[Collapsed Pediatric Care]③Residents Abandon Training: "Better to Be a General Practitioner Than Go Into Pediatrics"

Number of New Pediatric Specialists Plummets: 199 in 2022 to Just 24 This Year
Second-Half Residency Application Rate Stuck at 50%
Concerns Grow Over Worsening Workforce Shortage in Three Years

Editor's NoteAlthough there are expectations that residents who left hospitals a year and a half ago in protest against the expansion of medical school admissions in February last year will resume their training, the situation in essential medical departments that handle critical and emergency patients remains precarious. In particular, in the field of pediatrics, the combination of a low birth rate, an unreasonable reimbursement system, and increasing legal risks has led residents to avoid applying, while existing specialists are leaving the field. As regional disparities in medical services widen, the treatment system for sudden pediatric emergencies and serious pediatric diseases requiring specialized intensive care is also being destabilized. There are fewer children being born, but even fewer doctors to care for them. Asia Economy will examine the current state of the pediatric medical system and directions for improvement in a six-part series.

"Right now, if a child develops intussusception in a local area, it becomes a serious problem. Since there are no pediatric surgeons, families may have to travel across the country to find a hospital for surgery." (Nam Sohyun, Professor of Pediatric Surgery at Busan Paik Hospital)

"Even after being hospitalized, when I see children who start to smile as soon as they feel a little better, I still get emotional and deeply moved. However, with the growing aversion to essential medical departments and the recent conflict between doctors and the government, I sometimes question whether I really need to continue down this difficult path." (A resident considering returning to training after resignation)

On March 29, 2023, at the Korean Medical Association Hall in Yongsan-gu, Seoul, pediatric pulmonologists and specialists, including Im Hyuntaek, then president of the Korean Pediatric Society, are greeting attendees at the press conference titled "Farewell to the Public from the Pediatric Pulmonology Department." Photo by Yonhap News

In March 2023, pediatricians across the country declared the closure of the pediatric department, citing difficulties such as a decrease in patient numbers, challenges in running clinics, and malicious complaints from guardians. Most of the doctors who opened pediatric clinics demanded an increase in reimbursement rates and even issued a statement, but two years later, the situation on the ground has not improved at all. Last year, due to the conflict between doctors and the government, many residents in general hospitals resigned, further increasing the workload for pediatricians who were already operating with minimal staff. As more medical professionals chose to resign or transfer, unable to endure the situation any longer, the perception of pediatrics as an "undesirable specialty" became even more entrenched.

This crisis in pediatrics is most evident in the sharp decline in the number of newly certified specialists. According to the government and the medical community on August 27, the number of new pediatric specialists, which hovered around 200 annually, dropped to 199 in 2022, 172 in 2023, and 131 in 2024, and this year, only 24 new specialists were produced. The situation is even more dire for subspecialties within pediatrics that require additional training after becoming a pediatric specialist. In the past nine years (2016-2024), only 19 pediatric nephrologists, 29 pediatric hematology-oncology specialists, and 31 pediatric intensive care specialists have been certified nationwide, all of which are considered even more challenging fields within pediatrics.

The outlook for future specialists, as indicated by current residency applications, is even more alarming. The application rate for pediatric residency once recovered to 124% in 2016, but plummeted after the Ewha Mokdong Hospital neonatal deaths in 2018, dropping to 26% in 2023. Last year, 38 out of 50 university hospitals nationwide had no applicants for pediatric residency at all. After the recent conflict between doctors and the government, the application rate for pediatric residency this year fell to just 2.7%. As a desperate measure, the pediatric training period was shortened from four years to three starting in 2022, but this was not enough to change residents' minds. If this trend continues, it is only a matter of time before there are no specialists left to care for critically ill children.

Currently, training hospitals have completed recruitment for interns and residents for the second half of the year, but the application rates for essential departments such as obstetrics and gynecology and pediatrics remain around 50%. Even among the so-called "Big 5" major general hospitals, the application rates for these departments are reported to be well below average. In a survey conducted last month by the Korean Intern Resident Association among residents who had resigned, 72.1% of those who said they did not intend to return to their training hospitals were from essential medical fields such as obstetrics and gynecology, pediatrics, and emergency medicine.

A professor at a major general hospital said, "Among the pediatric residents who say they might return, some are setting conditions such as refusing extra shifts or overnight duties, or are aiming to open growth clinics and are only seeking specialist certification for that purpose. While the low birth rate is concerning, the decrease in pediatric specialists who can properly care for the children who are born is just as worrisome."