from abandoning the fundamental role of the state." Following this, the Ministry of Health and Welfare finalized the number to increase the quota of new medical students by 2,000 starting next year, and medical associations, taken aback by the unexpectedly large number, have announced collective action, escalating the situation to a critical point.

Even during the Lunar New Year family gatherings, the expansion of medical school quotas was one of the hottest topics at the dinner table. When the policy to increase the nationwide medical school quota by 2,000 students from next year?breaking the 19-year-old cap of '3,058 students'?was announced, local residents who had suffered from medical disparities expressed hopeful expectations. The government stated that the expanded quota of 2,000 students would be concentrated in non-capital region medical schools, and more than 60% of new students would be selected through regional talent admissions.

The problem lies in the details. In the medical field, it is pointed out that "the trickle-down effect the government expects may not be as significant as anticipated." According to the Ministry of Health and Welfare, the number of doctors working at clinic-level medical institutions labeled as plastic surgery was 1,769 in January 2022, a 76.4% increase from 1,003 ten years earlier. During the same period, the number of doctors at dermatology clinic-level medical institutions also increased by 39.6%. Even if the medical school quota is significantly increased, if these doctors flock only to popular specialties such as plastic surgery and dermatology, the issues of 'pediatric open runs' and 'emergency room round trips' are unlikely to be resolved.

The government is pursuing measures to strengthen essential medical care by introducing a regional essential doctor system and regional medical fees as alternatives, but there are concerns that these efforts may be insufficient. In Japan, for example, the 'Jichi Medical University' was established in 1972 with the purpose of training doctors to work in local areas, and when looking at the proportion of graduates working in the least densely populated regions, those from Jichi Medical University accounted for the highest at 65.8%. Japan is also securing regional medical personnel by implementing a 'regional quota system' that supports students willing to work in local areas after graduating from medical school.

Opposition lawmakers pointed out, "Jichi Medical University is similar to the 'public medical school' promoted by the Democratic Party of Korea, but the current government is not considering this." The medical community criticized, "It is overly optimistic to think that problems such as concentration and medical disparities will gradually be resolved over time if the medical school quota is increased," adding, "Without a definite plan to build educational infrastructure corresponding to the increased quota, the quality of medical care will decline, and ultimately, the public will bear the consequences."

Whether the government can gain momentum to push the policy forward despite strong opposition from the medical community is a key issue. This is not the first attempt to expand the medical school quota. In 2020, residents launched collective action against the government's plan to increase medical school quotas, resulting in the cancellation of the expansion. At that time, over 80% of residents left the medical field, causing a significant medical vacuum, forcing the government to back down. There is a high risk of such a situation recurring. Even Japan, which has seen some success with the establishment of Jichi Medical University, has repeatedly experienced numerous trials and errors to resolve regional doctor shortages and strengthen essential medical care. The difficulties faced by previous governments in implementing this policy indicate the magnitude of the challenges. For the expansion of medical school quotas to serve as a stepping stone toward becoming a medical advanced country, wisdom to deeply examine the details and enhance the completeness of the policy must accompany it.