South Korea senior doctors quit, escalating crisis as officials threaten to revoke trainee licences

South Korea's healthcare services risk being thrown into further turmoil as a nationwide doctors' strike worsens, with senior staff resigning and trainees continuing to give up internships in protest against a government plan to almost double the number of medical school admissions.

Junior doctors on Tuesday said they had no intention of returning to work even as officials launched steps to suspend their licences, warning that demonstrators would face serious problems in their future careers.

Yun Woo-sung of the Kyungpook National University School of Medicine on Monday became the first professor to resign over the issue, and others have said they would "not sit idle" if junior doctors were "hurt", as neither side shows signs of backing down in the gridlock that has dragged on for weeks.

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"This measure is irreversible," Second Vice-Health Minister Park Min-soo told journalists, as government officials on Tuesday visited 50 hospitals around the country to conduct checks on the attendance rates of trainee doctors.

The Korean Medical Association (KMA), which represents private practitioners, on Monday urged the government to rethink its reforms and accused authorities of a "witch-hunt" against doctors.

Some 9,000 residents and intern doctors - about 70 per cent of the country's trainee doctors - have resigned since February 20 over a government proposal to increase the number of students admitted to medical schools from 3,000 to 5,000 from next year, to plug doctor shortages in the rapidly ageing country.

South Korea ranks near the bottom in the developed world for its number of medical school graduates per capita, according to data from the Organisation for Economic Co-operation and Development.

Thousands of South Korean doctors on Sunday joined a mass rally organised by the KMA, defying calls to return to work.

A female resident in her early 30s told journalists on Tuesday that, like many of her colleagues, she was anxious about her future career path following government threats to suspend trainee doctors' licences.

"I wonder if I am living in a democratic country or not," said the resident, who covered her face with a mask to hide her identity, and declined to be named.

"If I had majored in a non-vital field such as skin care, would I be subject to government threats to revoke my licence like this?" she questioned emotionally. She accused the government of imposing "forced labour" on trainee doctors.

Park In-Sook, a KMA spokeswoman, accused the government and local news media of "demonising" doctors as only obsessed with money-making.

The protests have not received widespread public support, as doctors are viewed as among the highest-paid professionals in the country.

The striking doctors claim the increase of medical places is not an answer to poor pay and long hours, and would instead lead to a decline in healthcare quality as universities are not equipped to handle the surge in enrolments.

"The sudden increase of medical school admissions by 65 per cent is nothing but an election tactic to win more votes at the parliamentary elections," she said at the same press conference on Tuesday.

Chung Jin-haeng, a professor of pathology at the top Seoul National University, said the KMA would take the government to court over its decisions, as officials had "no right" to force anyone who resigned from their jobs to return to work.

The walkouts and strikes have led to serious disruptions at large hospitals, which are heavily dependent on trainee doctors, who work up to 80 hours a week at lower wages.

Aside from their own training and education, medical residents care for patients, assist senior doctors in surgical procedures, keep records and communicate with patients.

Hospitals are responding to the protests by scheduling fewer urgent surgeries and turning away new patients as emergency units run beyond capacity, local reports said.

To compound matters, an increasing number of post-resident fellows - who decide on the admission and discharge of inpatients, and play other crucial roles in treatments and surgical procedures - are declining to extend their annual contracts expiring this month.

Fellows account for 16 per cent of medical staff in South Korea's "Big Five" hospitals, and only around one-third of them have renewed their annual contracts, the independent Hankyoreh newspaper reported on Monday.

Major training hospitals in Seoul are facing an unprecedented situation, as few new interns and residents will begin their training this month.

To qualify as a specialist, a doctor must spend one year as an intern at a training hospital, and three to four years working as a resident, but many graduates have abandoned their internship contracts.

"There were 150 interns who were supposed to work [at the Severance Hospital at the Yonsei University from March 1], but only three signed contracts," university head Yoon Dong-sup told the Hankyoreh.

Fellows have been going beyond the call of duty to fill the gap left by colleagues, but they are burning out fast, he added.

As a way to fill gaps in the system so far, the government has opened up emergency rooms at military hospitals to the public, allowed telemedicine nationwide and encouraged people with minor illnesses to visit local clinics in their neighbourhoods.

Online communities for cancer patients have been flooded with posts expressing concerns over the strikes.

"I was supposed to receive inpatient chemotherapy at the Seoul National University Hospital, but I was told to wait for a further notice by phone without a confirmed date," a patient wrote.

"My liver surgery at the Asan Medical Centre was scheduled for the 14th of this month, but it was postponed indefinitely," another posted.

Doctor shortfalls are most keenly felt in rural areas and essential medical fields, including high-risk surgeries, paediatrics, obstetrics and emergency medicine, which are covered by the state healthcare system that pays out low reimbursements for these sectors.

Doctors working in these high-risk sectors are also plagued by risks of being sued for crippling damages over surgery mishaps.

Critics say the "distorted" medical insurance payout system compels doctors with specialisations to avoid crucial but low-paying fields in favour of more lucrative work such as beauty care and plastic surgery, which remain outside the state medical insurance package.

Doctors consequently call for the increase in the small state insurance payouts, legislation to protect them from malpractice suits, and improved wages for trainee doctors working long hours at hospitals.

"If admission quotas for medical students are increased, trainee doctors would increase in numbers, making it all the easier for hospitals to have them work harder for cheaper wages," Park Dan, one of the first 13 trainee doctors who were notified of their impending suspension, said on Monday.

The World Medical Association (WMA), a group representing physicians, issued two successive statements, one on Friday and another on Sunday, blaming the government for what it called an "unprecedented government-led crisis".

"I strongly urge the Korean government to reconsider its actions and cease the forceful measures imposed on the medical community," Dr Lujain Al-Qodmani, president of the WMA, was quoted as saying in the Friday statement.

In the Sunday statement, the group said it "strongly condemns the actions of the Korean government in attempting to stifle the voices of elected leaders within the Korean Medical Association", adding it affirmed the right of doctors to collective action, including strikes.

The government plan to increase the number of medical students is expected to boost election chances of the ruling conservatives ahead of the April 10 parliamentary elections, with President Yoon Suk-yeol's approval rating gaining five points to 39 per cent.

Yoon, for most of his two years in office, has been struggling with low ratings amid inflation, scandals connected to his wife and mishandling of disasters.

Additional reporting by Reuters, Bloomberg

This article originally appeared on the South China Morning Post (SCMP).

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