In a move intended to alleviate the pressing issue of doctor shortages in South Korea, the government proposed an increase in medical school admissions. However, this plan sparked significant backlash, leading to a massive walkout by thousands of junior doctors and plunging the nation’s healthcare system into turmoil.
The crisis began on February 20, 2024, with a widespread strike by resident and intern doctors – a critical segment of South Korea’s medical workforce. This drastic action was in direct response to the government’s announcement to substantially increase medical school enrollment quotas by 2,000 students annually for the next decade. Months later, this dispute remains unresolved, creating a prolonged standoff between the medical community and government authorities.
…Korea’s community of medical students and junior doctors does not believe increasing the number of medical students will address the core challenges within the nation’s healthcare system.
The government’s rationale behind the increased admissions quota was to combat the perceived shortage of doctors, a problem exacerbated by South Korea’s rapidly aging population. Data from the Organization for Economic Cooperation and Development (OECD) highlights that South Korea has approximately 2.6 doctors per 1,000 people, placing it among the lowest ratios in the developed world. This shortage is particularly acute in rural areas and essential medical fields.
However, the response from South Korean Doctors, particularly junior doctors and medical students, has been overwhelmingly negative. They argue that simply increasing the number of medical school graduates will not address the fundamental problems within the healthcare system. Their grievances are multifaceted, pointing to systemic issues that need to be resolved alongside, or even before, increasing the physician workforce.
Firstly, protesting doctors highlight the uneven distribution of medical professionals across the country and various specialties. Many doctors are concentrated in urban centers, leaving rural areas underserved. Furthermore, there is a significant preference for lucrative and less demanding specialties like dermatology and cosmetic surgery, while critical fields such as pediatrics, obstetrics, and emergency medicine struggle with understaffing.
Secondly, junior doctors emphasize the harsh working conditions they face, characterized by excessively long hours and inadequate compensation for those in essential but less popular fields. Intern and resident doctors in South Korea frequently endure grueling 36-hour shifts, significantly longer than the 24-hour shifts more common in countries like the United States. This intense workload contributes to burnout and dissatisfaction among junior doctors.
Thirdly, South Korean doctors face a high risk of medical malpractice litigation. Statistics indicate that one in three doctors in South Korea has faced a malpractice lawsuit since 2019. This litigious environment adds further stress and discourages doctors from entering or remaining in high-risk specialties.
Stalemate and Continued Protests
Despite the ongoing protests and significant disruption to healthcare services, the government has remained firm in its commitment to increasing medical school admissions. This is not the first time such a proposal has been met with resistance. A similar plan to increase quotas in 2020 was eventually retracted by the government in the face of strong opposition and the onset of the COVID-19 pandemic. Prior to the current decision, the medical school quota had been fixed since 1998, highlighting the entrenched nature of this issue. In May, the Korean Council for University Education finalized a revised quota increase of 1,509 for the 2025 academic year, a slight reduction but still a substantial increase.
In response to the finalized quota increase, over 12,000 junior doctors have participated in the walkout. Their protest has been further bolstered by solidarity strikes from medical professors. Adding to the pressure, a significant majority – reportedly over 95% – of medical students expected to graduate in 2025 have refused to take the national licensing exam, potentially delaying their entry into the medical workforce and exacerbating future shortages.
The South Korean Ministry of Health has attempted various measures to persuade striking doctors to return to work. Initially, the government issued a return-to-work order and threatened to suspend the licenses of non-compliant doctors. However, by June, the government softened its stance, halting the license suspension plan and introducing new guidelines aimed at easing the return of medical students to their studies. Further attempts to break the deadlock included calls for hospitals to process resignations, a move intended to either encourage doctors to resume their positions or allow them to seek employment elsewhere, potentially easing pressure on existing hospitals.
Despite these efforts, the impact of the strike remains severe. Currently, only a small fraction, around 8%, of junior doctors are actively working in the 211 general hospitals across South Korea, leaving significant gaps in medical service provision.
Counterproductive Outcomes and Public Impact
The ongoing standoff is having a palpable impact on patients, who are bearing the brunt of the healthcare disruption. Patients are experiencing significant difficulties in accessing emergency care and facing indefinite postponements of scheduled surgeries and treatments. Reports indicate that some emergency rooms are operating at severely reduced capacity, forcing individuals to travel considerable distances to receive urgent medical attention.
Public sentiment appears to be divided, with frustration directed at both the government and the striking doctors, and a general desire for a swift resolution. The political fallout has also been noticeable, with President Yoon Suk-yeol’s approval rating dropping to a record low of 21% in June, following his party’s electoral defeat in April.
The prolonged absence of junior doctors and the strain on the healthcare system paint a concerning picture for the future availability of new medical professionals in hospitals. The government is attempting to mitigate the crisis through various measures, including designating major hospitals to focus on critically ill patients. Another legislative response aimed at easing the burden is new legislation passed in August that expands the legal scope of practice for nurses, allowing them to perform tasks traditionally carried out by junior doctors. This situation in South Korea is unfolding amidst a broader global context of unrest within medical communities, with similar protests for improved working conditions occurring in countries like India and Germany this year.
The government’s urgency to address the doctor shortage is rooted in the demographic reality that South Korea is rapidly transitioning into a ‘super-aged’ society. Projections indicate that by 2035, 30% of the population will be senior citizens, and South Korea is projected to become the world’s oldest nation by 2044. This demographic shift will inevitably lead to increased demand for complex medical care, underscoring the long-term imperative to ensure an adequate and well-functioning healthcare system.
However, in the immediate term, the government’s policy of increasing medical school admissions appears to have backfired, triggering a crisis that has exposed deeper systemic issues within the South Korean healthcare system. Addressing these underlying problems, such as uneven distribution, working conditions, and litigation risks, is crucial for achieving a sustainable solution, even as the immediate focus remains on resolving the ongoing strike and its detrimental impact on patient care.
The views expressed are the author’s alone, and do not represent the views of the U.S. Government or the Wilson Center. Copyright 2024, Indo-Pacific Program. All rights reserved.
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