[The Editors' Verdict] Stopgap Measures for Residents Will Set Back Korean Healthcare

About 20 years ago, during its early days after opening, Bundang Seoul National University Hospital faced many challenges because patients would only get diagnosed there but travel beyond Bundang to Seoul Asan Medical Center or Samsung Seoul Hospital for surgery. The management invested hundreds of millions of won in consulting to establish a neurology hospital and made strenuous efforts, including researching surgical methods that perform complex major surgeries endoscopically.

Through this process, Bundang Seoul National University Hospital settled as the only tertiary general hospital for the population of 470,000 in Bundang. Without this hospital, residents with severe illnesses in Bundang would still have to travel to Seoul for medical treatment. For several years, the establishment of branch university hospitals (6,600 beds) has been promoted in 11 new towns in the metropolitan area. These are all ‘medical blind spots in the metropolitan area’ where the population is rapidly increasing but there are no large general hospitals. The goal of the new hospitals is to establish themselves in their regions like Bundang Seoul National University Hospital.

Amid conflicts over increasing medical school admissions, a claim has emerged in the medical community that "the real reason for increasing admissions by 2,000 at once is not regional medical development but to supply cheap residents to the 6,600 beds in the metropolitan area." This is because each branch requires hundreds of new doctors. In response, the Ministry of Health and Welfare announced it would "amend the Medical Service Act to restrict the establishment of metropolitan area university hospital branches." If this continues, the new metropolitan area new towns will become ‘Bundang new towns without Bundang Seoul National University Hospital.’ This is a side effect remedy that blocks the medical supply needed by local residents to maintain the justification for the increase.

Including this, many of the medical reform proposals the government is releasing are expected to have side effects. Measures related to resident doctor shortages are particularly worrisome. Medical experts point out that many are ‘deteriorations’ that will hinder the training of excellent specialists.

The Ministry of Health and Welfare decided to introduce a university hospital system where treatment is centered on specialists and residents focus on training. An active orthopedic professor pointed out, "Residents’ ‘clinical treatment = training,’ so the logic of ‘focusing on training instead of treatment’ does not hold at all," and added, "Residents improve their skills as much as they see patients."

The Ministry also said it would reduce dependence on residents by legalizing Physician Assistant (PA) nurses. However, if the number of PA nurses increases, training opportunities for residents decrease. One in four residents already feels "deprived of training opportunities due to PA nurses" (Journal of the Korea Health Personnel Licensing Examination Institute, 2021). The original purpose of PA nurses, first introduced in the U.S., was to reduce labor costs by partially substituting the medical acts of highly paid specialists. It is not about replacing residents with more expensive PA nurses.

The government has reached the stage of implementing medical reform measures. The Pandora’s box of ‘low-fee university hospitals,’ which everyone knew about but kept quiet, has been opened by the admission increase issue and cannot simply be closed again. The government must review the realism, financial burden, and expected side effects of the measures announced so far and select only those that will improve the level of medical care. If resident training deteriorates, the level of medical care will irreversibly decline, so the immediate resident shortage should not be patched up with the superficial measure of "reducing dependence on residents."

The government should support the expansion of the treatment scale and level (=resident training environment) of the top university hospitals and grow hospitals that will hire new specialists trained there according to regional medical demand. This should be the core of medical reform.