One doctor, one NICU, 100-hour workweeks: Korea's neonatal care crisis
A doctor holds a newborn baby delivered via cesarean section at Seoul National University Bundang Hospital, March 14, 2024. Korea Times photo by Jung Da-bin
Shrinking delivery networks spark 100-hour workweeks
"If a phone call comes in 24 hours a day, I run to the hospital," said Lee Byung-guk, a pediatrics professor at Sejong Chungnam National University Hospital. "I cannot sleep properly, so my greatest fear is making a bad judgment at a critical moment."
Lee made the appeal on Sunday. He has overseen the hospital's neonatal intensive care unit, or NICU, with a sense of mission since July 2020. The job consumes his daily life. Whenever emergency deliveries are scheduled or an extremely premature baby’s condition deteriorates, he must rush back to the hospital, remaining on call 24 hours a day.
Although the hospital employs contract physicians on duty, caring for high-risk newborns remains solely the responsibility of Lee, who is a specialist.
"Even though there are contract physicians on duty, if a baby is born before 32 weeks of pregnancy, I have no choice but to return to the hospital," Lee said. He added that he once received an emergency call during a medical school lecture and had to be speeding back to the facility.
Driven by a growing sense of crisis in the medical field, the Korean Society of Neonatology warned the government Friday that the shortage of specialists is now bleeding into small and medium-sized hospitals in the Seoul metropolitan area.
In its public appeal, the medical society said regional hospitals face disastrous conditions.
Low birthrate paradox
While some suggest that the chronic low birthrate has reduced the demand for neonatal care, doctors on the ground say otherwise.
According to the Korean Association of Obstetricians and Gynecologists, Korea's total annual births dropped 53.4 percent from 493,471 in 2003 to 230,028 in 2024. Over the same period, hospitals offering delivery services plummeted 70.8 percent from 1,371 to 400. Meanwhile, the share of high-risk newborns rose from 19.2 percent in 2018 to 22.9 percent in 2024, driven largely by women giving birth at older ages.
A chart generated by artificial intelligence
Indeed, the 20-bed NICU overseen by Lee regularly operates beyond full capacity, forcing him to work seven days a week. He frequently works shifts longer than 24 hours.
"My weekly working hours exceed 90 to 100 hours," Lee said.
Severe doctor burnout
This exhausting reality is not unique to a single hospital. Chang Yun-sil, president of the society and a pediatrics professor at Samsung Medical Center, said she frequently hears colleagues complain of deep fatigue.
"When I meet other doctors, they often say they do not know how much longer they can hold out, wondering if they can even last another year or two," Chang said. "Premature babies require intensive monitoring around the clock, which makes the workload extremely high, yet there is a severe shortage of new doctors willing to specialize in neonatal care."
The situation is even worse for regional hospitals. Yoon Young-ah, a pediatrics professor at Seoul St. Mary's Hospital, said major medical centers in Seoul have multiple professors on staff. However, many regional facilities rely on just one or two specialists to handle emergencies year-round.
"It is an unsustainable structure," Yoon said. "If even one person leaves, the entire neonatal care network of the hospital is shaken."
Imbalanced medical services
While the government has launched support policies focusing on NICUs, medical professionals say they have not felt the impact on the ground. According to the obstetric association, 130 hospitals nationwide suffer from an imbalance between neonatal and obstetric care, operating obstetric departments without NICUs or running NICUs without obstetricians.
Kim Jae-yeon, president of the association, said the government must act during the recent rebound in births, which he described as the critical window to prevent the system from passing the point of no return.
"If we miss this window, Korea’s maternal and child health care system will never recover," Kim said.
This article from the Hankook Ilbo, the sister publication of The Korea Times, is translated by a generative AI system and edited by The Korea Times.