Trainee doctors' strike reveals critical flaws in hospital operations

Patients wait to see a doctor at a major hospital in Seoul, Tuesday. Yonhap

The vacuum caused in the nation's medical services due to trainee doctors’ ongoing strike, in protest against the government's medical student quota increase policy, is highlighting hospitals’ heavy dependence on junior doctors.

Many major hospitals have adopted abnormal manpower distribution, in which trainee doctors account for nearly 40 percent of the entire medical professionals, due mainly to their lower labor costs.

Consequently, serious health care service disruptions have occurred whenever trainee doctors engaged in collective action. It became one of the major factors that resulted in the government surrendering and withdrawing, in the past, whenever they proposed policy changes aimed at the medical sector.

Experts pointed out that hospitals should deploy more medical specialists rather than relying too much on trainee doctors, and let those junior doctors focus more on their education and training.

Trainee doctors include interns and residents who learn on the job while working at teaching hospitals after obtaining their licenses, as they pursue medical specialization. They play a key role in emergency rooms, intensive care units and surgery rooms, providing crucial assistance to medical specialists.

Since Feb. 19, thousands of those junior doctors have begun submitting resignations and left hospitals to protest the government’s plan to increase the annual enrollment quota — at 40 medical schools nationwide — from the current 3,058 to 5,058 starting next year.

During a media briefing, Tuesday, Second Vice Health Minister Park Min-soo told reporters that the number of trainee doctors who submitted their resignations came to 9,909, or 80.6 percent of the total, as of Monday. Of them, 8,939, or 72.7 percent, have actually walked off the job.

Following the mass walkout of trainee doctors, the number of new patients fell 24 percent at general hospitals, while the number of surgeries performed plunged by 50 percent.

An emergency patient is transferred to a hospital in Daegu, Tuesday. Yonhap

During the previous Moon Jae-in government’s proposal to raise the quota in 2020, more than 80 percent of the trainee doctors engaged in collective action for about a month, causing massive disruptions to medical services. This led the Moon government to eventually retract its proposal.

Trainee doctors’ collective actions inevitably cause a medical service vacuum, as hospitals heavily rely on these young doctors who work long hours while enduring low wages.

According to statistics tallied by the Health Insurance Review and Assessment Service, trainee doctors account for 37.8 percent at general hospitals across the country.

In the five biggest hospitals in Seoul — Seoul National University Hospital, Seoul Asan Medical Center, Samsung Medical Center, Severance Hospital and Seoul St. Mary’s Hospital — that play a key role in providing medical care for patients in critical conditions, the junior doctors account for 39 percent.

These interns and resident doctors received 68.82 million won ($51,700) and 72.8 million won as annual income on average as of 2020, respectively, according to the Korea Institute for Health and Social Affairs. The amount was less than one third of the 236.9 million won given to medical fellows who are undergoing specialized training after completing a residency.

Young doctors are forced to work an excessive amount of hours. According to the Korean Intern Resident Association (KIRA), an association of interns and residents, these doctors work 77.7 hours a week on average, and 52 percent of them work more than 80 hours a week.

Experts say hospitals need to overhaul their manpower structure and deploy more personnel who have completed residencies, to reduce the working hours of junior doctors and give them more time to focus on their training.

“Interns and resident doctors are not only workers but also trainees, but they have played a role more as workers. This structure should be changed,” said Shin Young-seok, professor at the Korea University Graduate School of Public Health.

Meanwhile, the government stepped up warnings against doctors.

The Ministry of Health and Welfare filed a complaint with the police against five doctors affiliated with the Korea Medical Association (KMA), the nation's largest coalition of doctors, accusing them of obstruction of business, as they allegedly supported the mass resignations of trainee doctors and offered them legal aid.

It marks the first legal response by the government against the ongoing collective action.

Health Minister Cho Kyoo-hong said the government would also take legal action against trainee doctors, including suspension of their licenses, if they do not return to work by the Thursday deadline, which was suggested by the government on Monday.

President Yoon Suk Yeol said staging collective action and holding patients hostage cannot be justified for any reason, making it clear that the decision to raise the quota by 2,000 is firm.

“The government is pushing to reform the country’s health care system,” Yoon said. “The decision is not negotiable, as adding 2,000 slots is deemed a minimal increase to implement the constitutional responsibility of the state to provide timely and proper medical treatment to sick people.”