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The South Korean government has given striking trainee doctors until Thursday to end a mass walkout or face suspension and prosecution, as tensions mount over a stand-off that has exposed the country’s demographic challenges.
South Korea’s healthcare system was placed on its highest state of alert last week after thousands of trainee doctors resigned in protest against government plans to increase medical school admissions.
“We urge trainee doctors who have left their workplaces to return by Thursday. If they do, they will not be held accountable for previous actions,” health minister Cho Kyoo-hong told reporters on Tuesday. “Suspending licences and initiating legal proceedings will be unavoidable for those who do not return.”
The doctors, including residents and interns at Seoul’s five leading hospitals, say the issue is not a shortage of medical staff, but deep disparities in pay by specialisation and between rural and urban areas.
More than two-thirds of South Korea’s trainee doctors are on strike, according to the health ministry, leading to a 50 per cent drop in surgeries at general hospitals and a 24 per cent reduction in patient admissions.
Emergency rooms at military hospitals have been made available for civilian use, while the government has authorised nurses to conduct medical procedures usually performed by doctors.
“This is not a matter for negotiations or compromise,” President Yoon Suk Yeol said. “It is difficult to justify under any circumstances collective action that takes public health and lives hostage and threatens human lives and safety.”
South Korea’s government is scrambling to train more doctors in anticipation of a looming demographic crisis, as a rapidly ageing society increases demand for healthcare.
The country has among the lowest number of doctors per head in the developed world, according to the OECD, and the very lowest excluding practitioners of traditional Korean medicine. The Korea Institute for Health and Social Affairs has forecast a shortfall of more than 27,000 doctors by 2035.
The doctor shortage is particularly acute in rural and provincial areas, where residents are often forced to travel long distances to urban treatment centres.
South Korea has the world’s lowest fertility rate, which fell further in 2023 to 0.72 births per woman, according to government statistics released on Wednesday, far below the level of 2.1 needed to maintain a population.
The country is projected to become a “super-aged society” in 2025, meaning those aged 65 or older will constitute more than 20 per cent of the population. That proportion is set to rise to 25.5 per cent in 2030 and 46.4 per cent in 2070.
In response, the government wants to raise the annual nationwide cap on new medical school attendees from 3,058 to 5,058 in 2025, part of a plan to add 10,000 doctors to the workforce by 2035. The cap was last raised in 1998.
That proposal is fiercely opposed by the Korean Medical Association, which accuses the government of failing to address falling pay and deteriorating conditions for trainee doctors.
The South Korean healthcare system suffers from large pay disparities between specialisations, according to experts and doctors, who say the national health insurance system offers insufficient reimbursement rates in areas such as paediatrics, obstetrics and emergency medicine.
Many doctors are instead drawn to areas such as dermatology and cosmetic surgery, in which fees are uncapped because treatments are not covered by national insurance.
“Our view is that the current problem has nothing to do with the number of doctors,” said Joo Su-ho, a KMA spokesperson.
The government has said it will spend more than Won10tn ($7.5bn) on reforming the national health insurance system to reduce disparities between specialisations and regions.
Medical unions say the package does not go far enough, but critics within the profession say the unions have overplayed their hand, noting that South Korean doctors already enjoy some of the OECD’s highest levels of income relative to average wages.
“Korean doctors earn so much money because over the past 20 years they have been controlling government policies to maximise their monopoly power,” said Yoon Kim, professor of health policy and management at Seoul National University College of Medicine.
Jeongmin Kim, lead analyst at Seoul-based information service Korea Pro, said the strikes had garnered limited public sympathy. “Everyone seems to agree the country needs more doctors except the doctors themselves,” said Kim, adding that the stand-off had boosted approval of Yoon and his ruling party ahead of parliamentary elections in April.
Police in Seoul this week announced investigations into the union’s leaders on allegations of engaging in threats and coercion and violating medical law.
But the KMA’s Joo remained defiant. “We wouldn’t have started this if we thought we would have given in to the government intimidation,” said Joo. “We are not scared of anything.”
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