The conflict between the government and the medical community triggered by the medical school expansion policy announced last year has entered its second year. Most of the residents who left the medical field have not returned to hospitals, and medical students are continuing their leave of absence. Although more than 3,000 doctors graduate every year, this year, it is less than 300. The number of new specialists is only 20% of previous years.
There are concerns that if this situation continues, the problems exacerbated by the conflict between the medical community and the government will become chronic. Left with an unprecedented medical gap, the remaining medical staff are experiencing burnout, leading to ongoing patient inconveniences and harms. There are inevitable setbacks in fostering personnel who will be responsible for future medical care.
◇ Hospitals without residents face increased outpatient demand due to workload overload
According to the Ministry of Health and Welfare on the 6th, as of the tally taken at 11 a.m. on the 4th, out of 13,531 residents in 211 training hospitals nationwide, 8.7%, or 1,172, have returned to the medical field.
During the resident recruitment from the 15th to the 19th of last month, only 2.2%, or 199 out of 9,220 applicants from 1st to 4th year, applied. Although special measures were applied to encourage the return of resigned residents, the number of applicants fell far short of expectations. While an additional recruitment plan was announced, forecasts suggested that this would yield minimal results.
Most university hospitals continue to operate as 'hospitals without residents,' and as the medical gap extends, the medical personnel who have filled in the gaps from the absent residents are also becoming exhausted.
Especially in major large hospitals such as Seoul Asan Medical Center and Severance Hospital, where the proportion of residents reached 40%, professors, attending physicians, and physician assistants have suddenly taken on the workload left by the absent residents.
Hospital officials noted, "While the circumstances differ slightly by medical specialty, overall, due to the overload of work, outpatient treatment for new patients has been partially reduced, and referrals to secondary hospitals have surged."
University hospitals currently insist that there are no sharp solutions.
An official from one of the top five hospitals in the country, who requested anonymity, said, "It's a situation where we just have to endure," adding, "Cases where patients have to be referred to secondary hospitals are increasing. "
Another official from a top five hospital stated, "In our hospital, the number of outpatient patients has not drastically decreased," and emphasized, "Including professors approaching retirement, the remaining faculty have been working extremely hard, and the medical staff are exhausted. I don't know how long we can endure under this system."
Amid this unprecedented medical staffing crisis, according to data obtained from the National Health Insurance Service by Kim Yoon, a member of the Democratic Party of Korea who is part of the Health and Welfare Committee, the number of excess deaths reported in medical institutions nationwide from February to July last year is estimated to be 3,136. Excess deaths refer to the number of deaths that exceed what is normally expected.
The medical community analyzed that the increase in excess deaths is due to elderly patients with chronic diseases who did not receive timely and appropriate treatment and cancer patients whose surgeries have been delayed due to the shortage of medical staff.
◇ 7,500 medical students attending classes simultaneously this year… Medical Association says 'impossible' vs. Ministry of Education says 'no disruptions'
Whether it can resolve the disruption in medical education is critical.
If about 3,500 first-year students who took a leave of absence last year return, together with the 4,000 new students this year, a maximum of 7,500 will attend first-year classes simultaneously. In response, the Korean Medical Association and the medical community have demanded government measures (master plan) to prevent disruptions in medical education.
There is also a significant gap in perspective between the Ministry of Education and the medical community. The Ministry of Education believes that even if the number of 'first-year medical students' exceeds 7,000, there will not be significant disruptions immediately.
Most first-year classes are general subjects, so the classes will not be run exclusively by the medical school, but at the university headquarters level, which is why it is considered manageable. In addition, there is a plan to invest government support budgets to alleviate concerns in the education field.
On the other hand, the medical community is concerned that the confusion in the education field will grow. Park Dan, vice president of the Korean Medical Association, stated, "The Ministry of Education says it will be fine because it's general courses, but students are not just going to suddenly disappear, are they?"
Some medical schools will enter the 'basic practice' from the second semester of the second year, while first and second-year students mainly take practical classes. While education may be possible during the first two years with classes focused on general subjects, it will be impossible to educate the increased number of students effectively during the four years of practical training due to the simultaneous return of students alongside the expansion of medical schools.
It also poses a problem if students refuse to attend classes. The worst-case scenario that the government and the medical community are concerned about is that the 3,000 students from the 2024 class who are on collective leave and the 4,000 students who enrolled in 2025 refuse to attend classes simultaneously. This could lead to a domino effect negatively impacting the six-year education process, causing confusion in medical education and hindering the training of future doctors.
In response, the government is paying close attention to the potential return of students from the 2024 class who are on leave, as the semester begins in March.
However, it is projected that the likelihood of a large-scale leave of absence continuing is low, given that there are 15 universities where taking a leave of absence for three consecutive semesters is not allowed and many new students have difficulty even taking a leave.
The medical community agrees that it has become difficult for residents who have already lost trust in the government to return immediately and emphasizes the need to prioritize trust restoration. They assert that acknowledging the flawed policies and creating a proper environment for residents to train are essential for rebuilding this trust.
Kim Chang-soo, president of the National Association of Professors of Medicine (professor of preventive medicine at Yonsei University), said, "Recognizing the government's enforcement of flawed medical policies is the top priority," emphasizing that normalizing the abnormal training environment must also be implemented.
Chairman Kim stated, "Both the medical community and the government must clearly improve the poor training content, working hours, and compensation to even slightly move their hearts," adding, "Even if they don't return immediately, we must start building their trust."
On the 14th, a public hearing for the 'Medical Workforce Supply and Demand Estimation Committee' hosted by the Health and Welfare Committee of the National Assembly is anticipated to provide a breakthrough in resolving the conflict between the medical community and the government. The Korean Medical Association plans to attend the public hearing and present its official stance.