I was an aspiring internist, then became an aesthetic physician, and now I am preparing to train abroad. This is the story of how I had to make life-changing decisions as a doctor to survive in this ever-changing world.

In August 2020, as a fifth-year medical student, I experienced my first doctor’s strike. I remember standing under the scorching summer sun, chanting slogans in protest. The conflict? A standoff between medical professionals and the government over proposed health care reforms—specifically, increasing medical school admissions to address doctor shortages in rural areas and certain specialties. But doctors pushed back: South Korea did not lack physicians; it lacked sustainable working conditions. Simply increasing numbers would not solve the deeper systemic issues.

At the heart of the problem was financial strain. South Korea’s National Health Insurance Service (NHIS) operates as a single-payer system, ensuring universal access—but at a cost. The system had been financially struggling for years, with treatment reimbursements often failing to reflect the actual costs of care. Some specialties, like cardiothoracic surgery and obstetrics, suffered the most, while others, less entangled with NHIS regulations, thrived on non-insured services. This imbalance created a growing divide within the medical field.

The 2020 strike was an awakening for me. It forced me to reconsider my future. In search of a way out of the path laid before me, I turned to two areas of medicine that were less impacted by the National Health Insurance System (NHIS): aesthetic medicine and pain treatment. These specialties, not covered by insurance, were free from the constraints of government regulations. I chose aesthetic medicine and worked as a generalist in dermatology clinics for two years, with plans to open my own clinic by 2025.

For a while, it felt like I had found a way forward. Then, in 2024, another earthquake hit the health care field—another sweeping reform, another strike. But this time, the government introduced a new policy: Banning the co-use of insured and non-insured treatments. The intention was to curb health care overuse, but its failure was glaringly obvious. Patients would either forgo necessary uninsured treatments or face significantly higher costs for services previously covered. This reform did not just threaten affordability—it deepened health care inequities, hitting low-income patients the hardest.

Would it affect me? Indirectly, yes. Though I was already in a non-insurance sector, this policy could push NHIS doctors to flood into my field, escalating the competition. Most importantly, this reform further threatens Korea’s health care sustainability, if it has not already signaled its downfall.

The key difference between the 2024 doctor strike and that of 2020 is that this time, young doctors—who are usually at the forefront of protests—chose to walk away from residency training altogether. Perhaps it was the psychological toll of years of unresolved frustration, or maybe it was the undeniable reality that Korea’s health care system is failing. The cracks have become so obvious that an unprecedented number of doctors, both senior and junior, are now preparing to train abroad.

I am no exception. As a strong believer in the words from The Alchemist—”Everything that happens once can never happen again. But everything that happens twice will surely happen a third time”—the turmoil will continue, no matter the outcome of this reform. So, rather than becoming another casualty of this system, I am choosing to take control of my own future—to step beyond the storm and carve out a new path for myself.

Hong Bi Yoon is a general practitioner in South Korea.