As the number of public health doctors (public health physicians) plunged this year due to the fallout from the resident physician crisis, an emergency has hit the rural medical safety net. The government has begun overhauling the local health care system by changing the functions of township-level health subcenters and expanding remote care and teleconsultations.
According to the Ministry of Health and Welfare on the 13th, only 98 new medical public health physicians were assigned this year. That is a drop of more than 60% from 250 last year. Considering that 450 complete their service this year, the fill rate is only 22%.
As a result, the total number of medical public health physicians fell 37.2%, from 945 last year to 593 this year. Compared with just 10 years ago in 2017, when there were 2,116, the number has shrunk to about one-fourth.
◇Rural medical gaps begin… 82% of health subcenters without doctors this year
Public health physicians are conscripted doctors who serve 36 months as commissioned officers and provide care at rural public health centers and health subcenters. In areas without private medical institutions, they have effectively served as the only doctors, the so-called "village primary doctors."
But the decline has continued in recent years. The biggest reason is the length of service. Active-duty soldiers serve 18 months, while public health physicians serve 36 months. As the gap widened, more medical students chose to enlist as regular soldiers. This was compounded by a rising share of female medical students and more medical students taking military leave from school.
The decisive trigger was the doctor-government conflict in 2024–2025. With training gaps for residents and disruptions to medical school education, the supply of public health physicians dropped sharply.
The government expects the shortage of public health physicians caused by this to continue at least through 2031.
Rural medical sites are already in serious condition. The number of health subcenters without public health physicians surged from 730 (59.5%) last year to 1,023 (82.1%) this year. It is expected to reach 1,083 (86.9%) next year.
In some local governments, the medical gap has become a reality.
Buyeo County, South Chungcheong, shut down operations at five of its 15 health subcenters in Nov. last year. They are the Eunsan, Oesan, Hongsan, Imcheon and Seokseong township health subcenters. The county tried to continue care by hiring private physicians, but when the doctors' strike ended, they returned to their original hospitals.
In addition, with four of the seven public health physicians set to be discharged in April, leaving only three, the local government concluded it could no longer maintain operations at the subcenters.
◇Government to undertake a major overhaul to use staff efficiently… expand nurse-led care in place of doctors
The ministry plans first to reorganize health subcenter functions into four types to improve staffing efficiency.
There are 1,326 health subcenters nationwide and 1,894 community health clinics. Many facilities are small and scattered, and critics have long said this reduces medical efficiency, according to the explanation. In fact, the average daily number of consultations by a public health physician differs widely: ▲ health subcenters 4.3 ▲ public health centers 12.1 ▲ public medical centers 32.1.
The ministry selected 547 towns and townships nationwide that lack private medical institutions and have poor access to care. These areas have 532 health subcenters.
Of these, 159 public health physicians will be assigned first to 139 subcenters. This will be accompanied by stronger compensation, including raising the cap on work activity incentives. The ministry is reviewing a plan to gradually raise the incentives, currently a base 900,000 won to a maximum 1.8 million won, to a maximum 2.25 million won this year and 2.7 million won in 2028.
The remaining 393 will change functions. Local governments will choose or combine the four types according to local conditions. The types are integrated (151), clinic-conversion (42), rotating-clinic (200), and health-promotion.
In the integrated type, community health officers (nurses) handle medical consultations, while dental and Korean medicine public health physician services continue. In the clinic-conversion type, health subcenters are converted into community health clinics where nurses provide routine care, but dental and Korean medicine services are not offered.
In the rotating-clinic type, public health physicians from public health centers visit health subcenters two to three times a week to provide care. The health-promotion type targets areas with sufficient private medical institutions and shifts the focus to health management instead of treatment.
Community health officers can currently perform certain medical acts, including prescribing 91 types of medicines, vaccinations and emergency first aid. The government is also reviewing strengthening their clinical training and expanding the list of prescribable medicines.
It also plans to revamp personnel systems, including raising the top promotion grade (currently grade-6 without position), to enhance the professionalism and pride of the community health officer track.
◇Remote care, AI joint consultations and hiring senior doctors… full-scale measures amid concerns
To fill care gaps caused by the decline in public health physicians, the government will also expand remote care and teleconsultations. Given that older adults in rural areas struggle to use smart devices, nurses and staff at public health centers will guide and assist patients during remote visits.
It will also pursue ▲ expanding regions eligible for prescription delivery by courier ▲ expanding teleconsultations with private hospitals ▲ introducing an artificial intelligence (AI)-based diagnostic support system. For AI diagnostic support, one option under review is to connect specialists via teleconsultation when AI detects abnormal signs during home visits by nurses.
However, the medical community also voices concern that care without direct face-to-face contact makes it hard to adequately manage older patients, who are the main users. Older patients often cannot describe symptoms in detail, making it difficult to accurately assess their condition through a screen alone.
One specialist said, "There may be some value for simple follow-ups in chronic disease patients," but added, "The basics of care are looking (inspection), listening (auscultation), feeling (palpation) and tapping (percussion), and these steps are inevitably limited in remote care," and "Especially for first-time patients, it is hard to clearly grasp symptoms, which is a limitation."
The government will also broaden ways to secure physicians beyond public health physicians.
The Ministry of Health and Welfare plans to include public medical centers in the pilot program for contract-based regional essential physicians and continue supporting the hiring of senior doctors aged 60 and older.
It will also activate rotating and dispatched care by regional responsibility medical institutions, such as local medical centers. The government is also pushing to place physicians trained through the regional doctor system and public medical schools in local public health institutions.
In the mid to long term, the plan is to change the very structure of regional health care. From next year through 2029, the government will pursue consolidation of health subcenters and community health clinics around regional hubs.
There are two models: regional-hub type and public health center–focused type.
In the regional-hub type, health subcenters serving populations of 5,000 to 10,000 are developed into care hubs. They handle outpatient care (centered on internal medicine), chronic disease management, minor emergency care and basic health checkups.
In the public health center–focused type, physicians are concentrated at public health centers to strengthen their role as regional control towers. Rather than shutting down existing small facilities, the government is reviewing using them as bases for rotating clinics and in-home medical care.
◇Debate on shortening public health physician service as well… "With 24 months, 90% would apply"
Shortening the term of service is also being discussed to fundamentally resolve the decline in public health physicians. Minister Jung Eun-kyeong said at the Health and Welfare Committee's full session on the 26th of last month, "The ministry also supports it and is consulting with the Ministry of National Defense."
However, many expect that adjusting the service period will not be decided quickly because it could affect staffing in other military service tracks. The minister also noted, "Equity with other specialized officers, such as veterinary officers and judge advocates, must be reviewed together," and said, "Because this is a decision that considers the military's overall resources, it will take time, which is the Ministry of National Defense's position."
In a 2023 survey by the Korean Association of Public Health Doctors (KAPHD) and the Korean Intern Resident Association (KIRA), 74.7% of medical students and residents who had not yet fulfilled military service said they preferred to enlist as regular soldiers. In a 2024 survey by the Korea Institute for Health and Social Affairs, only 29.5% said they hoped to serve as public health physicians or military doctors.
By contrast, if the service period were shortened to 24 months, the intention to serve as military doctors and public health physicians would each surge to over 90%.