[Editorial] Shortage of doctors

Should the entrance quotas of domestic medical colleges be expanded or curtailed? The Ministry of Health and Welfare says student enrollments at medical schools need to be increased as physicians are in short supply. Yet practicing doctors argue exactly the opposite.

According to a report released by a Yonsei University research institute, Korea is suffering a shortage of medical manpower. A comparison of doctor-population ratios among OECD countries clearly shows this.

In 2010, Korea had two physicians per 1,000 people, much lower than the OECD average of 3.1. Korea’s ratio included Oriental medicine doctors. When they are excluded, the ratio falls to 1.67.

The report predicts that Korea will suffer a more serious doctor shortage in the years to come, if the current student quotas of medical colleges are maintained. As reasons, it cites rapid population aging and income growth, which increase demand for medical services.

The report’s estimates of Korea’s doctor shortage in 2020 range from 34,000 to 160,000. To meet this shortage, it recommends that the entrance quotas of domestic medical colleges be raised by at least 20 percent.

While demand for doctors is growing, their supply has actually been falling. In 2010, a total of 2,688 students graduated from medical schools across the nation. It represented a drop of 22 percent from 2009.

The decrease was the result of the government’s decision in 2002 to gradually reduce medical school enrollments. The ill-advised measure was part of the deal the government concluded with the Korean Medical Association to implement health insurance reforms.

At the time, physicians accepted the government’s demand that they leave drug dispensing to pharmacists. In return, they wanted the government to scale back the number of students at medical colleges in a bid to curb the growth of the medical workforce.

Hence, the number of students admitted to medical colleges was reduced from 3,253 in 2002 to 3,058 in 2003. In 2007, the figure fell to as low as 2,114. The admission quota has been restored to the 2003 level, but the effects of the reductions already made have begun to be felt.

Despite the warnings of doctor shortages, the KMA is adamantly against any increase in admissions to medical schools. It even argues that medical college enrollments should be further cut because there is a glut of doctors.

The association points to the fact that Korea’s population gained 7.5 percent between 2000 and 2010, while the nation’s physician manpower increased by as much as 40 percent during the period.

This argument, however, does not hold much water. First, the high growth rate of doctors was due to the low base effect. And the small population growth reflected the graying of Korean society, a phenomenon that calls for a growth in the health care workforce.

There is one more reason the ministry should hurry to increase the supply of doctors ― the pressing needs to make medical services available in rural areas with no or few health care personnel.

According to press reports, 54 of the nation’s 228 provincial cities and counties have no maternity wards. Expecting mothers in these areas need to travel to hospitals in other cities for checkups and childbirth.

To provide health care for residents in these areas, the government relies on public health doctors ― physicians who work at provincial public health centers for three years in return for exemption from conscription.

In recent years, however, the number of applicants to become public health doctors has been declining, forcing the government to try new ways to secure them.

One method proposed by the Health Ministry calls for allowing medical colleges to admit a certain number of students on top of their quotas. Then the government would subsidize the tuitions of these students on condition that they work as public health doctors for five years.

The scheme sounds rational but the KMA opposes it on the grounds that it would increase the number of physicians.

The association deserves criticism as it focuses only on doctors’ interests in crass disregard for the right of residents in backwater areas to access basic health care services.

The Health Ministry is also to blame for its timidity. In the face of the KMA’s opposition, it is not pushing for its proposal hard enough. It needs to work more proactively to beef up medical workforce.