Sixty percent of thoracic surgeons are over fifty years old. Where are the young doctors?

The more difficult the surgery, the more aging the doctors.

A data shows that more than half of Korean thoracic surgeons are over 50 years old, and young doctors are far from enough; The students flocked to it.

The more difficult the surgery, the more aging the doctors. A director of the South Korean metropolitan area bluntly stated that the surge in demand for surgery and outpatient treatment has resulted in a shortage of clinicians. If things go on like this, the hospital may face “surgical chaos” in 10 years.

This raises the question: what happened to Korean medical care?

Sections in general surgery, cardiothoracic surgery,

Mismatched treatment or main cause

General surgery and cardiothoracic surgery are the least popular categories of medical services in Korea.

According to the data cited by the Global Times, the enrollment of Korean medical schools has been increasing in the past 30 years, but the number of licensed surgical specialists has dropped sharply from 220 to 140 each year. . In thoracic surgery, the generation of doctors is also very serious. Among the 1,161 thoracic surgeons under the age of 65, 60.8% are over 50 years old, and 436 thoracic surgeons will retire within 10 years. insufficient.

Korean media reports indicate that after completing medical education and training, most medical students and clinical interns in South Korea are reluctant to become general surgeons even if they are interested in surgery and willing to learn more skills , they generally believe that the future of surgeons is fraught with uncertainty.

Korean Physician Licensing Exam. Figure/Korea Network

This uncertainty is first reflected in the inability of the general income package to match the expectations of medical students. Similar to China, Korean doctors have a very high socioeconomic status, Ms. Huang, who moved to Gyeonggi-do, South Korea for 17 years, told the “medical community.” “However, it is difficult to enter a Korean medical school. In addition to excellent personal performance, the family also needs to have considerable financial strength. The tuition fees for medical students are very expensive, which is a big burden for families with poor economy.” She added.

Song Gao-young, a professor of surgery at St. Mary’s Hospital in Seoul, once told the Korean media Korea Biomedical Review, “After graduating from a six-year medical school, you have to spend five or five years accepting Internship and residency training, and another 2 years to become a fellow doctor. Men also need 3 years of military service.”

Higher financial and time investment costs lead to higher career expectations. But medical students and interns generally agree that surgeons don’t earn much, and that general surgeons earn less than plastic surgeons. At St. Mary’s Hospital in Seoul, where Song works, one of the five largest hospitals in South Korea, trainees are scrambling to find work, but there is a shortage of applicants for the surgical department.

A doctor can make more money if he does plastic surgery instead of life-saving surgery. That’s why students and interns are reluctant to become surgeons, Song Jiaorong said.

It has been reported that “Dermatology, Ophthalmology, Plastic Surgery” and “Jing Kangying” (Mental Health Medicine, Rehabilitation Medicine, Imaging Medicine) are Korean The more popular medical fields, most of which are not covered by health insurance.

South Korea pushes forward health care reform,

Practice transitioning to non-medical insurance fields

Korea’s medical insurance supervision is characterized by a perfect organizational structure, highly specialized supervisors, and strong binding force on medical institutions [1]. But under South Korea’s medical insurance reimbursement system, more surgeries for patients mean greater economic losses for hospitals. Both hospitals and physicians earn more for non-Medicare-covered surgical services, such as plastic surgery. Song Jiaorong said.

In the late 1990s, due to an aging population and rising drug costs, South Korea’s health insurance fund ran into deficit year after year. In the field of medical service fee payment, South Korea adopts a project-based payment method. Medical service providers often do not take corresponding treatment methods according to the characteristics of the patients themselves, but blindly use high-profit treatment projects [2] .

In 2001, the Korean government began to take two measures to simultaneously advance payment system reform, namely diagnosis and treatment related groups (DRGs) and resource-based relative value criteria (RBRV). The former applies to inpatient treatment, while the latter applies to outpatient treatment.

In contrast, RBRV uses resources as a relative value standard to judge the value of various services to pay doctors. Given that it is still based on a service-item-based charging system, the reform has not encountered much resistance.

DRGs were met with strong opposition from healthcare providers when they were first introduced. The pilot projects of DRGs include services with large profit fluctuations, such as obstetrics and gynecology, medical beauty and psychological counseling services. Compression of profit margins has made relevant interest groups try to prevent the government from extending the reform to all medical institutions, and has also caused the government to increase the prices of relatively cheap medical services and refuse to reduce the prices of excessively high medical services.

Against this backdrop, the South Korean government remains helpless about physicians’ over-emphasis on high-profit services. Until 2013, South Korea mandated a DRG-based prepayment system for all hospitals, covering 7 diseases and inpatient care [3].

Korea’s DRG reform has achieved remarkable results, not only incentivizing providers to reduce costs and overall medical expenses, but also reducing the burden of out-of-pocket expenses for patients. However, compared with the United States and European countries, South Korea lacks a corresponding incentive system to promote technological innovation in the process of implementing DRG. For example, there is a high clinical demand for essential advanced instruments and equipment (such as surgery, etc.) There is little room for compensation in the instrumentation. In addition, Korean doctors also strongly oppose the cancellation of the paid service system, and the DRG cannot further expand its coverage and enforce it [4].

There are many emergency surgeries, which can easily lead to a decrease in the quality of life of doctors; operations with high risks such as childbirth are likely to cause medical disputes. In this field where the reward is less than the payment, there is no doctor . “Unless medical insurance reimbursement for surgery is improved, future specialists will rarely choose general surgery,” Song Jiaorong said.

In a highly market-oriented environment,

The government and the medical profession continue to compete

Since the beginning of the 21st century, the Korean government has vigorously promoted medical reform, including policies such as expanding the enrollment of medical schools by 4,000 in the next 10 years and establishing the National School of Public Health.

In July 2020, the South Korean government announced that it plans to increase the annual enrollment quota of 3,058 students in the medical school by about 400 in the next 10 years. At the same time, the salary for majors in epidemiology is lower Professional students and students who volunteer to work in public health in rural areas are rewarded. When the new crown epidemic broke out in South Korea, this policy became the fuse of the “130,000 doctors’ collective strike” incident.

The Korean Medical Association held a press conference in front of the National Assembly to oppose the expansion of enrollment. Photo/Yonhap News Agency

In this regard, South Korean medical practitioners have accused the government’s enrollment expansion plan as a “brain-beating” decision. The Korean Medical Association (KMA) believes that there is no problem with the current coverage of Korean doctors, but the treatment of existing doctors is more serious. Once the surge of medical interns will inevitably lead to bad competition, the Korean medical system will be more chaotic. The Physicians’ Association also said raising the wages of healthcare workers was a top priority.

However, according to the data reported by in 2018, the average monthly salary of Korean doctors is 13.04 million won (about 77,500 yuan). The average monthly salary is 2.79 million won (about 16,500 yuan), and the average salary of Korean doctors is 4.6 times that.

According to this, some media said that the reason for the treatment problem reported by the Korean Medical Association may not be tenable, and it is more likely that “wolves have more meat and less meat”, and the vested interests are worried that the existing cake will be destroyed Segmentation.