Why do doctors oppose raising medical student quota?

By Bahk Eun-ji

The Moon Jae-in administration has been at odds with doctors over its healthcare reform bills that will increase the number of medical students admitted to universities and establish a state-funded medical school.

The government said July 23 that it wants to produce more doctors to broaden the reach of public health care services as the necessity for this was confirmed with the onset of the ongoing COVID-19 pandemic. As soon as the plan was made public, however, doctors' groups were up in arms immediately, vowing to go on strike.

The Korea Medical Association (KMA), the nation's largest union for doctors, and the Korean Intern Resident Association (KIRA) announced plans to stage an all-out strike Aug. 14 to protest the reform.

According to the Korea Intern Resident Association (KIRA), a group that represents interns and resident doctors here, nearly 95 percent of the group's 16,000 members are expected to join the strike.

In response, Health Minister Park Neung-hoo urged the medical community to call off the planned strike and proposed dialogue to resolve the issue.

Although the health minister reiterated the need to raise the admission quota during a press conference at the government complex in Seoul, Thursday, many pointed out that the process of collecting opinions and discussing these with the medical community has largely been omitted.

In particular, some claim that raising the quota of medical school students and establishing a public medical school will reignite the controversy over increases in the national health insurance premium as well as medical bills.

If doctors wish to avoid criticism from the public for being a group with vested interests, it must open proper channels for dialogue with the government rather than going on strike or holding other protests, according to observers. They note that few patients would find a problem with the revision bill.

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"The purpose of the reform bill is to strengthen local medical care by bridging the gap between the Seoul metropolitan area and the provinces. Korea has fewer doctors per 1,000 people than other member countries of the Organization for Economic Cooperation and Development (OECD), but above all, there is a wide medical care gap mainly due to the lack of personnel in some provinces as well as in specific medical fields," Vice Health Minister Kim Gang-lip said during a recent press briefing at the government complex in Sejong.

It is generally accepted that it is difficult to run hospitals in provincial areas due to a lack of doctors. It is also difficult for patients living in these areas to receive the same quality and speed of medical services as delivered in more central areas.

Increasing practitioner numbers could prevent deaths from strokes or other emergencies due to there not being doctors able to treat serious conditions and handle emergency situations.

The bill also aims to increase the number of doctors in specialized fields, such as infectious diseases, pediatric surgery, trauma care, and epidemiology. The government will foster professional medical scientists working in various fields such as general medicine, pharmaceuticals, and biomedical devices.

Under the planned reform, the government aims to expand admission quotas at medical schools by 4,000 ― 400 per year over 10 years starting in 2022. The plan will be applied only for the 10 year period, and then the quota will return to the current 3,058 in 2032.

According to data from the Ministry of Health and Welfare, the country had 2.4 doctors per 1,000 people as of 2017, which was the lowest among OECD members. The OECD average is 3.4 per 1,000 people. However, patients here went to see doctors 16.6 times a year, which was the highest among the OECD members. The average number of hospitalization stays was 18.5 days here, the second longest in the OECD.

Regional imbalances are even more serious. As of last year, the number of doctors in Seoul stood at 3.1 per 1,000, but other regions had less than half that of the capital ― 0.9 in Sejong, 1.4 in North Gyeongsang Province, 1.5 in Ulsan and 1.5 in South Chungcheong Province.

Therefore, the government and the ruling Democratic Party of Korea (DPK) will make it mandatory for the students graduating as doctors to serve in local public health and medical institutions or work for essential medical services for a period of time.

Doctors' opposition

Contradicting the OECD figures, KMA President Choi Dae-zip said, "The country doesn't suffer from a shortage of doctors at all."

He said the government should consider not only the number of clinicians per 1,000 people, but also the population density and reductions in this in each area.

"The problem is not the number of doctors, but the imbalance among different specialties and regions which many of them are inclined to avoid due to low medical fees and weak infrastructure," said Sung Jong-ho, a policy director at the KMA.

"Almost all people are flocking to the Seoul metropolitan area due to the lack of provincial infrastructure such as education and housing."

The medical association believes that in order to eliminate the medical gap between regions, support measures such as offering incentives to doctors who go to practice in smaller provinces is necessary.