[Insight & Opinion] True Medical Reform Must Begin with the Ministry of Health and Welfare

The government’s politically engineered move to increase medical school admissions by 2,000 has backfired, becoming a self-inflicted wound that contributed to the ruling party’s crushing defeat in the general election. This is a consequence the government brought upon itself by branding the medical community?which had been the most dedicated in overcoming the COVID-19 pandemic?as a “demonic criminal group.” The government, which insisted it would push through reforms based on “scientific research” through “mechanical law enforcement,” has lost its way amid fierce opposition from medical students, residents, and medical school professors.

Social costs are snowballing. Over the past two months, the government has wasted 504.9 billion won. For a government that recorded a deficit of 87 trillion won last year, this is an unbearable cost. Training hospitals are collapsing as 12,000 residents (interns and residents) have left. Revenues at 50 training hospitals have dropped by 423.8 billion won. Some hospitals have entered emergency management mode, and others have started accepting voluntary retirement applications.

Despite Deputy Minister Park Min-su’s illegal and unethical threats and intimidation, the residents who left hospitals remain steadfast. To make matters worse, 2,937 medical school graduates?95.7% of the total?gave up their internship training in the first half of the year. Only 131 interns newly registered at training hospitals. This means that training hospitals are collapsing financially and structurally.

The situation at medical schools is also bleak. Despite the Ministry of Education’s trickery to prevent “group” failures, large-scale failures are becoming a foregone conclusion. Increasing the number of medical school professors by 1,000 is practically impossible. Instead of increasing the number of doctors in 10 years, we can only worry about the current shortage of doctors and medical education. The collapse of science and engineering universities due to extreme concentration on medical schools must also be a concern.

This is not the time for the president to boast that he will “listen carefully to reasonable opinions.” Once universities finalize next year’s admissions guidelines, the situation will become irreversible. The concern is not only about the imminent deterioration of medical education. Current training hospitals will be unable to accommodate the flood of medical school graduates six years from now. If this happens, 90% of the medical staff at training hospitals will be filled with interns, residents, and fellows. This means a real “medical crisis” where training hospitals lose their function as tertiary care institutions.

Responsibility must be held with the Ministry of Health and Welfare, which has brought the situation to this state. It is true that the Ministry of Health and Welfare has played a role in amplifying conflicts among doctors, nurses, pharmacists, oriental medicine doctors, as well as hospitals and the pharmaceutical industry. The 2000 separation of dispensing and prescribing, the 2005 medical graduate school system, the 2011 pharmacy “2+4 year” system, the 2014 telemedicine, and the 2020 public medical school were all disastrous failures far from “scientific rationality.”

The restructuring of medical graduate schools and pharmacy education has become a non-issue since last year. Telemedicine and public medical schools have not even started. The 2000 reduction of medical school admissions by 350 was a speed control due to a shortage of training hospitals. The core controversy in 2020 was not the increase of 400 admissions but the unconstitutionality of the 10-year mandatory service rule and the illegality of “special admissions for activist children.” The Ministry of Health and Welfare’s poor medical administration also fueled conflicts among doctors, nurses, pharmacists, and oriental medicine doctors.

Increasing the number of doctors is a matter of a different dimension than increasing the number of lawyers. No country has ever expanded medical school admissions by as much as 65% at once. True medical reform must begin by fundamentally overhauling the Ministry of Health and Welfare, which ruined medical administration by demonizing doctors.

Lee Deok-hwan, Professor Emeritus, Sogang University