From 'superstars' to 'privileged and spoiled': Doctors fight souring image

It used to be that when Park Ji-sun, a 45-year-old office worker, thought of a Korean doctor, it was the 2020 tvN drama series "Hospital Playlist" that first came to her mind.

The series became an instant hit in South Korea, depicting the lives of five doctors battling to save lives together. It was so successful that it was renewed for a second season, which is rare for a Korean drama.

"They were heroes with white gowns during the day, sometimes sacrificing their private lives in emergency rooms at night. But at the end of the day, they were human beings with warm hearts who could connect emotionally with their patients," she said.

"That was, until this year," according to her.

For the last nine months, since February, Park found herself reevaluating the profession, as thousands of junior doctors refused to work in protest against the decision to increase enrollment at medical schools by 2,000 students, up from the current 3,058.

The new policy, with which the government aims to increase the number of doctors in core medical fields and enhance regional health care, is set to take effect next year. Not only interns and residents, but also medical professors, joined the protest, not to mention the Korean Medical Association, the country's largest doctors association, with more than 140,000 members, holding intermittent sit-in protests.

The conflict over the proposed increase in medical student quotas, which has persisted for more than nine months, continues to disrupt medical services nationwide. Despite ongoing discussions, doctors and the government have yet to find common ground. The ruling party's proposal for four-way negotiations remains untouched, with no formal dialogue having taken place.

While the standoff has continued, Park has felt her understanding of what being a doctor means as a profession changing.

"I had thought of them as selfless heroes dedicated to public health, but now I see them as a privileged group driven by self-interest," she said.

Park is not the only one who questions the profession’s long-standing reputation for public service.

"The latest tension between doctors and the government has given the public the impression that they are a selfish and (a group) that requires negotiations for everything," said Lee Ju-yul, professor in the Department of Health Administration at Namseoul University.

Patients with chronic illnesses feel betrayed by doctors, with some complaining they have been treated as bargaining chips.

"Patients felt stung by the behavior shown by medical practitioners. Patients have reached a point of despair because this won't end soon,” Kim Sung-joo, 60, who is battling esophageal cancer, said.

The Korea Severe Disease Association, a group representing severely ill patients, released a statement in June framing doctors as "privileged" with no respect for the law.

"The government has worsened the situation with its lukewarm responses. This has made the doctors a privileged class that (undermines) the government and the people," the association said.

Nurses, the group working most closely with doctors, say they have suffered some of the worst consequences of the ongoing protest.

Bang, in her 40s, a nurse at the emergency intensive care unit of a university hospital in Seoul, said she saw many doctors abandoning their ethics.

"I tend to see patients who are given only a short amount of time to live, and at the moment, some doctors deal with such patients only through videos and photos,” she said. It's painful to see some doctors encourage guardians to withdraw life-sustaining treatment for terminally ill patients.”

Another nurse said that despite having to perform duties outside of their job descriptions under the current service vacuum, thus putting them in a legally vulnerable position, they were shocked to see doctors’ groups opposing the recent passage of the Nursing Act.

"Doctors are asking for help and support to oppose the quota hike, but they had been furious about the Nursing Act that allowed us to take on greater roles to fill the medical vacuum. It's actually for them, not us," a nurse in her 40s surnamed Kim, who works at a university hospital in Gyeonggi Province, told The Korea Herald.

The Nursing Act was passed by the National Assembly in late August this year, despite the public having been sharply divided over the legislation. It distinguishes the roles and responsibilities of nurses and nursing assistants from those of other health professionals such as medical doctors, dentists and traditional Korean medicine doctors stipulated in the Medical Service Act. Doctors’ groups had claimed that the Nursing Act might potentially allow nurses to open and operate their own clinics without their supervision.

Biggest, but not the first

This is not the first time that doctors have gone on a strike against the government's policy moves. There were major strikes in 2000, 2014 and 2020 against government policies that aimed to overhaul the medical system.

For example, in 2020, the Moon administration, which also tried to raise the medical school admissions quota -- but much more gradually by 4,000 over 10 years, or 400 a year -- scrapped their plans after a monthlong strike from physicians, interns and residents, as well as medical school students.

The current eight-month strike is the longest in Korea's history. Tensions among doctors, patients and the government are believed to be more intense compared to previous strikes. Doctors, for their part, claim they are being vilified by the current administration, which has left the public more hesitant to take sides with the doctors.

The KMA launched a full-scale, one-day general strike on June 18, which was a Tuesday, despite the government calling on them not to do so and patient groups’ requests to stay beside them.

Medical professors, who also act as senior physicians, said they would take days off and reduce treatment as they were struggling to cope with filling the gap left by absent junior doctors. Over 200 even resigned, leading to greater risk for the country’s health care system.

The situation took a turn for the worse when the presidential committee on medical reform, aimed at opening a dialogue for South Korea’s medical reform, kicked off in late April. It was boycotted by doctors who demanded the expansion plan be scrapped and the increase in the quota be reconsidered from the outset.

Amid the confrontation, the government has taken further steps to implement its plans. But doctors' positions only became more extreme, vowing to resist any decision the government made.

More than 10,000 trainees and residents, and a similar number of medical students, have walked out of their worksites and classrooms since February, with most of them refusing to respond to requests for them to return.

"The latest conflict has shown that the victims are always the patients and the weakest in the social pyramid. Doctors are a powerful group of people, which is why they have the power to drag (the conflict) out this long," Heo Chang-deok, a sociology professor at Yeungnam University said.

Why quota expansion?

The Yoon administration's main aim for the plan is to increase the provision of "essential" treatment and enhance regional health care.

The government argues that the current cap on the number of new doctors has left South Korea short of physicians who perform and provide higher-risk surgeries, pediatrics and emergency care. Many doctors opt for other fields that offer better financial opportunities and work-life balance, such as dermatology and plastic surgery.

A key issue is that fields like emergency care and heart surgery have to be carried out within major hospitals, where fees are restricted by the national insurance system to the extent that providers say they sometimes do not cover costs.

Doctors in other fields can set up their own clinics, and more easily charge high fees for optional services that fall outside the price controls of the national insurance system. The introduction two decades ago of new private insurance products that cover such services but not other treatments such as heart surgery, fueled demand for such services making independent clinics more profitable.

The number of new businesses opened by general practitioners from Jan. 1 to July this year came to 129, with 104 or 80.6 percent registered as dermatologist clinics, according to data by the state-affiliated Health Insurance Review & Assessment Service submitted to Democratic Party of Korea Rep. Jeon Jin-sook. Of the total, 48 were internal medicine clinics, while 34 dealt with family medicine. Obstetrics and gynecology clinics came to 22, while those opened by pediatricians came to only 9. Plastic surgery clinics came to 33.

Overall, the number of doctors for every 1,000 people stands at 2.2 -- below the average of 3.7 posted by the member countries of the Organization for Economic Cooperation and Development, according to the organization’s data on health statistics in 2023.

In addition, the staffing problem is likely to worsen, with the ministry estimating that, by 2035, the country will fall 15,000 doctors short of the number needed to meet the demand brought by demographic changes, Health Minister Cho Kyoo-hong said in a televised briefing on Feb. 6 as he announced the expansion plan.

Meanwhile, doctors maintain the rationale they have continuously had to oppose the quota hike: Increasing the quota isn’t the solution to getting more doctors to practice in medical deserts outside Seoul and will not lure new doctors into unpopular medical specialties.

They have cited that Korea already has high access to outpatient care compared to its 37 other OECD peers. Koreans attended an average of 14.7 outpatient care appointments per year, almost three times more than the OECD average of 5.9, according to 2020 data released by the Paris-based organization.

The World Health Organization, when asked about the monthslong medical standoff in South Korea, said earlier this month that the primary health care workforce -- local-level provisions such as general practice, physiotherapy and community health centers -- needs to be bolstered in general to cope with future challenges. A 2020 OECD report said only 6 percent of Korean doctors were general practitioners, as opposed to the OECD average of 23 percent.

"Challenges of the future -- including aging, the prevalence of non-communicable diseases and new patterns of accessing health services -- require expanding the supply of services, particularly at primary health care settings, where most health needs should be addressed," said the UN agency's Regional Office for the Western Pacific in an email response to The Korea Herald.

Doctors fight negative image

In response to accusations that they are using patients as leverage, doctors have pointed out their sacrifices during the COVID-19 pandemic and said that they are still upholding the Hippocratic Oath.

Leaving their families and the fear of being infected behind, doctors were on the front line in the battle against the coronavirus, treating patients under difficult conditions and pressure.

Korea was relatively more successful in detecting, containing and treating the virus compared to peer nations. People here lauded the doctors as “protectors,” thanking them for their efforts.

Public sentiment toward doctors, however, has soured since February.

Still, the doctors say they will continue to take the time to say no to a set of reform policies that they claim could lead to a collapse in the health care system, even if it costs them their reputation. Ihm Jin-soo, 32, is one of them.

Being a beacon of hope in a patient’s darkest hour motivated Ihm to become a surgeon.

Leaving little time for his own self-care, he found joy in helping patients heal after operations despite enduring 36-hour shifts as a first-year resident doctor at Kangdong Sacred Heart Hospital in Seoul.

But his hopes shattered the day the government announced the quota hike, and he felt he had no choice but to resign -- even if it seemed like a loss.

“Don't you think it will be painful for us to let go of years of dedication, hard work and genuine commitment to patient care? But the government rolled out policies ruining doctors and health care instead of coming up with plans appreciating doctors and throwing shame at us.”

“Does the public have the right to demand social responsibility from ordinary individuals by trampling on our pride? That only hurts our feelings and delays our return,” Ihm said.

Kang Hee-gyung, a medical professor specializing in pediatric kidney transplantation, stressed that doctors have a solid reason behind saying "no" to the government's quota hike.

“People think doctors are just saying 'no’ to the quota hike, but we actually aren't. Raising the medical school admissions quota by 2,000 seats could be possible if there are justifiable reasons. However, the government abruptly made the decision by breaking the Sept. 4 agreement signed in 2020,” explained Kang, who heads the Emergency Committee of Medical Professors at Seoul National University and Seoul National University Hospital.

The professor was referring to the agreement made by the Moon administration and the KMA, which stipulated that the Health Ministry would not make any attempt to push the expansion plan forward and would discuss the plan through a government-doctor committee.

“For example, having more doctors means a rise in the cost of medical services for the public. But the government is trying to solve the problem unreasonably, which is difficult for doctors to accept,” Kang explained.

Kang and other doctors have reasoned that salaries ultimately have to be paid for out of medical fees, so an increase in the number of doctors would involve an increased fee burden and unnecessary treatment.

However, the government has argued that recent increases in demand are due to the aging population, and that costs are rising more quickly than ever, despite slowing growth in the number of doctors.

The waning trust deficit in doctors has also left an indelible mark on her as she feels the standing and credibility of doctors are declining.

“Pride is the most important reason for doctors’ existence, but that has completely disappeared. Many doctors in medical fields where medical accidents can occur say they have no reason to stay anymore. They are staying because their contracts have not ended or because their patients are still undergoing treatment,” Kang said.

Choi Anna, a fertility doctor who acts as spokesperson for the KMA, said doctors are being vilified to an unusual degree because the government has framed doctors as demons.

“The government said doctors only care about money and exclusivity and started a war just for profit,” Choi told The Korea Herald.

“But the health care system is for the people, and doctors are also patients and guardians. Thankfully, the public is slowly recognizing that the government’s medical reform policies are reckless, and it’s time for us to rebuild our health care,” she said.

Also, Choi added that doctors are always there for their patients.

“A doctor wishes their patients a fast recovery. As a fertility doctor, I hope that my patient will get pregnant soon, and that’s what a doctor should and must do. Not a single doctor wants to see their patient die.”