South Korea doctors’ strike: President Yoon’s political move for the upcoming legislative election
On February 6, South Korea’s Ministry of Health and Welfare announced a plan to significantly expand the country’s medical school admissions by 2,000 slots for five years starting from 2025, from the current quota of 3,058 to 5,038. According to the OECD “Health at a Glance 2023” Report, South Korea's current ratio of 2.6 doctors per 1,000 people, which drops to as low as 1.6 in rural areas, well below the OECD average of 3.7. With the ageing population driving up healthcare demand, the government estimates a shortage of 15,000 doctors by 2035. Therefore, the officials believe implementation of this expansion plan is urgent for the country.
While the government’s plan to increase medical school admissions by 65.4% seems to benefit current doctors, as training more doctors could alleviate their workload, South Korea’s medical community has shown substantial resistance. Since February 20, over 90% of the country’s 13,000 trainee doctors have resigned or walked out, voicing strong opposition to the initiative. These trainee doctors, including interns (equivalent to the UK's Foundation Year trainees) and residents (equivalent to the UK’s Specialist trainees), constitute 30-40% of all doctors in the country. Their walk out has significantly impacted healthcare services, leading to the cancellation of half of the scheduled operations in major hospitals.
Despite the government’s orders for these doctors to resume work under Article 59 of the Medical Service Act, with threats of medical licence suspension and legal consequences, only less than 300 have returned to work in the past month. This firm stance of the government, and its reluctance to reconsider the scale of the medical school expansion plan or engage in dialogue with doctors, led some senior doctors to also resign on March 25 in solidarity with trainee doctors who have been on strike for nearly five weeks.
Why are doctors and the government so strong with their viewpoints, even knowing that their decision could cost the health and lives of citizens?
Doctors' Perspective
Doctors believe that the proposed expansion plan is superficial and fails to address the root problem of South Korea’s healthcare system. They are concerned that the drastic increase in the number of doctors would only bring more competition within the medical field and worsen the quality of medical education, without tackling the core problems of inequality – the urban-rural divide and disparities between medical specialties.
In 2022, South Korea’s National Medical Centre reported that rural residents face twice the risk of delayed access to emergency services compared to urban residents. While 90% of people in Seoul can receive emergency services within 30 minutes, this figure drops to below 45% in rural regions like Gangwon Province, North Gyeongsang Province, and South Jeolla Province. Yet, the government’s plan will not narrow the urban-rural gap even with an expanded medical workforce. The concentration of teaching hospitals and medical schools in Seoul suggests that new doctors may continue to cluster in the capital and even exacerbate the regional divide.
Doctors have also raised concerns that the expansion plan does not address the issue of specialty selection due to the significant disparities in incentives. According to data published by MediGate in 2021, specialties such as thoracic surgery, ophthalmology, and plastic surgery have the highest annual incomes, reaching up to GBP 285,000. In contrast, those in family medicine and paediatrics earn considerably less, with annual incomes of GBP 88,000 and GBP 64,000, respectively.
Besides income, South Korea’s doctors face a higher rate of medical disputes than in countries like Japan (14.7 times higher) and the UK (580.6 times higher). Such risks push many doctors towards specialties perceived as safer from legal disputes, with plastic surgery emerging as a particularly popular choice. 20% of medical school graduates moved into cosmetic practices even without formal dermatology training and could enjoy more stable and structured work hours compared to the demanding schedules of junior doctors, often required to work for 100 hours per week. Doctors believe the government should implement policies to incentivise current doctors to join less popular specialties instead of blindly increasing the number of total doctors.
While it is clear why doctors are dissatisfied with the government’s proposal, the decision to resort to prolonged strikes, despite high risks to patient health and their own qualifications, is still difficult to understand. The successful opposition to government policies through strikes in the past 20 years could be a sensible explanation. After the 2000 doctors’ strike against pharmaceutical reforms, the government proceeded with the reform but promised to limit the number of medical students, a compromise seen as a victory by doctors. Similarly, the medical community successfully opposed the Park Geun-hye administration's proposal for telemedicine implementation in 2014 and Moon Jae-in's plan to expand medical school positions by 400 in 2020, both of which were withdrawn following doctor strikes.
Yet, President Yoon’s firm stance mixed with the complicated political motives for the upcoming election, may make the current strike different from the previous ones.
President Yoon’s concern over the April legislative election
In the lead-up to South Korea's legislative election on April 10, the political landscape is marked by intense competition for seats in the National Assembly. The People Power Party (PPP) that President Yoon Suk-yeol is a part of is striving to win an absolute majority out of the 300 seats in the assembly. Achieving this is crucial for Yoon, as failure would mean he has to face challenges from the main opposition, Democratic Party of Korea (DP), in passing both domestic and foreign policies during his remaining three years of presidency.
Since Yoon got elected in 2022, his popularity has remained low due to various controversies, including allegations of corruption involving his wife, criticism of abolishing the gender equality ministry, and concerns over his real estate policies. Yoon sees the proposed expansion of medical school admissions as a potential turning point. A Gallup study shows that more than 76% of respondents support the expansion. By achieving medical reform—a feat Yoon’s three predecessors failed to accomplish, the president’s governance capabilities could be validated. Conversely, failure could exacerbate negative public perceptions of his administration and the PPP.
The ongoing doctors' strike has attracted criticism for disrupting patient care. However, it's necessary to also consider the government's role in prolonging this situation. The government’s strong approach to the strike adds complexity to the issue. We might need to wait until after the upcoming election to see a turning point to resolve this matter.
Bibliography
https://www.oecd.org/health/health-at-a-glance/
https://news.kbs.co.kr/news/pc/view/view.do?ncd=7893842
https://en.yna.co.kr/view/AEN20240325001953320
https://asianews.network/number-of-south-korean-junior-doctors-resigning-nears-10000/
https://www.twreporter.org/a/hello-world-2024-02-27
https://theinitium.com/article/20240311-whatsnew-international-korean-doctors-strike
https://www.cw.com.tw/article/5129386
https://www.thenewslens.com/article/186150
Photo: Kim Jae-Hwan/SOPA Images/REX/Shutterstock
https://www.theguardian.com/world/2024/mar/12/south-korea-doctor-strike-government-suspends-medical-licenses
Note that opinions expressed in the article above do not necessarily represent the overall stance of Asiatic Affairs, Students' Union UCL or University College London. If you have read something you would like to respond to, please get in touch with uclasiaticaffairs@gmail.com.
Want to write for us? Don’t worry about experience - we are always looking for writers interested in Asiatic affairs. Submit your ideas athttps://forms.gle/koQbsExb6XsAy1Tk6 and we’ll get in touch.