[Exclusive] "Will You Take Responsibility If the Child Dies?" Desperate Pleas... Pediatric ERs Only Admit After a Fight [Crumbling Pediatric Care] ①

No Pediatric Emergency Medical Centers in Gangwon, North Chungcheong, North Gyeongsang, and South Jeolla
Night Operations Only Twice a Week Due to Staffing Shortages
No Backup Care Available

Editor's NoteAlthough it is expected that residents who left hospitals in protest against the increase in medical school admissions in February last year will resume their training after a year and a half, the situation in essential departments that handle critical and emergency patients remains precarious. In particular, in the field of pediatrics, residents are reluctant to apply due to low birth rates, an unreasonable reimbursement system, and increasing legal risks. Existing specialists are also leaving the field. As regional disparities in medical services widen, the system for treating sudden pediatric emergencies and severe pediatric illnesses requiring specialized intensive care is also being shaken. With fewer children being born and even fewer doctors to care for them, the situation is dire. Asia Economy will examine the current state and future directions of the pediatric medical system in a six-part series.

At 10 p.m. one night in April, a four-year-old girl who had lost consciousness due to a febrile seizure was carried into a pediatric hospital in Daejeon that offers night treatment. The doctor administered an antipyretic, but after 20 minutes, the child's condition did not improve. The hospital director, identified as Dr. A, urgently requested a transfer to a larger hospital through the 119 emergency service. However, the response was that all nearby hospital emergency rooms were unable to accept the patient. For young children, prolonged seizures can lead to aftereffects or, in the worst case, death, making every second critical. Ultimately, Dr. A had to call the emergency room of a major hospital directly and shout, "Will you take responsibility if the child dies?" Only then did the emergency room call in medical staff and allow the transfer.

At around 1 a.m. on the 5th, at the entrance of the emergency room of Sejong Chungnam National University Hospital in Dodam-dong, Sejong. A notice states that night treatment is only available on Wednesdays and Saturdays. Photo by Choi Taewon

Across the country, there is a shortage of pediatric emergency centers and it is difficult to recruit pediatric specialists, resulting in repeated situations where it is challenging to respond to pediatric emergencies. In particular, in regions far from Seoul, it is often impossible to secure medical staff, so pediatric emergency rooms operate only during the day, or even if night treatment is available, there is no backup care.

According to data obtained by Assemblywoman Seo Myungok of the National Assembly Health and Welfare Committee from the Ministry of Health and Welfare on the 27th, as of January this year, only 7 out of 29 emergency medical regions nationwide have a pediatric emergency center.

The pediatric emergency care environment in local areas was especially poor. There are a total of 12 pediatric emergency centers nationwide: 3 in Seoul, 2 in Gyeonggi, 2 in Incheon, and 1 each in Chungnam, Daegu, Gyeongnam, Sejong, and Jeonbuk. In contrast, 22 emergency medical regions, including Gangwon, Chungbuk, Gyeongbuk, and Jeonnam, do not have a single pediatric emergency center.

There are also significant differences in the number of pediatric specialists. As of March, pediatric emergency centers in the Seoul metropolitan area, such as Inha University Hospital and Severance Hospital, have relatively large numbers of pediatricians, with 10 and 7, respectively. In contrast, Soonchunhyang University Cheonan Hospital in Chungnam and Sejong Chungnam National University Hospital in Daejeon each have only 3. In particular, Sejong Chungnam National University Hospital is reportedly the only hospital in the entire Chungcheong region with a single pediatric radiology specialist, who is a retired professor working at the hospital's earnest request.

Some pediatric emergency centers are unable to operate normally due to a shortage of medical staff. Currently, the two pediatric emergency centers in the Chungcheong region offer night treatment only two days a week each. A staff member at the Sejong Chungnam National University Hospital Pediatric Emergency Center said, "At least six doctors are needed to consider sustainable 24-hour operation," and added, "Even when emergency care is provided at night, there is often a shortage of doctors from other departments, so we frequently transfer patients to hospitals in the southern Gyeonggi area, which tend to have more available staff." A representative from Soonchunhyang University Cheonan Hospital said, "More doctors are needed for 24-hour operation, but it is not easy to recruit them. We will resume normal operations as soon as staffing is increased."

To fill the gap in pediatric night care, the government is running the "Moonlight Children's Hospital" program, which allows outpatient clinics to treat mild pediatric cases at night and on holidays instead of the emergency room. The program provides additional support, such as increased reimbursement, for pediatric hospitals and clinics that offer night treatment until 11 p.m. However, when a severe pediatric case arises that cannot be treated at a Moonlight Children's Hospital, there is often no hospital willing to accept the patient. Dr. A said, "When a severe case arrives, I have to provide minimum emergency care and look for a hospital to transfer the patient to, which means I cannot treat other mild cases in the meantime. Other sick children and their guardians sometimes have to wait an hour for treatment."

This year, the government budget for pediatric emergency centers is 9.1 billion won. The government provides 100 million won in salary support per dedicated specialist, and for patients under the age of six, the consultation fee for emergency specialists is increased by 15 percent compared to regional centers. Emergency care management fees, observation fees for critical emergency patient areas, and intensive care unit management fees for emergency use are also increased by 30 percent. However, the government says that due to budget constraints, it is difficult to provide as much additional support as is needed in the field.

Song Youngjo, director of the Emergency Medical Division at the Ministry of Health and Welfare, said, "The pediatric emergency center program has only recently begun and is in the process of expanding. We are planning to cover a wider area than the existing emergency medical regions. We hope the situation will improve somewhat when the residents who resigned return next month."