Medical student's opinion on doctor's protest

found on r/medicine by u/A_Humble_Student

Student from Korea here. I didn’t expect to see this on r/medicine, but I’ll do my best to explain our situation here. Take it with a grain of salt as I’m a medical student who just started seriously researching this, especially the economic aspect.

Yes, Korea does have fewer doctors compared to the OECD average, but you have to consider the fact that a significant portion of the population is around the capital and our country is tiny. Adjusted for geography and population density, our access to healthcare is actually on the higher end. We have a lot more hospital beds, have very little waiting time, and the general population can access tertiary care with ease (too much, some would say, as our primary care is almost non-existent).

Medical students, interns, and residents are all pissed not just because of expanding the number of physicians. The government released a four-package policy that also includes changing our current internship program. In Korea, after med school (six years), you become an intern which is a separate concept from residency. It’s essentially another year of clinical rotation except you are employed and not protected like a student would be. Then you go on a four-year-long residency program, which is the same duration for all specialties unlike in the US. The government has expressed interest on multiple occasions to change the system to two-years internship and three-years residency to increase interest in vital specialties (OBGYN, pediatrics, NS, trauma, cardio thoracic surgery), but everyone doubts that will motivate residents to go into that path. They just want more inexperience interns as disposable labor.

The biggest reason why those specialties are avoided is because they are underpaid. In Korea, the Health Insurance Review and Assessment Service (HIRA) control the payment per service/surgery/prescription, etc. That is, around 20% is paid by the patient while 80% is paid by national insurance for a “vital” service. Problem is that HIRA’s standards on what is appropriate treatment deserving of payment is quite arbitrary, not to mention its arbitrary price determination. Lee Guk-jong, perhaps the greatest trauma surgeon and one of the most respected doctors in Korean history, has criticized the HIRA system for decades now, citing it as the primary reason why trauma surgery in Korea is understaffed, underpaid, and overworked.

Yet the Korean government only said they would “investigate” into normalizing HIRA payment for vital specialties, and they relegated this part of the plan to long-term/policy-dependent payment(정책수가). This means that it is extremely impermanent, unlike the expansion of number of medical students and two-year internship, which can be passed this year and stay for some ten years or so. (They placed this as short-term action and the rest as long-term).

That is the reason why medical students are on leave and doctors are on strike/resignation. Simply increasing the number of total doctors will not help them go into vital specialties if they’re treated poorly.