[Exclusive] From the Start of Legislative Consultations to Collapse... Obtained Internal Report Document of the Korean Medical Association

Record of 27 Legislative Consultations Over 367 Days
Negotiation Team Hardliners Replaced After Government Surveys Demand for Medical School Expansion
Scale of Medical School Expansion Never Mentioned in Meetings

The Seoul High Court's deadline for the government to submit the minutes of the medical school expansion meetings passed on the 10th. Among the three government meetings related to the medical school expansion, the Medical Issues Consultative Body meetings held 27 times between the Ministry of Health and Welfare and the Korean Medical Association were conducted without minutes by mutual agreement, and the government reportedly submitted only related briefing materials to the court. The exact content of the meetings remains shrouded in secrecy.

The first page of the Medical Issues Council Operation Status document prepared by the Korean Medical Association for internal reporting purposes.

Asia Economy obtained an internal report document from the KMA titled 'Status of Operation of the Medical Issues Consultative Body' related to these meetings. This document was prepared on February 14. It is 19 pages long and summarizes the main contents of the 27 meetings held over 367 days in chronological order. According to the document, there was never any mention of increasing the number of medical school admissions during the 27 meetings.

The initial atmosphere of the medical-government consultations recorded in the document was not particularly bad, but the differences in positions between the two sides were clearly revealed. At the first meeting held on January 30 last year, both sides decided to actively discuss various tasks aimed at 'strengthening essential medical care and improving the medical system' and to review specific implementation plans for 'essential medical care support measures,' agreeing to discuss these core tasks within the consultative body. Subsequently, at the 2nd and 3rd meetings, they agreed to discuss ▲non-face-to-face medical treatment ▲strengthening essential and regional medical care ▲hospital bed measures and other medical system improvement plans ▲normalization of medical education and improvement of working conditions.

Differences began to appear from the 4th meeting held on March 22 of the same year. The Ministry of Health and Welfare proposed as measures to strengthen essential and regional medical care ▲reallocation of essential medical personnel to strengthen essential medical care and resolve regional medical imbalances ▲efficient utilization and training. On the other hand, the KMA proposed ▲enactment of the (tentatively named) 'Essential Medical Accident Handling Special Act' ▲restriction on opening branches of metropolitan university hospitals as alternatives. From this point, the government and the medical community started talking past each other.

During this period, the medical negotiation team repeatedly insisted three times in the 3rd to 5th meetings on 'blocking the establishment of branches of metropolitan university hospitals that destroy the regional medical ecosystem.' The 6th meeting records include the phrase 'agreed to mutually cooperate and make efforts to prepare legal and institutional measures,' suggesting that the differences on this issue were narrowed at a fundamental level. The medical community's demand to ban branches of metropolitan university hospitals continued steadily until the 22nd meeting in December of the same year. Currently, university hospitals have branches in several metropolitan areas including satellite cities of Seoul, with a combined capacity of 6,600 beds. The medical community fears that these branches will absorb patients from local primary care institutions such as neighborhood clinics, and some argue that the government's plan to increase medical school admissions by 2,000 students is intended to secure low-wage residents to supply newly opened metropolitan university hospitals.

From the 7th meeting held on April 20, the Ministry of Health and Welfare gradually began to raise the necessity of increasing medical school admissions. They requested that the KMA discuss the basic principles and reasonable directions for expanding essential medical personnel at the KMA's regular general assembly. At the 8th meeting that followed, they emphasized the need for training and expanding medical personnel for regional and essential medical care.

Lee Hyung-hoon, Director of Health and Medical Policy at the Ministry of Health and Welfare (second from the left), is attending the '2nd Medical Issues Council' held on February 9 last year at Conference House Dalgaebi in Jung-gu, Seoul, delivering opening remarks. Photo by Dongju Yoon doso7@

At the 10th meeting, the medical community expressed the opinion that rather than increasing medical school admissions, fundamental solutions such as creating a medical environment where medical personnel can voluntarily enter regional and essential medical care are necessary. The Ministry of Health and Welfare agreed with the medical community's opinion but counter-proposed to the KMA, "Let's prepare a plan so that appropriately reviewed and expanded medical personnel based on scientific evidence can flow into essential and regional medical care." This was a euphemistic way of saying they intended to increase medical school admissions.

After ten meetings, the KMA showed dissatisfaction. At the 11th meeting held on June 15, they requested feedback from the Ministry of Health and Welfare on the proposals they had made so far. In response, the Ministry disclosed the review status and future plans regarding the KMA's proposals.

As the 12th meeting scheduled for the end of the same month approached, the medical-government conflict intensified. Minister Cho Kyu-hong of the Ministry of Health and Welfare announced two days before the meeting that the issue of medical school admissions would be newly started at a subcommittee under the Health and Medical Policy Deliberation Committee (HMPDC).

The KMA immediately raised the issue, insisting that discussions on medical school admissions be based on the September 4 medical-government agreement. Previously, the government and the KMA had agreed in the 2020 September 4 medical-government agreement that the issue of expanding medical school admissions would be discussed within the medical-government consultative body. In response, the Ministry stated, "We will sincerely discuss the issue of medical school admissions with the KMA in the consultative body," but added, "Expanding medical school admissions requires gathering opinions from various fields including medical service users and experts."

Then the medical community hinted at a hardline struggle. At the 14th meeting held on September 21, the KMA reiterated the opinion that "discussions on training medical personnel should be conducted in the consultative body, not the HMPDC." However, this opinion was not accepted. On October 15, the People Power Party, government, and the Presidential Office held a closed high-level party-government meeting at the Prime Minister's official residence to discuss 'measures to improve access to medical services.' When reports emerged that the party-government meeting decided to increase medical school admissions by 1,000, the Presidential Office denied the reports as groundless.

Two days later, on October 17, the KMA held an 'Emergency Representatives Meeting to Respond to Medical School Admission Expansion.' Through the 'Medical Community Representatives Resolution,' the KMA demanded ▲faithful implementation of the September 4 medical-government agreement ▲listening to the medical community's opinions to prepare fundamental measures to save essential and regional medical care, and declared that if the government forcibly pushes forward with medical school expansion, they would strongly resist including through struggle.

On the afternoon of October 17 last year, Il-soo Lee, former president of the Korean Medical Association, gave a greeting at the "Emergency Medical Representatives Meeting to Respond to the Expansion of Medical School Quotas" held at the Korean Medical Association in Yongsan-gu, Seoul.
[Image source=Yonhap News]

At the 15th meeting held on October 26, the expansion of medical school admissions was mentioned as one of the measures for essential medical personnel placement, training, and improvement of working conditions. At this meeting, the Ministry explained, "Expanding medical school admissions is just one means to save essential and regional medical care, and the expansion itself is not the goal."

However, the government conducted a survey the next day, October 27, targeting 40 medical schools nationwide to assess the demand for expansion and the capacity to accommodate students, in order to understand the field demand and feasibility as well as the medical infrastructure situation.

Subsequently, there was a major change in the composition of the consultative body. On November 3, the KMA General Assembly issued a recommendation to "reorganize the medical negotiation team and actively negotiate with the government." According to KMA officials, this recommendation was a measure to put forward a tougher figure amid internal criticism that the meetings were proceeding according to the Ministry's intentions. In particular, the government's survey on expanding medical school admissions nationwide on October 26 without going through the Medical Issues Consultative Body played a significant role, according to KMA officials.

Accordingly, the second KMA consultative negotiation team was newly formed with Yang Dong-ho, chairman of the Gwangju Metropolitan Medical Association General Assembly, as the new leader. Yang served as co-chairman of the '2nd Emergency Countermeasures Committee to Block the Nursing-Only Act' in 2022. At the 17th meeting on November 15, the first attended by the 2nd negotiation team, both sides selected key tasks to discuss in future consultative body meetings, including ▲appropriate compensation ▲establishment of the medical delivery system ▲improvement of the personnel system. Broadly, the KMA maintained the position that fundamental measures such as appropriate compensation are a priority to normalize essential and regional medical care. The Ministry requested the KMA to participate in discussions not only on appropriate compensation and legal burden relief but also on measures to expand medical personnel.

Former Korean Medical Association President Lee Pil-su is shaving his head at the nationwide doctors' representatives and expanded executives joint meeting held on November 26 last year at the Korean Medical Association Hall in Yongsan-gu, Seoul, to discuss countermeasures against the expansion of medical school quotas.
[Image source=Yonhap News]

On November 21, the Ministry announced the results of the medical school admission demand survey. The demand for expansion for the 2025 academic year presented by 40 medical schools ranged from a minimum of 2,151 to a maximum of 2,847 students. Along with the survey results, the government announced, "We will prepare a policy package to expand medical personnel and create an ecosystem for regional and essential medical care." This is the '4 Major Essential Medical Care Package' announced at the 'Medical Reform and Livelihood Discussion to Save Lives and Regions' chaired by President Yoon Suk-yeol on February 1 this year.

The KMA held an emergency press conference on the day the Ministry announced the medical school admission demand survey results. The KMA condemned the government's survey as a hasty, poor, and unfair survey containing only the wishes of interested parties and strongly denounced the government's attempt to use unscientific survey results as grounds for expanding medical school admissions. They declared that if the government unilaterally pushes forward with the medical school admission policy without scientific evidence and sufficient communication with the medical community, the KMA would launch a strong hardline struggle including a general strike by the medical community.

The KMA also showed a gradually tougher stance toward the government's actions. At the 18th meeting held the day after the press conference, the KMA expressed regret and all members of the negotiation team left after the opening remarks by former leader Yang. Three days later, they held the 'National Medical Representatives and Expanded Executive Joint Meeting' to respond to the medical school expansion policy. At this meeting, the KMA formed an Emergency Special Committee under the executive branch and resolved that 140,000 doctors nationwide and 20,000 medical and dental students would unite for a strong response.

Subsequent meetings repeated similar discussions. The KMA maintained the position that "discussions on medical school admissions requested by the government can proceed only after scientific and objective grounds for appropriate personnel are prepared and measures for appropriate compensation and legal responsibility relief as well as inflow into essential and regional medical care are established." On the other hand, the Ministry stated, "The demand survey conducted by the government is a simple basic survey and the results are not directly reflected in policy," and "We will continue discussions by mutually reviewing scientific standards and grounds presented by the KMA and the government regarding the appropriate medical school admissions." The government also said, "We are not unilaterally pushing forward with the medical school admission policy."

Yang Dong-ho, head of the negotiation team from the Korean Medical Association (Chairman of the Gwangju Metropolitan City Medical Association Delegates Council), is reading a statement at the 28th Medical Issues Council meeting held at 10:10 AM on February 6th at the BizHub Seoul Center in Jung-gu, Seoul.
Photo by Tae-won Choi peaceful1@

As the deadlock over medical school expansion continued, the Ministry sent an official letter to the KMA on January 15 this year requesting submission of opinions related to medical school admissions. The KMA responded, "Regarding the medical school admission policy, all possibilities are open for discussion and review within the consultative body," and judged that "requesting opinions on the scale of expansion separately through an official letter is very inappropriate." From the 25th meeting held on January 17 to the last meeting on the 30th, both sides failed to narrow their differences.

Ultimately, the consultative body ended in disaster. On February 5, the government requested the KMA to hold an unscheduled meeting the next day. Upon entering the meeting room on the morning of the 6th, KMA leader Yang immediately stated, "I did not come to hold a meeting today but to deliver a position," and said, "The government is trying to unilaterally notify the consultative body of the number of medical school admission expansions today and is preparing to submit the medical school admission expansion agenda at the HMPDC scheduled for the afternoon," then left.

After announcing their position, leader Yang told reporters, "Medical-government negotiations will be temporarily suspended," and added, "If the government abandons unilateral communication, we are ready to resume negotiations." However, the consultative body meetings did not resume afterward. That afternoon, the government held the HMPDC at the Seoul Government Complex and announced an increase of 2,000 medical school admissions for the 2025 academic year, and the KMA leadership watched this announcement via TV broadcast at the KMA Hall in Dongbu Ichon-dong, Seoul. Two weeks later, on February 20, about 10,000 residents simultaneously submitted resignations and left hospitals, marking the start of the ongoing medical service blackout.