2024 South Korean medical crisis

Last updated

2024 South Korean medical crisis
DateFebruary 20, 2024 (2024-02-20) – present
(8 months and 2 weeks)
LocationFlag of South Korea.svg  South Korea
Cause
  • Government's plan to increase of medical students enrolment
  • Imbalance of medical services

2024 South Korean medical crisis is an ongoing healthcare crisis following the announcement of new government policies on significantly increasing the medical student quotas. Thousands of residents and interns have since resigned, which has resulted in medical school professors working to cover for residents. This has forced non-urgent, less complicated patients to no longer be treated at tertiary care facilities, leading to concerns about large university hospitals running into financial trouble. There has been anxiety about patients being unable to receive timely treatment. [1]

Contents

Background and causes

Demographic change of South Korea

South korea's population pyramid (1960-2020) South korea population pyramid 1960-2020.gif
South korea's population pyramid (1960-2020)

In June 2012, South Korea's population reached 50 million, [2] and by the end of 2016, South Korea's population peaked at about 51 million people. [3] However, in recent years the total fertility rate (TFR) of South Korea has plummeted, leading some researchers to suggest that if current trends continue, the country's population will shrink to approximately 28 million people by the end of the 21st century. [4] In 2018, fertility in South Korea became a topic of international debate after only 26,500 babies were born in October and an estimated 325,000 babies for the year, causing the country to achieve the lowest birth rate in the world. [5] [6] [7] In a further indication of South Korea's dramatic decline in fertility, in 2020 the country recorded more deaths than births, resulting in a population decline for the first time since modern records began. [8] [9]

In 2023, 69% of local medical centers of Korea could not fill their doctors quota, [10] with Chungnam Seosan medical center being unable to hire enough radiologists despite offering an annual salary of 420 million won (about $300,000) [11] with 4.5 working days per week. Gangwon Sokcho medical center also increased the annual salary of emergency medicine specialists to 420 million won ($300,000) because they were unable to fill in the position with lower salary. [12]

South Korean President Yoon Suk Yeol argued the basic medical system is collapsing with many disciplines such as pediatrics, obstetrics, and gynecology, lacking manpower and thus many people are not able to receive timely treatment. He also cited the imbalanced distribution of medical services between urban and rural areas as one of the reasons to expand the enrolment of medical students. [13]

Government of healthcare system

South Korean healthcare system has significant distortions. A mandatory designation system integrates all doctors and private medical institutions into public health insurance, enforcing predetermined fees and rigorous audits. Low fees necessitate subsidization from non-insurance treatments or high-volume, low-margin practices, without compensating doctors for their extensive training and experience. Medical malpractice criminalization rates in the country are extremely high, leading to an exodus of young doctors from high-risk essential medical fields. The government provides minimal support for medical education and residency training, making medical schools rely on hospital profits. Residents often work up to 100 hours a week, and university hospitals depend on their cheap labor due to strict fee controls. [14]

Every year, the government engages in negotiations with medical professional organizations to determine the extent of the increase in medical treatment fees. Healthcare practitioners argue that South Korea's medical fees are insufficient when compared to other OECD countries, and the fees reimbursed by the government do not cover the cost of services. This debate concerning medical fees and reimbursement has persisted for several years. Virtually, medical fees have been controlled strictly by the government and remain at a fraction of the prices in the United States, and cheaper than those in China and Singapore. [15] [16]

South Korea has an insurance system with low reimbursement rates which encourages high turnover by hospitals and does little to dissuade patients from seeking second opinions. [17] [18] The health finance system in South Korea is characterized as "low premiums, low medical consultation fees, low pay". [19] The medical policy not to give adequate payment and working condition to medical workers caused shortage of medical workers in some specialties, such as pediatrics, because these specialties involve underpaid treatments which is due to involvement with National Health Insurance. National Health Insurance, setting low medical fees and taking advantage of medical workers, made medical workers in these specialties overworked but underpaid. [20] [21] [22]

When the government broadens the range of health insurance benefits, healthcare facilities tend to offer uninsured services, due to low insurance benefit payment. The cost of healthcare services covered by insurance only amounts to 87% of the original cost. Consequently, healthcare institutions get financial losses when providing services covered by insurance. [23] Among OECD countries, South Korea has a notably low proportion of active nurses. Despite a steady increase in the overall number of nurses, the expected growth in the number of active nurses has not been realized due to persistent turnover issues. [24] The failure has sparked opposition from medical workers, leading to strikes and public debate. South Korea is recognized as a nation that offers excellent medical services despite the relatively low burden of public health insurance premiums. Nonetheless, patients bear the responsibility of paying for medical services that are not covered by health insurance, which places a financial strain on them. Healthcare providers encounter challenges due to the significantly low prices set by the health insurance system for the medical services they offer. Healthcare providers face challenges in terms of satisfaction and burnout as they struggle to obtain sufficient treatment time due to inadequate reimbursement. [25] [26] [27]

The policymaking process in South Korea neglected proper channels for professional opinions. This omission ultimately resulted in governance failure, sparking unnecessary severe conflicts among key actors such as doctors, pharmacists, civil society organizations, and the news media. [28] One research examined how the media granted more legitimacy to the government than to the doctors. According to the study, the government's image is presented as "an actor that partially contributed to the cause of the conflict but is keen to exert its best efforts to resolve the problem in the best interest of the public and everyone involved in the conflict." The study showed the image of doctors is shaped by three major news frames: the "morality frame," the "internal dissent frame," and the "inconciliatory attitude frame." These frames depict doctors as "a group primarily motivated by economic interests, violating the ethical code of their profession, experiencing internal divisions, and refusing to engage in dialogue." According to the research, the arguments of medical providers pointing out the structural problems of our medical community, which has been made by the government, have considerable validity, the news media's bias is expressed by the use of strong labels such as "criminals" and "murderers," which are applied to medical providers. [29]

Admission quota of medical schools of South Korea

Since 2006, the admission quota of medical schools has been 3,058 per academic year. [30] The number was decreased from 3,500 in 2000 which is the year when another strike of South Korea doctors happened. The strike was due to the proposed plan of government to strictly separate the job of physicians and pharmacists, which could cause a significant damage to the income of doctors. Residents and interns refused to work, [31] and emergency rooms of local hospitals were also closed.

Repulsion from residents

The announcement of increasing medical school from the government immediately caused repulsions from the residents and interns because they have claimed that the welfare of trainee doctors must be improved first. According to the Korea Intern Resident Association, intern and resident doctors in South Korea work 36-hour shifts, in comparison to the United States where they work less than 24 hours. About half of these doctors would work no more than 60 hours per week on average in the United States, while in South Korea it is common to exceed more than 100 hours per week. [32] The average salary of residents of South Korea is about 70 million won (about $50,000). It was surveyed that 100% of thoracic surgery residents, 82% of surgery residents, and 77.4% of neurosurgeons work more than 80 hours a week. This is one of the aspects of cheap and high-quality medical care in Korea that the government has been boasting about. [33]

Skewed distribution of doctors in South Korea

Doctors and the government posited that it is not the number of medical school admissions but the government policy and laws about healthcare of South Korea that made the doctors move to the profitable field rather than the field for vitality of patients. In South Korea, according to the law, it's illegal for physician assistants (PA) do basic activity such as suture, as well as for tattoo artists to do tattoos, because their activities are invasive and therefore will hurt the health of citizens. [34] Skin care treatments such as laser treatment and neurotoxin are only legally allowed to doctors, making general practitioners (medical students who passed Korean Medical Licensing Examination) work in the beauty market without being a training doctor.

The core issue for local public hospitals in South Korea lies in the inherent conflict between serving public interest and achieving profitability. They are mandated to fulfill a public mission, encompassing tasks like establishing a medical safety net for low-income individuals and managing financially unsustainable medical facilities and emergency healthcare situations. Simultaneously, they are expected to pursue profitability by delivering high-quality care through competition and operating as an independent, self-sustaining entity following private business principles. The decline in inpatient revenue at local public hospitals can be attributed to several factors, including low reimbursement rates, the provision of charitable care to individuals with low incomes, and the delivery of low-revenue-generating services such as obstetrics and gynecology and pediatric services in medically underserved regions. Local public hospitals have received very little from the central government. [35]

Events by time

The government announced they will increase medical school enrollment by 2,000 every year from 2025, setting the quota to 5,058. [30] Doctors have collectively opposed Yoon's proposal, stating there are already sufficient doctors in major hospitals. [36] However, the government moved forward with the plan. [37]

Many doctors resigned collectively. [38] Many undergraduate students in medical schools suspended their studies. [37]

The government raised the crisis level of the country's medical system to "serious". [39]

The Ministry of Health and Welfare announced that all clinics and treatment centers were allowed to provide telemedicine services. [40]

Ministry of Health and Welfare stated that among the 100 hospitals, 10,034 interns and resident doctors submitted resignation letters with 9,006 of them resigning. [41] In response, the Ministry suspended the medical licenses of two leaders of the Korea Medical Association and ordered the return of intern doctors. [42] [43] The government indicated that if they resumed their work by February 29, they would not be punished. [44] On March 1, there were 565 doctors who had yet to return to their duties. [45] The government stated that they would take action against those who refused to return to work by March 1 and threatened administrative sanctions and other possible judicial measures. [46]

The Ministry announced that nurses would be able to assume some of the duties of doctors. [47] On March 1, the Ministry issued a return-to-work order to 13 intern and resident doctors who formed the committee of the Korea Intern Resident Association. [48]

The Korea Medical Association held a general meeting at Yeouido island located on the Han River in Seoul, condemning the government's pressure on the doctors and mobilizing doctors to protest against the government. [49]

South Korean Prime Minister Han Duck-soo chaired a response meeting, acknowledging that a large portion of the doctors had yet to return to work. Han stated that the government would urgently prepare a budget to employ replacement doctors and reward those who stayed in the hospitals. Various committees under the government would also work to implement healthcare reforms. [50]

In order to ensure that regional emergency centers were able to treat severe cases, the Ministry began to classify patients into critical and non-critical groups. [51]

The Ministry announced that it would conduct a second inspection at 50 hospitals for the return of intern and resident doctors. If these doctors returned to their posts by then, they would not pursue further discipline. However, if they still haven't returned to work, they would face punishments on the following day. Those who did not comply with the government's order to return to work would have their medical licenses suspended for at least three months, delaying their qualification as medical doctors by more than a year. Further administrative sanctions would also be recorded in their employment records. [52] [53]

Online users of a doctor community MediStaff collaboratively wrote "참의사 목록" (a list of true doctors) that lists residents who were still working in hospitals. [54] Since only those who certified their doctor licenses during membership registration could read the articles in MediStaff, this list was exposed to the public only after an anonymous resident revealed this incident on a public online community. The name ("참의사 목록", a list of true doctors) sarcastically expresses that the doctors in the list are in the hospitals because they more value the wellness of patients. The list contained the names and associations of working residents in 70 hospitals. Seoul police later searched and seized 5 doctors who were suspected to lead the crime (April 19), and the head of the Korea Medical Association (KMA), Lim Hyun-taek, asserted that this is tyranny against doctors. [55]

At 11:00 am local time, more than 11,994 intern and resident doctors remained absent, representing 92% of the trainee doctors. [56] On March 11, the Ministry had issued a notice of suspension of medical licenses to 5,566 intern and resident doctors. [51] The Ministry indicated that those who returned to work before the completion of the notification process would be dealt with leniently. [57]

The government started sending out 158 military and public health doctors to hospitals. [58]

Senior doctors and professors from 20 hospitals had indicated that they would submit their resignation letters from March 25 in support of junior medics' walkout. [59] But instead, they began cutting back on hours spent in practice on March 25. [60]

President Yoon gave a speech to the nation for almost an hour. He reaffirmed his will to expand the number of medical school admissions and appealed to the public for support. [61]

"As the president, I regret not being able to promptly address the public inconvenience... All rational people will agree that the country faces a shortage of medical doctors."

— Yoon Suk Yeol, President of South Korea

The South Korean government reduced the increasing quota of medical school admissions from 2,000 to 1,500 for one upcoming academic year. [62] [63] The number was determined after receiving updated numbers from universities who wanted to shrink the quota in order to minimize the conflict between the medical school professors and other faculty members. However, the Korea Medical Association (KMA), residents and interns kept their stance.

The high court of South Korea judged that increasing the quota of medical schools is necessary for the greater good. [64]

As of July 18, 2024, only 8.4% of resident doctors who had left their jobs in protest had returned to work. Their terminations were finalised on July 15 on instructions from the government [65]

To fill in the empty positions, recruitment of 7,645 residents for the second half of the year began at teaching hospitals across the country. [66]

At a National Assembly parliamentary hearing, Health and Welfare Minister Cho Kyoo-hong said the ministry plans to announce additional reform measures related to increasing medical school admissions early next month. [67]

Resolutions and negotiations

Adjusting the increased quota

The government offered to adjust their healthcare reform plans to let medical schools determine their own admissions for the 2025 intake, lowering the designated quotas by up to 50% for 2025 while maintaining the original increased quota from 2026 onwards on April 19, 2024. [68]

Hiring doctors from foreign countries

As the medical crisis remained unabated, the government in May 2024 sought to allow vetted foreign doctors to work in South Korea. In response, the head of KMA, Lim Hyun-taek, shared a screenshot of a news report of newly graduated Somali doctors in his Facebook with the text "Coming Soon.", a message connotating that doctors from foreign countries are inferior to South Korea doctors. Although it was subsequently removed, it was deemed as "racist" and "exploiting Islamophobia and stereotyping against developing countries". [69] [70]

The government's proposed plan was an extension of preparing the new medical environment for upcoming plural society of South Korea, which is already becoming reality since the number of people from foreign countries in South Korea reached 2.5 million in 2024 [71] and the ratio of international marriage of South Korea reached 10% in 2024 as well. [72] A collaboration between South Korea and the Middle East/African countries from 2010s reported that over 130 doctors from the Middle East are already working as specialists in South Korea in 2024 as a part of the official government program for international healthcare collaboration of South Korea. According to the news, these foreign doctors are overall satisfied with their hospital environment. [73]

Reactions

Government

South Korean President Yoon Suk Yeol denied that the increase in medical students would lead to a decline in quality of medical education. He stated that the proposed increase of 2,000 students is the minimum required. [74] The government stated that if the doctors did not return to work, their medical licenses would be suspended. [37]

The Ministry of Health and Welfare deployed military and public health doctors to affected hospitals to ensure emergency patient care. The government warned the trainee doctors of potential license suspensions for their collective action. [75] The South Korean government tried to expand the role of nurses in emergency care units at general and training hospitals. The Ministry of Health and Welfare planned to release guidelines allowing experienced nurses to perform certain tasks typically assigned to doctors, such as CPR and administering medication to critical patients. [76]

A Central Disaster and Safety Countermeasure Headquarters was established, headed by the Prime Minister, to coordinate the government's response to the crisis. Regional emergency situation rooms were also set up to manage the transportation of severely ill patients in major regions. [77]

The Education Ministry introduced guidelines to prevent boycotting medical students from failing their semesters due to insufficient class attendance. [78] Measures included:

Experts in Medicine

Medical professionals argue that the plan would impair the quality of medical education. However, commentators pointed out student-to-faculty ratio in Korea is one-third of Germany's and half of the United States, with each Korean medical professor handling 1.6 medical students on average. [56]

Medical professionals pointed out that the planned enrollment increase will not be able to fix the immediate manpower issue as training doctors typically takes ten years. [79] If a fresh medical student wants to qualify as a specialist, they must undergo a six-year study, a one-year internship and three to four years of residency training after graduation. [80] This implies that not only the increased quota of medical schools but more immediate actions such as partially allowing doctors from overseas to work in South Korea is necessary.

Medical professionals also point to high rates of medical malpractice litigation. Approximately 750 South Korean doctors are criminally charged for medical malpractice every year. That is 14.7 times higher than Japan, 580.6 times higher than the United Kingdom, and 26.6 times higher than Germany. [81] A 2019 study found that one-third of doctors had experienced a medical malpractice in the past 3 years. These litigations often occur in more critical medical specialties such as emergency medicine, cardiothoracic surgery, gynecology, and pediatrics. A criminal charge due to medical malpractice does not lead to revocation of their doctor license according to the law of South Korea, but this can still be a significant threat to doctors in the specialties.

Korea Medical Association

The Korea Medical Association stated that the right to resign is protected by the constitution. [82]

Korean Health and Medical Workers' Union

The Korean Health and Medical Workers' Union has voted in favor of a general strike. This decision was made following a vote where approximately 91% of health workers from 61 hospitals across South Korea supported the strike action. The strike is a response to the emergency measures implemented by hospitals due to financial pressures, which include furloughs, unpaid leave, and mandatory overtime. [83] After that, unionized hospital workers called off their planned strike after negotiating with hospitals for pay raises and improved working conditions. [84]

Residents

The Korea Intern Resident Association wanted the government to withdraw the plan to increase the enrollment of medical students and cancel the return-to-work order. [85]

Students' boycott

Medical students began to boycott attending their classes since February 20. As a result, Gachon University postponed the start of the semester from mid-February to March 4 initially, then once more until March 25, while Gyeongsang National University delayed the start to March 15. By March 6, 5,401 students (28.7%) had applied for leave. However, if including improperly filed applications, the number of applications would potentially be over 14,000. [86] Due to ongoing boycotts by medical students over increased admissions, only 2.7 percent of students attended classes, with just 495 out of 19,345 enrolled students returning as of July 22. Attendance rates varied, with first-year pre-med students at 1.7 percent and medical school seniors at 3.5 percent. Government concessions have not significantly increased attendance. [87]

Media

The government labeled the collective criticisms and social advocacy of medical students, residents, and doctors as "doctors' illegal collective actions," leading to a declaration of a national healthcare crisis at the highest risk level. The "Central Disaster and Safety Countermeasures Headquarters for Doctors' Collective Actions," led by the Prime Minister, was established. In line with changes in digital media, the Emergency Response Headquarters conducted daily public briefings, marking an unprecedentedly swift governmental response. A large-scale campaign was launched to bolster government policy, featuring the President's commitment displayed on public buses and subways, and promotional videos in movie theaters. Screens inside apartment elevators also broadcast the government's message against "emergency room ping-pong" and "pediatric clinic open run," representing an unprecedented promotional campaign. Doctors and the medical community were portrayed as a self-serving cartel, a characterization cemented by the President in a national address. This portrayal marked doctors as adversaries rather than partners in healthcare reform, significantly undermining the trust that forms the foundation of the doctor-patient relationship. [88] [89]

Patient groups

Patient groups in South Korea spoke their concerns about the continuing conflicts between the government and the doctors. [90] In July 4th, 92 patient groups including the Union of Korea Breast Cancer Patients, Korea Alliance of Patients Organization and Korean Organization for Rare Diseases gathered and claimed stopping the collective actions of doctors and promoting a law that will prevent the patients-damaging action from happening in the future. [91]

Opposition parties and the public

Lee Jae-myung 2022 Lee Jae-myung portrait (crop).jpg
Lee Jae-myung

Lee Jae-myung of the Democratic Party also opposed doctors and supported the increase in enrollment of medical students. [92] Groups representing cancer and ALS patients have also called for the quick return of doctors. [93] The Korean Buddhist order, Jogye Order had urged the return of doctors on February 22. [94] In a poll conducted by Gallup Korea from February 13 to 15, 2024, 76% of respondents were more positive about the government’s proposal to increase the number of medical school students by 2,000. Only 16% expressed opposition. In a poll conducted by Gallup Korea from March 12 to 14, 2024, 49% of respondents said that the government’s response was inadequate compared to the medical community’s opposition to expanding medical services. [95]

Impact

Severance Hospital, Seoul National University Hospital, and many other hospitals were forced to cancel or postpone many surgeries. [96] Some hospitals also decided to shorten the time to operate on patients or give priority to critically ill patients. [97] An ophthalmology professor in his 40's died of brain hemorrhage on March 24, 2024 [98] and an internal medicine professor in his 50s died of intestinal obstruction on April 20, 2024, [99] causing significant concerns about health risks to the medical school professors who were overworked trying to cover for all of the resident doctors who have resigned.

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References

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  10. ↑ "jibang-uilyowon 69% uisa bujog… jeongnyeon neomgin 70daedo chaeyong" 지방의료원 69% 의사 부족… 정년 넘긴 70대도 채용 [69% shortage of doctors at local medical centers… Recruitment of people in their 70s who are past retirement age]. The Dong-A Ilbo (in Korean). March 6, 2023. Retrieved July 18, 2024.
  11. ↑ 채, 혜선 (March 19, 2024). "4.5il geunmu, yeonbong 4eog-edo musosig…deo simhaejin jibang-uilyowon gu-innan" 4.5일 근무, 연봉 4억에도 무소식…더 심해진 지방의료원 구인난 [4.5 days of work, no news despite annual salary of 400 million won... Local medical center recruitment crisis worsens]. JoongAng Ilbo (in Korean). Retrieved July 18, 2024.
  12. ↑ 박, 진호 (February 19, 2023). ""yeonbong 1eog deo…uisa, 4eog-e mosibnida" sogchouilyowon chogangsu" "연봉 1억 더…의사, 4억에 모십니다" 속초의료원 초강수 [“100 million more won in annual salary… Doctors are offered for 400 million won” Sokcho Medical Center Super Gangsu]. JoongAng Ilbo (in Korean). Retrieved July 21, 2024.
  13. ↑ "Yīxué shēng kuòzhāo'yǐnbào wéijī! Nánhán wàn míng yīshēng bàgōng" 醫學生擴招」引爆危機！ 南韓萬名醫生罷工 ["Expansion of medical student enrollment" triggers]. February 26, 2024. Archived from the original on March 13, 2024. Retrieved February 27, 2024.
  14. ↑ Park, Hyoung Wook (June 30, 2024). "The 2024 Medical Crisis : Challenges for Medical Education". Korean Medical Education Review. 26 (2): 118–121. doi: 10.17496/kmer.24.021 . ISSN   2092-5603.
  15. ↑ Dohyeong Kim, Soojin Min and Hyoungah Kim, "Korean health policies", In: Chung-in Moon, M. Jae Moon (eds.) Routledge Handbook of Korean Politics and Public Administration (2020)
  16. ↑ Yoon, Hee Sung; Cho, Sung Woock; Sugumaran, Vijayan (2011). "A Service System Design to Support Medical Tourism in South Korea". CONF-IRM 2011 Proceedings.
  17. ↑ Kim, Hyun Ah; Jung, Sung Hoon; Park, In Young; Kang, Seong Hun (September 1, 2020). "Hourly wages of physicians within medical fees based on the Korean relative value unit system". The Korean Journal of Internal Medicine. 35 (5): 1238–1244. doi:10.3904/kjim.2018.452. PMC   7487311 . PMID   31870135.
  18. ↑ Jack, Andrew (June 24, 2015). "Why the panic? South Korea's MERS response questioned". BMJ. 350: h3403. doi:10.1136/bmj.h3403. ISSN   1756-1833. PMID   26108610. S2CID   38833740.
  19. ↑ Lee, Wang Jung (January 1, 2004). "What Drove Korean Doctors into the Streets?". AMA Journal of Ethics. 6 (1): 37–40. doi: 10.1001/virtualmentor.2004.6.1.msoc1-0401 . PMID   23260071.
  20. ↑ "Korean pediatrician shortage means long lines, frustration". Korea JoongAng Daily . January 11, 2023. Retrieved February 12, 2023.
  21. ↑ Kim, Arin (February 22, 2023). "Korea declares emergency measures over children's health care crisis". The Korea Herald . Retrieved June 18, 2023.
  22. ↑ Lee, Hae-rin (June 14, 2023). "'Unpopular' medical departments face shortage of doctors". The Korea Times . Retrieved June 18, 2023.
  23. ↑ Lee, Yuri; Kim, Siwoo; Kim, So Yoon; Kim, Ganglip (March 2019). "Ethical Consideration of National Health Insurance Reform for Universal Health Coverage in the Republic of Korea". Asian Bioethics Review. 11 (1): 41–56. doi:10.1007/s41649-019-00079-1. PMC   7747280 . PMID   33717299.
  24. ↑ Lee, Eunhee (December 2019). "Why newly graduated nurses in South Korea leave their first job in a short time? A survival analysis". Human Resources for Health. 17 (1): 61. doi: 10.1186/s12960-019-0397-x . PMC   6664533 . PMID   31358009.
  25. ↑ "South Korean medical students revolt over government health reform plans". Reuters. August 26, 2020. Retrieved February 12, 2023.
  26. ↑ "S. Korea suffers shortage of medical workers as burned out nurses quit". The Hankyoreh . Retrieved February 25, 2023.
  27. ↑ Koh, Jung Min (November 30, 2022). "Harassed by low medical fees, Korean doctors see their patients hurriedly". Korea Biomedical Review . Retrieved June 18, 2023.
  28. ↑ Kwak, J. Y. (2010). "Searching for good governance of Korean medical policy: case study of the separation of dispensary from medical practice". Korean Party Stud Rev. 9 (1): 149–181.
  29. ↑ Yang, JungHye (2001). "Media Framing of a Social Conflict-A Case Study of Medical Doctors' Strike in Korea". Korean Journal of Journalism & Communication Studies. 45 (2): 284–315.
  30. 1 2 "Hánguó xué é fēngbō jiē yīliáo xìtǒng zhēngyì yīshēng cízhí kàngyì zǒnglǐ jǐnggào wù yǐ rénmìng yào xié" 韓國學額風波 揭醫療系統爭議 醫生辭職抗議 總理警告勿以人命要脅 [South Korea’s school quota scandal reveals controversy in the medical system. Doctors resign in protest. The Prime Minister warns not to threaten human lives.]. 明報新聞網 - 每日明報 daily news (in Chinese). February 19, 2024. Retrieved February 22, 2024.
  31. ↑ Watts, Jonathan (2000). "Doctors' first strike in Republic of Korea likely to end". Bulletin of the World Health Organization. 78 (12): 1478. ISSN   0042-9686. PMC   2560667 . PMID   11196505.
  32. ↑ "We're overworked and unheard, say South Korean doctors in mass walkout". The Straits Times. February 26, 2024. Retrieved August 29, 2024.
  33. ↑ "'ju 80sigan' jeongong-ui jwieojjaneun byeong-won… "jeonmun-ui neulligo jeosuga gaeseon-eul"[icham-e tteud-eogochyeoya hal, daehanmingug gihyeongjeog uilyochegye]" '주 80시간' 전공의 쥐어짜는 병원… "전문의 늘리고 저수가 개선을"[이참에 뜯어고쳐야 할, 대한민국 기형적 의료체계] [A hospital that is squeezing in residents for ‘80 hours a week’… “Increase the number of specialists and improve the number of medical staff” [Korea’s deformed medical system that needs to be repaired now]]. Seoul Shinmun (in Korean). March 8, 2024. Retrieved July 18, 2024.
  34. ↑ "munsinsa habbeobhwa yogue ui bandae ibjang jaehwag-in" 문신사 합법화 요구에 醫 반대 입장 재확인 [The hospital reaffirms its opposition to the demand for legalization of tattoo parlors.]. 청년의사 (in Korean). October 10, 2023. Retrieved July 15, 2024.
  35. ↑ Yeo, Young Hyun; Lee, Keon-Hyung; Kim, Hye Jeong (November 11, 2016). "Closure of a local public hospital in Korea: focusing on the organizational life cycle". Journal of Healthcare Leadership. 8: 95–105. doi: 10.2147/JHL.S113070 . PMC   5741012 . PMID   29355194.
  36. ↑ "uidae jeung-won susja '2cheon myeong'…geungeowa nonlan-eun?" 의대 증원 숫자 '2천 명'…근거와 논란은? [Number of medical schools increased by ‘2,000’… What is the basis and controversy?]. Korean Broadcasting System . February 19, 2024.
  37. 1 2 3 "'jibdansajig jeongong-ui' 831myeong eobmugaesimyeonglyeong…'myeonheo bagtal' gyeong-go" '집단사직 전공의' 831명 업무개시명령…'면허 박탈' 경고 [831 ‘residents who resigned collectively’ ordered to start work… ‘License revoked’ warning]. Korean Broadcasting System . February 20, 2024.
  38. ↑ "Trainee doctors set to stop work in protest over med school quota hike". February 20, 2024. Retrieved August 26, 2024.
  39. ↑ "Chāo 9000 míng yīshēng jítǐ cízhí! Hánguó yīliáo xìtǒng wéijī shēng zhì zuì gāojí-xīn húnán" 超9000名医生集体辞职！韩国医疗系统危机升至最高级-新湖南 [More than 9,000 doctors resigned en masse! The crisis in South Korea's medical system reaches the highest level - New Hunan]. 新湖南_湖南新闻第一端 (in Chinese). February 22, 2024. Retrieved February 22, 2024.
  40. ↑ "Telemedicine services to be expanded as 'golden hour' of medical crisis looms". February 23, 2024. Retrieved August 26, 2024.
  41. ↑ 집단사직 전공의 ‘1만명’ 넘었다…전체 80.5% [The number of students who resigned en masse exceeded 10,000… 80.5% of the total]. 청년의사 (in Korean). February 26, 2024. Retrieved August 29, 2024.
  42. ↑ "Health ministry sends final notice of license suspension to 2 leaders of doctors' group". koreatimes. March 18, 2024.
  43. ↑ "Police open probe into doctors' ringleaders as deadline approaches". koreajoongangdaily.joins.com. February 28, 2024.
  44. ↑ "Nánhán cízhí yīshēng pò wàn zhèngfǔ zhǐ ruò zài zhōu sì qián fùgōng jiāng bù zhuījiù" 南韓辭職醫生破萬 政府指若在周四前復工將不追究 [The number of doctors who resigned in South Korea exceeds 10,000, and the government says that if they resume work before Thursday, they will not be held accountable]. Now 新聞 (in Chinese). February 26, 2024. Retrieved February 26, 2024.
  45. ↑ "Hánguó 100 jiā dàxíng yīyuàn zhōng yǐ yǒu 565 míng cízhí yīshēng fǎn gǎng_zhōngguó wǎng" 韩国100家大型医院中已有565名辞职医生返岗_中国网 [565 resigned doctors from 100 large hospitals in South Korea have returned to work_China Net]. 中国网新闻中心_传递中国价值. March 1, 2024. Retrieved March 3, 2024.
  46. ↑ "Hánguó jìn 300 yīshēng fùgōng zhèngfǔ míng qǐ chǔfèn wèi fǎn gǎng yīshēng" 韩国近300医生复工 政府明起处分未返岗医生 [Nearly 300 doctors in South Korea have returned to work. The government will punish doctors who fail to return to work tomorrow.]. 联合早报 (in Chinese). February 29, 2024. Retrieved February 29, 2024.
  47. ↑ "Hánguó bǎojiàn fúzhǐ bù xuānbù jírì qǐ tiáozhěng hùshì yèwù fànwéi chéngdān bùfèn yīshēng yèwù" 韩国保健福祉部宣布即日起调整护士业务范围 承担部分医生业务 [South Korea's Ministry of Health and Welfare announced that it will adjust the business scope of nurses and assume some of the doctor's business from now on]. 川观新闻 (in Chinese). August 11, 2020. Retrieved February 27, 2024.
  48. ↑ "Hán zhèngfǔ yī jiè fǎn gǎng lìng shíxiàn yǐguò jíjiāng cǎiqǔ xíngzhèng sīfǎ chǔfèn" 韩政府医界返岗令时限已过 即将采取行政司法处分 [The time limit for the Korean government’s order for the medical community to return to work has expired and administrative and judicial sanctions will be taken soon]. 韩联社（韩国联合通讯社） (in Chinese). March 3, 2024. Retrieved March 3, 2024.
  49. ↑ "Doctors take to streets in protest of medical school quota hike". koreatimes. March 3, 2024. Retrieved August 26, 2024.
  50. ↑ "Hán zǒnglǐ: Jiāng cǎiqǔ cuòshī yìngduì fēifǎ lí gǎng yīshēng" 韩总理：将采取措施应对非法离岗医生 [Prime Minister of South Korea: Measures will be taken to deal with doctors who leave their jobs illegally]. 韩联社（韩国联合通讯社） (in Chinese). March 3, 2024. Retrieved March 3, 2024.
  51. 1 2 "Shǒu'ěr dàxué yīxué yuàn jiàoshòu huò jítǐ cízhí hánguó bǎojiàn fúzhǐ bù chēng jiāng yǔ yīshēng duìhuà" 首尔大学医学院教授或集体辞职 韩国保健福祉部称将与医生对话 [Professors at Seoul National University School of Medicine may resign en masse. South Korea’s Ministry of Health and Welfare says it will have dialogue with doctors]. 新闻频道_央视网(cctv.com) (in Chinese). March 12, 2024. Retrieved March 12, 2024.
  52. ↑ "Hánguó zhèngfǔ: Jiāng xiànchǎng jiǎnchá yīshēng chūqín qíngkuàng wèi fù gǎng yīshēng zhízhào jiāng bèi diàoxiāo zhìshǎo 3 gè yuè" 韩国政府：将现场检查医生出勤情况 未复岗医生执照将被吊销至少3个月 [South Korean Government: Doctors’ attendance status will be checked on-site. Doctors who fail to return to work will have their licenses revoked for at least 3 months.]. 新闻频道_央视网(cctv.com) (in Chinese). March 4, 2024. Retrieved March 4, 2024.
  53. ↑ "Hánguó zhèngfǔ jì tiěwàn xíngdòng, qīqiān míng shíxí yīshēng zāo diàoxiāo zhízhào" 韓國政府祭鐵腕行動，七千名實習醫生遭吊銷執照 [The South Korean government's iron-fisted operation resulted in the suspension of the licenses of 7,000 intern doctors.]. Yahoo News (in Chinese). March 4, 2024. Retrieved March 4, 2024.
  54. ↑ "'cham-uisa liseuteu'… uisa keomyunitiseo hyeonjang nam-eun jeongong-ui saegchul nonlan" ‘참의사 리스트’… 의사 커뮤니티서 현장 남은 전공의 색출 논란 [‘List of true doctors’… Controversy in the medical community over identifying remaining specialists in the field]. ChosunBiz (in Korean). March 7, 2024. Retrieved July 24, 2024.
  55. ↑ "'cham-uisa liseuteu' gong-gae uisa absususaeg…imhyeontaeg 'uisa pog-ab'" '참의사 리스트' 공개 의사 압수수색…임현택 '의사 폭압' [Search and seizure of 'Cham doctors list' made public... Lim Hyun-taek ‘Doctor tyranny’]. 매일신문 (in Korean). April 19, 2024. Retrieved July 24, 2024.
  56. 1 2 "South Korean Doctors Should Return to Duty". thediplomat.com. Retrieved March 17, 2024.
  57. ↑ "Hán zhèngfǔ xiàng jìn 5000 míng jù bù fǎn gǎng yīshī fāsòng diàoxiāo zhízhào tōngzhī" 韩政府向近5000名拒不返岗医师发送吊销执照通知 [South Korean government sends license revocation notices to nearly 5,000 doctors who refuse to return to work]. 韩联社（韩国联合通讯社） (in Chinese). March 11, 2024. Retrieved March 11, 2024.
  58. ↑ "Gov't deploys military doctors to address medical service disruptions". koreatimes. March 11, 2024. Retrieved August 26, 2024.
  59. ↑ "South Korean senior doctors to resign in support of junior medics' walkout". CNA. Retrieved March 17, 2024.
  60. ↑ "South Korea's medical professors join protests, reduce hours in practice". TODAY. Retrieved March 26, 2024.
  61. ↑ "Yoon refuses to back down on medical school quota hike". The Korea Times . April 4, 2024.
  62. ↑ "2025hagnyeondo uidae jeung-won choedae 1500myeongdae choban…2026nyeon-eun '2cheon myeong' jeung-won" 2025학년도 의대 증원 최대 1500명대 초반…2026년은 ‘2천 명’ 증원 [Medical school enrollment for the 2025 school year is expected to increase to around 1,500 students… In 2026, the number of employees will be increased by ‘2,000’.]. KBS News (in Korean). Retrieved July 23, 2024.
  63. ↑ "South Korea adds 1,500 medical student slots in scaled-back expansion". Nikkei Asia . Retrieved July 23, 2024.
  64. ↑ "uidae jeung-won: seoulgobeob, uidaejeung-won jibhaengjeongji 'gagha·gigag'... uilyo galdeung eotteohge doena?" 의대 증원: 서울고법, 의대증원 집행정지 '각하·기각'... 의료 갈등 어떻게 되나? [Medical school expansion: Seoul High Court 'dismisses/dismisses' suspension of medical school expansion... What happens to the medical conflict?]. BBC News 코리아 (in Korean). May 16, 2024. Retrieved July 19, 2024.
  65. ↑ "15일 정오 기준 '전공의 출근율 8.4%…인턴은 3.4%'". 청년의사 (in Korean). 청년의사. July 16, 2024. Retrieved August 26, 2024.
  66. ↑ "oneulbuteo habangi jeongong-ui mojib sijag…inteon·lejideonteu chong 7,645myeong chaeyong" 오늘부터 하반기 전공의 모집 시작…인턴·레지던트 총 7,645명 채용 [Recruitment of majors for the second half of the year begins today... Recruitment of a total of 7,645 interns and residents]. KBS News (in Korean). Retrieved July 26, 2024.
  67. ↑ "Health ministry to unveil measures in connection with medical school admission hike". Yonhap News Agency . August 16, 2024.
  68. ↑ "South Korea set to adjust medical reforms in bid to end walkout". CNA. Retrieved May 15, 2024.
  69. ↑ "Korea medical body's response to foreign doctor hiring plan blasted as 'racist'". South China Morning Post. May 10, 2024. Retrieved May 15, 2024.
  70. ↑ "uihyeobhoejang "somallia uisa keomingssun"…"injongchabyeol" musmaee sagje(jonghab)" 의협회장 "소말리아 의사 커밍쑨"…"인종차별" 뭇매에 삭제(종합) [Chairman of the Medical Association "Somali doctor Coming Sun"... Deleted due to criticism over “racism” (comprehensive)]. Seoul Shinmun (in Korean). May 9, 2024. Retrieved July 22, 2024.
  71. ↑ "gugnae oegug-in 251manmyeong···'damunhwasahoe' jin-ib nun-ap" 국내 외국인 251만명···‘다문화사회’ 진입 눈앞 [2.51 million foreigners in Korea... we are on the verge of entering a ‘multicultural society’]. 한국문화홍보서비스 (in Korean). Retrieved July 21, 2024.
  72. ↑ "Int'l couples account for one out of 10 marriages in Korea". The Korea Times . March 19, 2024. Retrieved July 22, 2024.
  73. ↑ "jeongong-ui gongbaeg me-uneun 'jungdong-uisa' 130yeomyeong, susul-jinlyo bojo… uisasotong deung-en hangyedo" 전공의 공백 메우는 '중동의사' 130여명, 수술-진료 보조… 의사소통 등엔 한계도 [About 130 ‘Middle Eastern doctors’ fill the gap in specialties, assisting in surgery and medical treatment… There are limits to communication, etc.]. The Dong-A Ilbo (in Korean). May 30, 2024. Retrieved July 15, 2024.
  74. ↑ "'uidaejeung-won = jil jeoha' jujang-e daehan daetonglyeong-ui banbag [hyeonjang-yeongsang]" '의대증원 = 질 저하' 주장에 대한 대통령의 반박 [현장영상] [President's rebuttal to the argument that 'increasing medical schools = lowering quality' [On-site video]]. Korean Broadcasting System . February 20, 2024.
  75. ↑ "Gov't deploys military doctors to address medical service disruptions". koreatimes. March 11, 2024.
  76. ↑ "PA nurses to fill medical manpower gap amid gov't-doctor conflict". koreatimes. March 7, 2024.
  77. ↑ Jun-hee, Park (February 23, 2024). "Health care crisis hits highest level amid doctor walkout". The Korea Herald . Retrieved August 6, 2024.
  78. ↑ "Gov't unveils measures to prevent boycotting med students from failing semester". The Korea Times . July 10, 2024. Retrieved August 6, 2024.
  79. ↑ Davies, Ed; Shin, Hyonhee (March 6, 2024). "Explainer: Why South Korean doctors and the government remain at odds over walkout?". Reuters .
  80. ↑ "jeongong-ui 'ju 80sigan' jangsigan geunmu" 전공의 '주 80시간' 장시간 근무 [Residents work long hours, ‘80 hours a week’]. Korean Broadcasting System . February 21, 2024.
  81. ↑ Guzman, Chad de (February 9, 2023). "South Korea Has a Dire Doctor Shortage. Will Relaxing Malpractice Punishment Help?". TIME. Retrieved July 27, 2024.
  82. ↑ "uihyeob bidaewi "jeongong-ui sajig-eun gibongwon haengsa…wiheonjeog haengtae jungdanhala"" 의협 비대위 "전공의 사직은 기본권 행사…위헌적 행태 중단하라" [Medical Association Non-Captain "Resignation by a major is an exercise of basic right... Stop this unconstitutional behavior."]. Korean Broadcasting System . February 20, 2024.
  83. ↑ "Health care worker union to launch general strike on Thursday". JoongAng Daily. August 25, 2024. Retrieved August 30, 2024.
  84. ↑ "Unionized hospital workers pull out from strike". The Korea Herald. August 29, 2024.
  85. ↑ 전공의 대표가 '복귀 조건'으로 언급한 7가지 요구안은?. 의협신문 (in Korean). February 23, 2024. Retrieved August 29, 2024.
  86. ↑ "Coursework boycotts could mean thousands of Korean med students are held back a grade". The Hankyoreh . Retrieved August 6, 2024.
  87. ↑ Jun-hee, Park. "2.7% of med students return to class amid ongoing boycott". The Korea Herald . The Korea Herald. Retrieved August 4, 2024.
  88. ↑ An, Shinki (June 30, 2024). "The Abyss from Which We Must Arise Despite Our Pain: The 2024 Medical Crisis and the Moral Injury of Medical School Professors". Korean Medical Education Review. 26 (2): 125–132. doi: 10.17496/kmer.24.023 . ISSN   2092-5603.
  89. ↑ ""90eog ssod-a bueossda" gugmin yeonghwagwan-eseo nandeeobs-i 'uidaejeung-won'…mwonga bwassdeoni" "90억 쏟아 부었다" 국민 영화관에서 난데없이 ‘의대증원’…뭔가 봤더니 [“We poured 9 billion won” The national movie theater suddenly ‘increased the number of medical schools’… I saw something]. 헤럴드경제 (in Korean). March 24, 2024. Retrieved July 28, 2024.
  90. ↑ Wendy (July 5, 2024). "'Heading straight towards death': South Korean patients urge doctors to end prolonged strike". The Straits Times. ISSN   0585-3923 . Retrieved August 7, 2024.
  91. ↑ "uilyopa-eob jang-gihwa-e gyeolgug geolilo naseon hwanjadeul...'50nyeon gat-eun 5gaewol-ieossda'" 의료파업 장기화에 결국 거리로 나선 환자들...'50년 같은 5개월이었다' [Patients ended up taking to the streets due to the prolonged medical strike... 'It was 5 months that felt like 50 years']. BBC News 코리아 (in Korean). July 4, 2024. Retrieved August 7, 2024.
  92. ↑ "ijaemyeong "uidae suncha jeung-won-i mattang…uisa pa-eob jeuggag jungdanhaeya"" 이재명 "의대 순차 증원이 마땅…의사 파업 즉각 중단해야" [Lee Jae-myeong "Medical schools should be sequentially increased... The doctors' strike must be stopped immediately."]. Korean Broadcasting System . February 21, 2024.
  93. ↑ "jungjeungjilhwanja·simindanche "byeong-won-eulo boggwihaedalla"" 중증질환자·시민단체 "병원으로 복귀해달라" [Severely ill patients and civic groups ask to return to the hospital]. Korean Broadcasting System . February 21, 2024.
  94. ↑ "jogyejong, jeongong-ui boggwi hoso…"saengmyeong-eun mueosboda jongwi"" 조계종, 전공의 복귀 호소…"생명은 무엇보다 존귀" [Jogye Order appeals for the return of majors… “Life is more precious than anything else”]. Korean Broadcasting System . February 22, 2024.
  95. ↑ "의료공백 장기화에... 국민 49% "정부 대응 잘못"[한국갤럽]". 한국일보 (in Korean). March 15, 2024. Retrieved August 29, 2024.
  96. ↑ "jeongong-ui eobsneun big5 byeong-won 'olseutob'?…jungjeung·eung-geub jinlyo choeuseon" 전공의 없는 빅5 병원 '올스톱'?…중증·응급 진료 최우선 [Big 5 hospitals without medical residents ‘all stop’?… Severe/emergency care is the top priority]. Korean Broadcasting System . February 22, 2024.
  97. ↑ "jeongong-ui jibdan ital uilyo pahaeng bongyeoghwa…jeongug byeong-won bisang un-yeong dol-ib(jonghab)" 전공의 집단 이탈 의료 파행 본격화…전국 병원 비상 운영 돌입(종합) [Medical crippling is in full swing due to group departure of medical residents... Nationwide hospitals begin emergency operation (comprehensive)]. Naver News (in Korean). February 20, 2024. Retrieved February 22, 2024.
  98. ↑ "byeong-won jikideon busandaebyeong-won angwa gyosu samang…uilyogye aedo" 병원 지키던 부산대병원 안과 교수 사망…의료계 애도 [Pusan National University Hospital ophthalmology professor who was guarding the hospital dies... medical community mourning]. 청년의사 (in Korean). March 24, 2024. Retrieved June 12, 2024.
  99. ↑ "ibeon-en naegwa gyosu samang...uilyogye "gwalo ttaemun", byeong-won "gwalowa mugwan"" 이번엔 내과 교수 사망...의료계 "과로 때문", 병원 "과로와 무관" [This time, an internal medicine professor dies... The medical community says it's "due to overwork," and the hospital says it has nothing to do with overwork.]. The Chosun Ilbo (in Korean). April 21, 2024. Retrieved June 12, 2024.
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