To stop the so-called "delivery merry-go-round," in which high-risk pregnant patients and newborns bounce from ambulance to ambulance because they cannot find a hospital for treatment, the government will tap retired doctors (senior doctors) and expand full-time faculty in obstetrics and neonatology at national university hospitals.
However, the medical community said the plan leans toward improving operating systems and still falls short on the most urgent task: securing medical personnel.
On the 28th, the Ministry of Health and Welfare held the sixth Medical Innovation Committee meeting at the National Medical Center (NMC), chaired by Chairperson Jeong Gi-hyeon of the Medical Innovation Committee, and received a report on measures under discussion by the committee's subcommittee on strengthening regional, essential and public health care to improve care for high-risk pregnant patients and newborns.
◇ Call in "retired doctors" to the regions and expand "full-time obstetrics faculty"
From early and mid-pregnancy, the government will screen for high-risk pregnancies, pre-designate appropriate delivery facilities, and build a system to manage high-risk pregnant patients separately. It will share information on high-risk pregnant patients in advance with severe and regional maternal and newborn care centers to ensure rapid admission and transfers in emergencies, and plans to add regional maternal and newborn care centers in the Chungcheong, North Jeolla and Jeju regions within the year.
Maternal and newborn care centers will also maintain standby beds at all times, and the government will establish a transport and transfer support system linked to the National Medical Center (NMC)'s dedicated transfer team. It will also expand emergency transport using doctor helicopters and fire and military helicopters to minimize treatment delays for high-risk pregnant patients and newborns.
Still, staffing is essential for this system to function properly. By next year, the government will subsidize labor costs when regional maternal and newborn care centers outside the Seoul metropolitan area hire senior doctors. It will also push to increase full-time faculty in obstetrics and neonatology at national university hospitals among severe and regional centers. It plans to draw back obstetrics and gynecology and pediatrics specialists who have opened private practices or shifted to non-delivery fields.
Alongside this, the government will ease staffing regulations by allowing rotating on-call duty and part-time work using specialists from local hospitals, and will bolster night and holiday response personnel.
For maternal and newborn care centers outside the Seoul metropolitan area, it will gradually introduce a "performance-based ex-post compensation" system that rewards according to the level of role fulfillment. The government said this will improve staffing and operational stability at regional maternal and newborn care centers.
◇ Specialists are aging and there are no residents… the obstetrics staffing crunch deepens
But in frontline care for high-risk pregnant patients, the shortage of medical staff is cited as the most urgent issue. No matter how well transport and bed management systems are arranged, the system is hard to run if there are no obstetrics and neonatology specialists to actually treat patients.
According to the ministry, as of 2024 there are 6,082 obstetrics and gynecology specialists nationwide. The number of obstetrics and gynecology specialists per 100,000 people is 7.6 in North Gyeongsang, 8.7 in Sejong, and 8.8 in North Chungcheong, South Chungcheong and South Gyeongsang, all below the national average of 11. Except for some areas such as Seoul, most regions lack obstetrics and gynecology specialists.
Specialists are also aging rapidly. The average age of obstetrics and gynecology specialists nationwide is 54.4, and about one-third are 60 or older, the legal retirement age group. As new inflows of personnel decline and existing specialists age, concerns are growing about future staffing gaps.
Whether senior doctors will actually move into regional obstetrics is uncertain. Few senior doctors want to work in the regions, and the government's "senior doctor support program" failed to meet its target headcount. Last year, regional medical institutions hired 85 people through the program, short of the original target of 110.
The problem is that there is also a shortage of follow-on personnel to replace specialists. According to the medical community, in the first half recruitment of residents at major university hospitals this year, most obstetrics and gynecology departments failed to fill their quotas. Even at Seoul National University Hospital, only 6 applied for 9 slots in obstetrics and gynecology, for a fill rate of 66.7%.
The medical community says the field of high-risk deliveries and newborn care has heavy workloads, high medical malpractice risk and insufficient compensation, leading young doctors to avoid applying.
◇ Medical community: "Seoul also lacks obstetrics doctors… training personnel is the fundamental solution"
The medical community says the latest plan is far from a fundamental solution to the staffing shortage. It criticized the focus on reallocating existing staff rather than addressing the root cause of insufficient personnel.
The Korean Association of Obstetricians and Gynecologists said, "If there are no physicians and nursing staff to actually provide care at regional and area maternal and newborn care centers, all systems are meaningless," adding, "Easing staffing regulations also amounts to propping up the system by putting even more burden on delivery specialists who are already exhausted."
It added, "This could ultimately lead to further medical accidents and staff departures," and argued, "The fundamental solution is to overhaul, from the ground up, the training pipeline for obstetrics personnel, the compensation system and the working environment." On easing criminal liability for medical accidents, it also emphasized, "Speed is crucial to prevent departures from essential medical fields."
On the ground, experts say the staffing shortage is hard to solve with simple quota increases.
An obstetrics and gynecology professor at a university hospital, who requested anonymity, said, "It is difficult to secure staff for high-risk obstetrics and neonatal intensive care not only in the provinces but also at major hospitals in Seoul," adding, "While using retired doctors is necessary, in the long term it is more important to build a structure that trains new obstetrics specialists and keeps them in the field."
Some say using senior doctors is effectively the only alternative in the current situation, where producing new specialists is difficult. However, the focus of government support on areas outside the Seoul metropolitan area is cited as a limitation.
Hong Sun-cheol, an obstetrics and gynecology professor at Korea University Anam Hospital, said, "It appears aimed at aggressively attracting seniors who are practicing as private physicians," adding, "Given that we cannot immediately produce new specialists, this may be the most practical option."
However, Hong said, "It is concerning that government support is concentrated outside the Seoul metropolitan area and that the metropolitan area is effectively excluded," adding, "The government seems to think conditions are relatively better in the metropolitan area, but it must not overlook that the same incidents can happen there as well."