On the 13th, the government rolled out short-term measures to respond to the sharp drop in public health doctors, including overhauling the functions of rural health subcenters, expanding the scope of care by community health practitioners (nurses), and introducing telemedicine. However, if consultations with the Ministry of National Defense do not make progress on the issue of the "36-month service period," which has been cited as a structural cause of the decline in public health doctors, there are concerns that workforce shortages in medically underserved areas could be prolonged.
According to the Ministry of Health and Welfare, the number of newly assigned public health doctors from medical schools is expected to remain below 100 until 2027. It is projected to recover to the 100s between 2028 and 2031, and normalize to the usual size (in the 300–400 range) from 2032 onward. The ministry explained that as medical education returns to normal and policies to train regional doctors take full effect, the shortage of public health doctors will be eased to some extent.
However, this outlook assumes that the current size of medical students and the flow of assignments to the mandatory officer candidate corps after graduation are maintained. Analysts note that if, as recently, more medical students choose to enlist as rank-and-file soldiers instead of becoming public health doctors or military doctors, the actual supply could decrease further.
Jeong Gyeong-sil, director general for health care policy at the Ministry of Health and Welfare, said, "This year's decline in public health doctors was largely influenced by the trainee doctors' situation, but this trend has continued for a long time," adding, "For this reason, to use limited medical personnel more efficiently, we are pushing to reorganize the functions of health subcenters and community clinics around regional hubs."
Jeong added, "Even if many medical specialists are produced after 2032, we should continue to pursue this policy direction." The following is a Q&A with Jeong and Lim Eun-jeong, head of the Health Policy Division at the Ministry of Health and Welfare.
-How far have discussions on shortening the public health doctors' service period progressed?
"It is not a simple issue. We are continuing consultations with the Ministry of National Defense and the Military Manpower Administration. Because this is related not only to public health doctors and military doctors but also to other specialized military service resources such as legal officers and research personnel, I understand that it is being reviewed comprehensively at the Ministry of National Defense level."
-What led to the push to reorganize the functions of health subcenters?
"Medically underserved areas are places where care gaps must not occur even if there are not many patients. Local governments and the central government tried to secure as many public health doctors as possible, but as the numbers of military doctors and public health doctors declined, some local governments were unable to place them. As a result, we developed various alternatives, such as expanding the role of community health practitioners, and we have been in continuous discussions with local governments since the second half of last year to that end."
-When will the reorganization be completed?
"We aim to finish in 2029. The start time varies by type. For the integrated model, we plan to begin in April this year as a pilot health care project before amending the relevant laws. For the clinic-conversion model, if the clinic requirements are met, we plan to proceed within the year through amendments to the local government ordinance. The rotating-clinic model and the health-promotion model are already being implemented in some regions."
-Why do the reorganization types differ by local government?
"Because regional conditions vary greatly. For example, in areas where public health doctors are concentrated at public health centers, rotating clinics can be conducted with the centers as hubs. In contrast, in island or remote areas where there are no private medical institutions and rotating or home visits are difficult, it is necessary to place public health doctors directly.
"We also considered whether there are other physicians or nurses besides public health doctors at the public health center or in the area. Community health practitioners have already been providing examinations and prescriptions to local residents, so we also reviewed how to utilize such personnel."
-If rotating clinics are expanded, won't the workload for public health doctors increase?
"In discussions with local governments, many noted that because there are many health subcenters, the approach of permanently placing physicians or staff at each subcenter is inefficient. In fact, at some health subcenters, the average number of daily visits was as low as four. As a result, we examined how to use limited medical personnel efficiently and considered expanding rotating clinics.
"If rotating clinics are expanded, the workload for public health doctors could increase. To address this, we are discussing with local governments the expansion of support staff at public health centers and nursing staff, and we are consulting with relevant ministries on budget securing and staffing increases."
-You said health subcenters in areas with fewer than 2,000 people will remain as is. Why?
"Population size is only one of several factors in determining functional reorganization; it is not an absolute standard. For example, even if the population is small, in island or remote areas with very low access to care, it may be necessary to place public health doctors. Conversely, if the population is small and transportation is poor, making rotating clinics difficult, converting to a community clinic may be more appropriate. We will determine the reorganization type by comprehensively considering not only population size but also local medical conditions and the distribution of medical personnel."
-How much will the scope of examinations and prescriptions by community health practitioners be expanded?
"We are preparing related guidelines. Community health practitioners were introduced in the 1970s and can currently prescribe 91 pharmaceutical ingredients. However, because this standard was set long ago, it needs to be adjusted in consultation with experts. The expansion of prescribing scope will likely focus on chronic diseases."
-What is the scale of utilizing senior physicians?
"This year's budget for the related program increased to 7 billion won from 3 billion won last year. We are currently receiving new requests and proceeding with selections. A total of 194 positions have been requested, of which 118 were requested by regional public health institutions. Based on the functional reorganization and analysis of underserved areas, we plan to prioritize placement in regions with significant care gaps."
-Some local governments have already halted the operation of health subcenters.
"Even before the decline in public health doctors, some health subcenters or community clinics were closed due to population decreases or changes in program structures. However, to prepare this functional reorganization plan, we have been gathering opinions from local governments since the second half of last year. Before deciding on closure, we will first review whether medical functions can be maintained through functional reorganization, and only if unavoidable will we decide whether to close."
-What is the national status? Which areas are particularly at risk of care gaps?
"We do not yet have accurate nationwide data on closures. When the functional reorganization has taken hold to some extent, we will assess the situation and review whether to secure the data."
-How are you envisioning the telemedicine model for rural and fishing communities?
"The Medical Service Act has been amended regarding telemedicine and is set to take effect in Dec. this year. We are currently developing a concrete model.
"Unlike cities, many provincial areas have no clinic-level medical institutions or pharmacies at all. If ordinary telemedicine is based on private medical institutions, rural areas need a model that utilizes public medical infrastructure, such as public health institutions."
"As for medication delivery, eligibility is currently limited to island or remote areas, long-term care insurance beneficiaries aged 65 or older, and patients with infectious diseases. Considering the realities of areas without pharmacies, we are also reviewing ways to improve this."
-The number of public health doctors could decrease further next year. Any additional measures?
"Rather than introducing new additional measures, it is possible that we will further review functional reorganization by local government while maintaining the direction of the measures released this time, depending on changes in staffing."
-Is there a possibility of opposition from physician groups to expanding the scope of practice for community health practitioners?
"Physician groups also agree that care gaps should not occur in underserved areas. Because there are no private medical institutions in these regions, competition is not a major issue. As we prepare clinical support guidelines and build models suited to underserved areas, such as remote consultations or telemedicine, we will continue to consult with physician groups to develop reasonable measures."