CNA Explains: Why thousands of doctors in South Korea are striking - and defying deadlines to return to work

Thousands of junior doctors in South Korea walked off the job last week, to protest against the government’s plan to raise the number of students admitted into medical schools.

The striking doctors-in-training have continued their labour action past the Thursday (Feb 29) deadline to report back to work, and now risk facing prosecution and suspension of their medical licence. 

Why are junior doctors protesting?

Doctors, who are considered essential workers in South Korea, are restricted by law from striking.

But some 9,000 medical interns and residents - about 80 per cent of the trainee workforce - have been on strike since Feb 20, disrupting services at major hospitals, which have been forced to cancel surgeries and turn away some patients. 

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Most striking doctors remained off the job on Friday, according to South Korea's Yonhap news agency. 

Their main gripe? 

President Yoon Suk-yeol’s government wants to boost medical school admissions by 2,000 a year, from the current 3,058 to alleviate a shortage of doctors and a looming demographic crisis. The plan is meant to eventually add up to 10,000 doctors by 2035. 

Some observers believe the striking junior doctors are concerned that adding more doctors would result in a lower income.

“So junior doctors are complaining about their long working hours and low pay,” health policy and management professor Yoon Kim of Seoul National University College of Medicine told CNA’s Asia Tonight on Wednesday.

“What they are really concerned about is that increasing numbers of medical doctors would be less income for them when they finish their residency and get a job in hospitals, or open a clinic.”

Medical interns and resident doctors are also complaining that the government should focus on their working conditions, instead of making plans to sharply increase medical school admissions to cope with shortages and a fast-ageing population.

Doctors-in-training said they are underpaid, overworked and unheard. 

They regularly work multiple shifts. This keeps many on the job for more than 80 hours per week, way past the country's legal limit of 52 hours a week. 

In some major hospitals, junior doctors account for between 30 to 40 per cent of the total number of doctors. 

Dr Soonman Kwon, professor of health economics and policy at Seoul National University, said: “In my view, as a health economist, I think that there's an overall undersupply of doctors in almost all specialty areas, except for some like cosmetic things.”

Analysts said the medical community is also ageing. 

“When considering the retirement of elderly doctors, they say there is an urgent need for more doctors,” said Dr Chung Jin-Haeng, a Seoul National University College of Medicine professor who was involved in mediating dialogue between doctors and the government in the initial days of the protest. 

Are trainee doctors overworked?

While South Korea takes pride in its affordable healthcare system, it has among the fewest physicians per capita in the developed world.

Data from the Organisation for Economic Cooperation and Development (OECD) shows there are approximately 2.6 doctors per 1,000 people, compared with an average of 3.7. Austria, which is the top ranked, has 5.5 doctors per 1,000 people.

“Aged people need healthcare much more than the average younger generation,” Dr Kwon told CNA’s Asia Now on Wednesday.

“So facing one of the most rapidly ageing societies, the demand for doctor services is very rapidly increasing.”

Now, the shortage of doctors has led to an overcompensation for established physicians.

Being a doctor in South Korea has long been regarded as a coveted occupation, with post-residency doctors being some of the best-paid in the developed world. 

According to one survey, the country’s top 20 university majors were all in the medical field last year.

“In Korea, an average doctor earns about more than four or five times that of ordinary employees, whereas that number is usually two or three times in OECD countries,” said Dr Kwon, adding that such inflated salaries could threaten the sustainability of the healthcare system in the long run. 

How is the government responding? 

The government has warned of zero-tolerance for those who fail to end their walkouts. 

Health Ministry officials have started visiting the homes of trainee doctors, delivering the government's back-to-work order.

Only 565 doctors out of the 9,000 striking doctors resumed work by the deadline, according to figures released by the health ministry. 

Observers believe the authorities will likely limit disciplinary action to strike leaders, for fear of straining healthcare operations.

The government has filed a criminal complaint with the police on Tuesday against five doctors it suspects of encouraging a mass walkout of trainees.

Mr Yoon has maintained his hardline stance, vowing on Tuesday to go ahead with the medical reforms that had triggered the protests.

“He has a reputation to go ahead and is really determined to make it,” said Dr Kwon. 

Further, the plan to raise medical school admissions has garnered the support of the public, with one survey showing that about 80 per cent of respondents back the government's recruitment plan.

Mr Yoon's approval rating has also climbed, exceeding 40 per cent for the first time in eight months, a poll by Realmeter showed on Monday. 

“So it turns out that this is one of a very few examples of popular policies from this very unpopular government,” said Dr Kwon, adding that pushing ahead with the reforms may play well for Mr Yoon’s administration ahead of the Apr 10 legislative elections.  

“It is possible that the government will go ahead and really introduce this.”

This is not the first time the government has tried to increase the medical school quota and recruit more students.

In 2020, a similar increase was proposed, but authorities backed off after a month-long strike by physicians.

“The junior doctors and the Korean Medical Association (KMA) are continuously demanding that our government cancel those increases in medical school quota,” said Prof Kim, referring to South Korea’s largest doctors’ lobby group.

“So there is a little possibility of compromise at the moment now.”

What lies ahead?

Observers said South Korea’s medical system would suffer a major blow if the protests continue or if senior doctors join the walkouts.

The KMA, which represents about 140,000 doctors in South Korea, said there are no changes in plans to protest past the Thursday deadline, according to Bloomberg. It is expected to hold a rally on Sunday, involving some 20,000 doctors. 

Dr Kwon noted that the increase in the number of admissions to medical schools “is not a panacea”, but it is a necessary step before other health policies can kick in. 

On Thursday, South Korea said it was seeking talks with striking junior doctors. 

Health Minister Cho Kyoo-hong said some doctors have started to return to work, even though “a full-scale return has not yet materialised”.

On Friday, South Korean police raided the offices of the KMA, an officer told AFP. 

Observers believe the current standoff will persist for a while. 

“(The chances of doctors returning) are not expected to be that high. More may contemplate as time goes by,” Dr Chung told CNA’s Asia First on Friday.

“It's an incredibly challenging time now. From my perspective, it seems that the more the government emphasises this issue, the more public support it garners. So, I doubt there will be any agreement reached, at least not until before the April general elections.

“It's very heartbreaking. I sincerely ask whether the government truly has the will to resolve this crisis.”

The government has sent military and community doctors to work at hospitals as part of emergency measures.

In the wake of the walkouts, doctors and medical personnel who have continued to work “feel like they are on the verge of collapse”, said Dr Chung, adding that these healthcare professionals have been working more than 180 hours over the past 10 days. 

“Many of them are considering resigning. It's not to protest against the government but rather due to exhaustion.”

Dr Chung stressed that the issue needs national policy adjustments. 

“Framing the situation as a patient's life being lost due to doctors' unavailability, and being left unattended for an hour in the emergency room is misleading,” she added. 

“It's unreasonable to place the responsibility for the health of a large population solely on one profession. I believe the country is unfairly making the medical profession a scapegoat.”