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ED'K-care' dilemma

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Nation must increase doctors and improve reward system

Korea's healthcare system was exemplary until a few years ago. It was easy to access, had skilled physicians and was cheap to use.

Suddenly, it seems to be a mess.

Emergency patients die in ambulances, as some accident and emergency departments failed to accept them. Parents with feverish children must wait hours to see a doctor. Even the nation's largest hospital failed to save one of its own nurses who suffered a stroke, due to the lack of cerebrovascular surgeons.

Doctors have for now just thwarted the attempts of nurses, who are looking to improve clarity regarding their responsibilities with a separate law, by threatening to walk out. Instead, nurses are on partial strike, refusing to play the role of assistants to physicians.

Bureaucrats at the Ministry of Health and Welfare are unable or unwilling to right the wrong. The bloated ministry is not good at either health or welfare administration. It is led by a former finance ministry official parachuted in only a year ago. Politicians appear only to be concerned about the effects a crippled medical system will have on votes.

Korea needs more doctors. In 2021, the nation had 1.9 physicians, excluding oriental doctors, per 1,000 people, barely half of the OECD's average of 3.7. A doctor saw 6,989 patients in 2019, more than three times higher than the 2,130 in the club of mainly rich countries. The average visit time was 4.3 minutes, nearly a quarter of the OECD's 16.4 minutes. The enrollment quota of medical schools has been fixed at 3,058 for 18 years.

Still, the Korean Medical Association (KMA), which has nearly 130,000 doctors as members, claims otherwise. The KMA says not the total number but its distribution among different regions and medical departments matters. It then calls for better rewards for members who work in alienated areas and who major in vital, complex care. Some doctors cite the dwindling population and robots armed with artificial intelligence as reasons for freezing their numbers. Sounds reasonable but this hides their vocational selfishness.

Better treatments for doctors in a harsher environment and increasing their number is not an either/or situation but a both/and proposition. Various studies show that Korea will need at least 10,000 more doctors by 2030, based on their workload in 2019. Korea's aging society will require more medical services even if the population plateaus or falls. AI and robots can only assist humans, not replace them yet. "Who but doctors would agree that Korea has sufficient doctors?" said Yoon Han-deok, the late ER chief at the National Medical Center who died due to overwork a few years ago.

All humans want to live longer and healthier. Korea is a wealthy capitalist country, and all Koreans seek to lead a wealthier and more leisurely life. Doctors are humans, too. They prefer dermatology, plastic surgery, and psychiatry to surgery, pediatrics and obstetrics and gynecology. Besides, the scarcer they are, the higher their value.

The government must increase their number, capitalizing in part on the medical school craze where all talented engineering students are wishing to become doctors. It therefore, should devise the fairest and most precise reward system, preferring thoracic surgeons, particularly those who work at night, on holidays and who conduct the most complex operations over those who fix noses or conduct double eyelid surgeries.

Officials should force large hospitals to hire more vital care specialists instead of relying too much on trainee doctors by setting strict standards. The government should also benchmark Japan's regional hospital system, where provincial institutions foster regional talents with scholarships, provide mandatory service for nearly a decade and then settle there.

Health-related bureaucrats must abolish the current "medical caste" system, where doctors reign over all other medical workers rather than working with them as a team. Bureaucrats and politicians must try again when it comes to the Nursing Act or amend the Medical Services Act, clarifying each profession's duties and responsibilities more thoroughly than now.

Normalizing the healthcare service may be one area where President Yoon Suk Yeol can exercise his specialty of unilateralism ― with widespread support. If the president spends only half the force he used to crush construction workers, to push for this healthcare reform, all medical patients will be happier.


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