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Join us for a discussion on the recent wave of resident physician resignations in South Korea and the underlying issues within the country’s health care system. Our guest, Joo-Young Lee, a child and adolescent psychiatrist, provides expert insights into the factors driving young doctors to despair and resignation. We delve into the challenges faced by essential medical fields, the impact of government policies on training quality, and the implications of societal perceptions on physician autonomy.

Joo-Young Lee is a child and adolescent psychiatrist.

They discuss the KevinMD article, “Why South Korean resident physicians are quitting.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Joo-Young Lee. He’s a child and adolescent psychiatrist. Today’s KevinMD article, which he co-wrote, is titled “Why South Korean resident physicians are quitting.” Joo-Young, welcome to the show.

Joo-Young Lee: Yeah, thank you for having me, Dr. Pho.

Kevin Pho: All right. So Joo-Young Lee has been on in the past. Go to KevinMD.com/podcast to search for his name and hear his story. But today, let’s jump right into the KevinMD article that you co-wrote with Jin Wook Park. It’s titled “Why South Korean resident physicians are quitting.” For those who didn’t get a chance to read it, tell us what it’s about.

Joo-Young Lee: So this is about a series of events that unfolded earlier this year. The South Korean government announced an immediate 66 percent increase in medical school admission quota, effective from the 2025 academic year. This sudden change caught the attention of physicians, educators, and medical students, residents, all alike. However, the decision lacked transparency and scientific justification.

So as a practicing physician, I felt very frustrated that such a critical change could be enforced without meaningful dialogue with providers and medical schools. So my colleague Jin Wook and I decided to raise awareness of this issue within the US medical community. We hope it could spark some discussion about residents’ education quality and physician involvement in health care reform.

So I can break down some of the situation in bullets. First, the issue was about lack of evidence and transparency. The government implemented the significant increase without providing scientific evidence to support its urgency. Some minutes from government officials’ meetings about the discussion on this matter were not publicly shared, leaving stakeholders in the dark.

And there are already brewing core problems in the Korean health care system. The first is low reimbursement rates. So hospitals faced financial losses of 10 to 15 percent for each insurance-covered procedure due to inadequate reimbursement. And there are ongoing legal challenges. Physicians grapple with criminal prosecutions, not civil, for malpractice, as well as unavoidable adverse outcomes of their procedures.

But in response to this, the government considered just increasing the total number of physicians, believing that someone would trickle down into the underserved areas.

So in response, the resident physicians resigned in waves, and medical students refused to advance to their first-year residency. And many students even requested gap years, leading to empty classrooms right now.

And the government is overlooking some critical factors. First is population decline. South Korea is facing the lowest fertility rate in the world, impacting the future health care needs. And the physician surge. So even without the quota adjustment, South Korea already boasts the highest rate of increase in number of physicians among the OECD nations right now. And the government is not mentioning the cost implications of this change, because an increase in the number of physicians will inevitably increase medical expenditure, which will require more taxpayer money in the future.

Kevin Pho: So you mentioned that the government didn’t negotiate at all with the physicians. Did this come as a surprise to the physicians in South Korea?

Joo-Young Lee: Yeah, because there was some mentioning about a potential increase in medical student quota. That was the first time I heard, was the end of last year or so. But this number, 2,000, just struck me so hard. And we were asking for evidence, why 2,000, why not 1,500 or 1,000? But the government refused to answer, just saying that we’re just lacking numbers, projection of this trend will devastate the health care industry if we do not act right now. So that just surprised me so much.

Kevin Pho: All right. So what’s the situation today? And I believe that this strike started earlier this year. What’s the situation on the ground now?

Joo-Young Lee: So it is surprising that the gridlock situation between the government and medical society continues despite the passage of time.

I thought by the time I would record this podcast the issue would be resolved and that I’d be debriefing the whole thing. The Korean midterm election is over towards the end of April, and I thought the resolution would be reached, but negotiation is still far from occurring.

It is significant that still over 90 percent of residents have not returned to their teaching hospitals, and the hospitals are not able to process resignations due to the government’s executive orders. Therefore, the resigned residents cannot work in other hospitals even, and they’re getting these financial strains, and the situation is putting a devastating strain on the whole health care system right now.

And the media coverage is quite skewed right now. When news outlets focus on justifying government reforms without adequately representing physicians’ perspective, it creates an uneven playing field, I think.

And what surprised me most is that it’s trickling down, it’s affecting the physicians who are seeking to come to the US. So there are J-1 visa requiring physicians who just matched into the US training program for year 2024. J-1 visa was a track I also participated in when coming to the US in 2018. But the government is delaying the issuance of this document called a statement of need, that needs to be processed in order to get a J-1 visa from the United States.

And these are people who applied for residency back in September 2023, and were not involved in any of this mass walkout or anything. But they are getting this impact by the government, and they’re not letting them easily pursue their training in the upcoming summer. So I am very concerned that this situation is unprecedented, and the government is outright saying that they’re going to make their lives harder to emigrate to other nations, for the physicians.

But it is encouraging that the court is now actively looking into the legal cases filed by the residents and attendings. They requested the courts to help halt the government’s unidirectional reform. And a few days ago, the court demanded scientific evidence justifying the need to increase medical student quota by 2,000 so urgently. And this shows the court’s commitment to evidence-based decision-making. And the verdict is expected around May 15th, and I’m very much looking forward to hearing it.

Kevin Pho: So give us an example on the ground. So the South Korean government arbitrarily increased medical school quotas to, I think the number you said was 2,000 more medical students per year. You wrote in your article, what are some specific ways that increased quota is going to affect medical residents currently?

Joo-Young Lee: Like I wrote in the article, I already faced a hardship of sustaining a good training quality as a resident. Back in the day, I trained between 2011 and 2015 as a psychiatry resident in one of the, you know, considered top teaching hospitals in Korea.

Even after training, I didn’t feel confident with my skill set as a psychiatric resident. That’s why I felt, oh, OK, I’ll do residency one more time if I relocate to the US and I’ll learn more. So I feel OK about having a second training.

But with this dramatic increase of 2,000, this will just fully populate the classrooms. And they’re talking about, we’re even lacking cadavers for anatomy lessons, starting from first year med school. And the training hospitals don’t have enough beds even to host all the increased number of residents. And the government did not do any research on this kind of issue, that the overpopulated teaching hospital could also become a problem to sustain a good training quality.

And if the resigned residents from this year go back and have to redo the year again, they’ll collide with the newly coming medical students, and that’ll just snowball into a total disaster. That overpopulation of medical school or residency will just continue to become an issue, and their training quality, I feel, would be totally compromised.

Kevin Pho: So those residents who resigned, what are some of their demands to fix the problem? Is it simply just asking the government to go back on their quota, or are they asking for anything else?

Joo-Young Lee: So a couple months ago they promulgated, I think, six requirements they wanted in order to return back to their teaching hospitals.

The biggest thing was to go back to the original spot of discussion, and create this committee between government and health care professionals to start discussing about the real science-backed numbers in terms of physician needs.

And the other thing was, they really wanted the chair of the Department of Health and Welfare to step down, blaming him for demonizing the physicians during this process. He used the media to portray the physicians as, you know, they’re doing this just for money, they don’t want the health care market to be saturated with more doctors. So they were really, I think they’re really hurt about the whole movement that the chair of this ministry kind of created.

So I think those two were the big requirements. And there are additional requirements related to their teaching situation, teaching environment, and the quality. And like 36 hours of continuous shift, that’s legalized under the current system, they wanted that to be reformed as well.

Kevin Pho: So as the situation stands now, what’s it like for patients, the fact that all these resident doctors resigned? Are they getting the physician care?

Joo-Young Lee: So it is residents who stopped working, that constitute less than 10 percent of physicians nationwide, and physicians in the private practice sector still are doing their work. So are professors in the major teaching hospitals. I heard there is some movement around professors resigning, but the number stands around 6.6 percent as of now, so it’s not major.

So they are doing their work, but they’re overstretched, they’re getting burnt out, but there is no major impact on patients right now. They are redirected to secondary hospitals, and the tertiary hospital is very limited in taking care of the patients that they only can treat. So they are kind of navigating through this newly balanced ecosystem of health care right now.

But I feel like the patients are overall having the subjective uncertainty around their care. They are quite uncertain whether the remaining professors and attending physicians might resign in the context of this whole movement. I feel like the total sense of urgency and uncertainty are the biggest impact right now, versus the objective falling of the health care delivery.

Kevin Pho: Are these resignations making a difference? Is the government coming back to the negotiating table or reconsidering some of their positions?

Joo-Young Lee: Surprisingly, no. I am not seeing any significant change in their stance.

I think the medical professional sector is awaiting that court verdict as of now, and May 15th, because they firmly believe there have been many violations in their constitutional rights during this process. So I believe they are waiting for this as kind of a watershed moment.

But I really believe there comes some kind of a compromise between the two sectors. But I feel like they are just emotionally quite aggressive towards each other right now, and it’s really hard to imagine them sitting down and talking reasonably towards each other. I feel like this court verdict will bring something significant to this table.

Kevin Pho: All right. So you are certainly familiar with the politics in South Korea, and of course you trained in South Korea. Just from what you know about those dynamics, what’s your prediction in terms of what you think is going to happen next?

Joo-Young Lee: So it’s really hard to predict, because when I was in Korea, up until then, the overall ambience I’ve been feeling from that government was more civil. And I didn’t feel this much of a top-down kind of trickling down of command from the government. I felt like there are checks and balances between Congress and the government and the court system.

But now everything’s kind of different. And the messages I’m hearing from the media make it really hard for me to extrapolate from my experience of my life in Korea. I feel like it’s drastically different.

So I think many people are on the same page. It’s just so unprecedented, and it’s so hard to anticipate. Like I said, as of the time I’d be recording this podcast, I believed that everything would be over and things were back to normal. But that didn’t happen. It’s just beyond my imagination at this point.

Kevin Pho: We’re talking to Joo-Young Lee. He’s a child and adolescent psychiatrist. Today’s KevinMD article that he co-wrote is titled “Why South Korean resident physicians are quitting.” Joo-Young, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.

Joo-Young Lee: Yeah. So I believe residents play a vital role in the teaching hospitals, and their contribution should be valued and respected. It is essential to strike a balance between cost management and ensuring residents receive fair compensation and support and education.

And I really believe residents need a safe and supportive environment to learn and grow. A respectful atmosphere fosters confidence and encourages innovation.

And residents are the future leaders of medicine, I believe, and by providing a positive and protected learning environment, we empower residents to envision a brighter future in health care.

Kevin Pho: Joo-Young, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.

Joo-Young Lee: Yeah. Thank you, Dr. Pho.