[Full Text] Yoon on Medical School Expansion: "If the Medical Community Proposes More Reasonable Measures, Discussion Is Possible"

by Lee Kimin

Published 01 Apr.2024 15:28(KST)

Yoon Delivers 51-Minute Address
Emphasizes Detailed Points on Expected Medical Demand and International Comparisons

President Yoon Suk-yeol stated on the 1st regarding the increase of medical school quotas by 2,000, "If a more reasonable and rational plan is brought forward, we can discuss it at any time." He pointed out the situation where medical organizations are throwing out numbers haphazardly without scientifically presenting the scale of the increase.

However, it is known that the presidential office views President Yoon's stance as more progressive than the previous policy, which insisted that the quota could not be reduced by even one from 2,000 despite the departure of residents in February.

At 11 a.m. that day at the Yongsan Presidential Office, President Yoon said in a public address, "If the medical community insists on reducing the increase scale, they should propose a unified plan to the government based on solid scientific evidence, not collective action."

During the 51-minute address, President Yoon explained in detail the reasons for setting the medical school quota increase at 2,000, based on changes in population structure and medical demand, and comparisons with overseas cases with similar medical systems.

Below is the full text of President Yoon's public address

On the 1st, amid the prolonged medical-government conflict over the plan to increase medical school admissions by 2,000 students, citizens at Seoul Station in Jung-gu, Seoul, are watching President Yoon Seok-yeol's national address regarding healthcare reform. Photo by Kang Jin-hyung aymsdream@

Dear fellow citizens,

How uncomfortable and anxious are you due to the ongoing collective actions by residents? I thank the citizens who are enduring inconvenience and supporting the government's medical reform even in these difficult times. I also feel sorry as the president for not being able to promptly resolve the public's inconvenience.

Citizens,

The medical reform the government is pursuing now is for you. Patients in urgent situations are wandering around emergency rooms and sometimes dying on the streets. When a child is sick, people have to line up in front of hospitals from early morning. Non-metropolitan areas are even worse. There are no nearby obstetrics and gynecology clinics, forcing people to travel far for treatment and childbirth. How could the government stand by knowing this situation?

The government's medical reform aims to strengthen essential and regional medical care so that all citizens can receive treatment with peace of mind regardless of where they live or what illness they have. For this, more doctors are needed. If increasing the number of doctors to protect citizens' lives and health cannot be done without doctors' permission, then one must question whether citizens' lives and their value are worth so little.

The people are the sovereigns of this country. The government has faithfully included the tasks doctors have demanded in the four major medical reform packages to protect citizens' lives and health. It plans to invest over 10 trillion won to provide fair compensation and infrastructure support to doctors working in essential and regional medical care, and to establish a judicial risk safety net to alleviate legal risks related to medical accidents. Specific reform measures for both citizens and doctors include the Medical Accident Handling Special Act, essential medical investment plans, improvement of resident training environments, transition to specialist-centered hospitals, and improvement of the medical delivery system. Yet, residents have been illegally withdrawing from medical sites for nearly 50 days.

All this is solely to block the increase in the number of doctors. If the opposition to the increase is due to concerns about future income reduction, that is not the case. Currently, Korean doctors have the highest average income among OECD countries. Worries that income will decrease because 20,000 more doctors will be added in 20 years are unfounded. Although the number of doctors will increase by 20,000 in 20 years, medical demand due to rising national income and aging will increase even more dramatically.

The government's medical reform is not intended to reduce doctors' income. While income disparities between essential and non-essential medical care, and between regional and metropolitan medical care, may decrease, overall doctors' income will not decrease from current levels. Moreover, with the development of the medical industry, markets requiring doctors such as bio, new drugs, and medical devices will expand significantly. Our medical industry must also enter the global market more, opening bigger and more opportunities for doctors in medical service exports and overseas medical bio markets.

Furthermore, the government will invest huge funds in strengthening regional and essential medical care, improving compensation systems, and building medical infrastructure. Previous governments left medical issues solely to health insurance finances without active fiscal investment. However, I have promised to invest massive funds in medical reform to protect citizens' lives and health, as medical care is related to national security and public safety. Government investment in medical care will also attract greater private investment.

Moreover, even if medical school quotas are increased now, doctors will only begin to increase in medical sites at least 10 years later. Currently, Korea has 115,000 doctors. If 2,000 doctors are added annually starting 10 years from now, it will be 2045, 20 years later, when 20,000 more doctors are added. I worry more about the hardships our citizens will face in the next 10 years when the increased doctors have not yet graduated. Some argue that increasing by 2,000 at once is excessive and even criticize the government for arbitrarily deciding on the increase. This is not true. The number 2,000 is the minimum increase calculated carefully by the government after extensive discussions with medical organizations and the medical community.

Anyone with common sense would agree that the current shortage of doctors in Korea is real. Research results also prove this. The government reviewed various doctor supply and demand forecasts from national research institutes. These studies use statistical models reflecting changes in population structure such as low birth rates and aging, changes in disease structure like chronic diseases, and changes in medical demand due to income growth. Regardless of methodology, all conclude that by 2035, 10 years from now, at least 10,000 doctors will be lacking even considering natural fluctuations.

Additionally, to secure doctors at the national average level in medically vulnerable areas and guarantee fair access to medical services, about 5,000 more doctors are needed immediately. Ultimately, at least 15,000 doctors must be added by 2035. The situation will be more severe in the future. At the time of the 2000 separation of drug prescribing and dispensing, the elderly population was only 7%. Now it is 20%, and by 2035 it will approach 30%. Statistics show that people aged 65 and over use inpatient services 11 times more than those in their 30s and 40s. Japan, with an aging rate of 30%, has an average hospital stay length three times the OECD average. Aging explosively increases medical demand.

Doctor aging is also a serious problem. The proportion of doctors aged 70 and over was 6.8% in 2022 and will reach 19.8% by 2035. Doctors' working hours are decreasing. Recent statistics show doctors' working hours decreased by 12% on average, and residents' by 16%. Additionally, demand for health industry services is increasing due to aging. Naturally, more doctors are needed. Yet, for the past 27 years, medical school quotas have not increased by even one and have actually decreased. Yielding to doctors' demands at the time of the 2000 separation of drug prescribing and dispensing, quotas were reduced by 351 by 2006. Considering the reduced quotas, about 7,000 doctors have not been produced, and by 2035 this will reach 10,000. Moreover, nearly 600 to 700 doctors leave annually for cosmetic surgery. Consequently, doctors responsible for essential medical care decrease by nearly 1,000 annually compared to 20 years ago.

Let's look at countries similar to Korea in population and area, facing similar demographic challenges including aging, and having similar public medical systems. The UK currently has 203,000 doctors, which converts to 156,000 based on Korea's 50 million population. France has 214,000 doctors, converting to 163,000; Germany has 374,000, converting to 232,000; Japan has 327,000, converting to 134,000. All are significantly higher than Korea's 115,000 doctors. Moreover, the annual number of new doctors is 11,000 in the UK, 10,000 in France, 10,127 in Germany, and 9,384 in Japan, all much higher than Korea's 3,058. In 10 to 20 years, the gap between these countries' doctor numbers and Korea's will widen further. Korea's doctor-to-population ratio is the lowest among OECD countries. The OECD average is 3.7 doctors per 1,000 people, while Korea has only 2.1 per 1,000. Based on Korea's 50 million population, this means a shortage of 80,000 doctors compared to the OECD average, and medical student numbers are half the OECD average. Furthermore, Korea's elderly population growth rate is 1.7 times the OECD average, worsening the doctor shortage problem.

Currently, Korea's national medical expenses are 9.7% of GDP. Out of approximately 2,162 trillion won GDP, 210 trillion won is spent on medical expenses, higher than the OECD average of 9.3%. Moreover, over the past six years, Korea's medical expenses as a percentage of GDP have increased at three times the OECD average rate, indicating rapidly rising medical demand. This inability to meet surging medical demand causes emergency room wandering and pediatric open runs. One doctor sees too many patients, leading to the term "3-minute consultations."

Regional general hospitals and local medical centers cannot recruit doctors even with salaries of hundreds of millions of won. Yeongwol Medical Center in Gangwon Province posted eight recruitment notices for psychiatrists since November 2023 but received no applicants. Sokcho Medical Center posted a specialist recruitment notice with a 220 million won annual salary but had no applicants, issuing a fourth re-announcement. Jeongeup City in Jeonbuk is on its fifth re-announcement for doctor recruitment. Sancheong County Health Medical Center in Gyeongnam took a year to recruit an internal medicine specialist, finally succeeding by raising the salary to 360 million won.

Hospitals for special groups such as military, police, and fire services face difficulties establishing tailored medical systems due to the inability to recruit long-term specialists. The military requires doctors experienced in trauma like gunshot wounds, burns, and respiratory treatment from chemical and biological warfare. However, among about 2,500 military doctors, 92% serve only three years, and 30% are replaced annually. The military has 480,000 personnel, but only 130 long-term military doctors perform duties excluding trainees. More long-term military doctors leave after their service, and more medical students enlist as active-duty soldiers. Now, very few doctors remain dedicated to military medical care. Attempts to establish a Defense Medical Institute similar to the US Uniformed Service University of the Health Sciences or Japan's Defense Medical College were canceled due to opposition from the medical community. Correcting this abnormal structure makes doctor increases an urgent national task.

Medical personnel cannot be trained overnight. Medical school takes six years (two years pre-med, four years medical), followed by one year internship, three to four years residency, and three years of public health or military service. Even if quotas increase next year, the first graduates will appear in 2031, and specialists will take at least 10 years. Only by 2035 will doctors responsible for essential medical care begin to increase. Currently, there are 115,000 active doctors. Specialists will graduate in 10 years, so 20,000 more doctors will be added in 20 years. The 2,000 figure is not arbitrary. The government reviewed statistics and research carefully, considering current and future situations. Even increasing by 2,000 annually from next year is insufficient to meet rapid aging and regional medical needs. Increasing medical school quotas by 2,000 is the minimum necessary to fulfill constitutional duties to protect citizens' lives and safety and respond to rapid aging.

Citizens,

Claims by some in the medical community that discussions were insufficient distort the facts. Since its launch in May 2022, the government has continuously discussed doctor increases with the medical community. Through various consultative bodies such as the Medical Issues Consultative Body, Doctor Supply and Demand Expert Forum, Health and Medical Policy Deliberation Committee, and its subcommittee Doctor Supply Expert Committee, 37 meetings have been held to discuss doctor increase plans. Especially, the bilateral Medical Issues Consultative Body between the Korean Medical Association and the Ministry of Health and Welfare has held 19 meetings since January 2023. The Korean Intern Resident Association, under the Korean Medical Association, also participated.

On February 9, 2023, at the 2nd Medical Issues Consultative Body meeting, the government proposed appropriate medical personnel training as a discussion topic. On March 16, at the 3rd meeting, the Ministry of Health and Welfare and the Korean Medical Association agreed to discuss medical personnel expansion, essential medical personnel redistribution, and improvement of doctors' working conditions simultaneously. On March 30, at the 5th meeting, the Ministry presented doctor supply forecast results to the Korean Medical Association, explaining the shortage and requesting discussions on increasing medical school quotas at the Intern Resident Association meeting and the Korean Medical Association general assembly. On April 20, at the 7th meeting, policies to be pursued alongside doctor increases were discussed, and the Korean Medical Association was again asked to discuss doctor workforce expansion and redistribution at its general assembly. On May 4, at the 8th meeting, the Ministry requested the Korean Medical Association to present principles and directions for medical personnel recruitment cooperation. On June 8, at the 10th meeting, the Ministry and the Korean Medical Association agreed to discuss appropriate doctor workforce expansion based on scientific evidence, plans to attract expanded doctors to regional and essential medical care, and improvements in resident training and working conditions. On August 16, 2023, the legally deliberative Health and Medical Policy Deliberation Committee discussed doctor workforce expansion with representatives from the Korean Medical Association, Korean Hospital Association, medical service providers, and demand-side groups. The committee formed a Doctor Supply Expert Committee with medical school professors, Intern Resident Association representatives, hospital directors, and experts to discuss detailed policies on doctor workforce expansion and training. From August to December 2023, the committee held nine meetings discussing doctor supply forecasts, increase scales, medical school quota expansion, medical education capacity, resident training improvements, and specialist system reforms. The government continuously explained these results to the Korean Medical Association and the Korean Intern Resident Association through the Medical Issues Consultative Body.

On November 15, 2023, at the 17th Medical Issues Consultative Body meeting, the Korean Medical Association stated that discussions on medical school quota expansion are possible if based on scientific, objective data and preceded by measures to save essential and regional medical care. From the 20th to 23rd meetings in December 2023, the government and the Korean Medical Association continued discussing doctor workforce expansion based on doctor status, demand, and OECD cases. The government presented evidence of doctor shortages and increases, including regional medical disparity statistics, future medical demand growth, doctor supply forecasts, and medical site surveys. They also discussed policy tasks to be pursued alongside doctor increases, such as legal burden relief for medical accidents, resident working condition improvements, workforce system innovation, and medical delivery system improvements. Measures to improve medical education quality, such as enhancing accreditation standards and expanding faculty, were also discussed.

After continuous discussions, on January 15 and 16, 2024, the government sent official letters to six organizations including the Korean Medical Association, Korean Intern Resident Association, and Korean Hospital Association, requesting opinions on appropriate medical school quota increases. On January 17, at the 25th Medical Issues Consultative Body, the Ministry officially requested the Korean Medical Association to present the increase scale. However, the Korean Medical Association did not submit any opinion on the quota increase and repeatedly claimed there is no doctor shortage. The Korean Intern Resident Association also did not submit any opinion.

Meanwhile, after announcing the 'Essential Medical Innovation Strategy' on October 19, 2023, the government conducted a demand survey for quota increases at 40 medical schools nationwide from October 27 to November 9, 2023, to identify the feasible increase scale while maintaining education quality. The current total medical school admission quota is 3,058, but the demand for 2025 admissions ranged from a minimum of 2,151 to a maximum of 2,847. Furthermore, universities hope to continue expanding quotas to add between 2,738 and 3,953 by 2030, assuming additional educational conditions are secured through government support.

Alongside this, the government confirmed through various statistics and surveys that increasing medical school quotas will not reduce education quality. As of 2023, the average number of students per full-time medical faculty member is 1.6, far below the legal standard of 8 students per faculty. The Ministry formed a 'Medical Education Inspection Team' of experts to review and inspect medical education conditions at each school. The 40 medical schools operating in Korea submitted quota increase applications for 2025 admissions between February 22 and March 4, 2024: 365 from eight Seoul universities, 565 from five universities in Gyeonggi and Incheon, and 2,471 from 27 non-metropolitan universities, totaling 3,401. This far exceeds the maximum quota increase of 2,847 reported by universities in November 2023.

Citizens,

Thus, the government decided on a 2,000 medical school quota increase based on solid evidence and sufficient discussion. To supply adequate medical services meeting citizens' medical demand, sufficient doctor supply and education and training must precede. Since medical personnel training takes a long time, mid- to long-term workforce planning and policy are crucial. However, the medical community, which remained silent when the government requested specific numbers for the increase, is now throwing out various numbers like 350, 500, or 1,000 without evidence. They are also threatening to reduce the increase by 500 to 1,000.

If the medical community insists on reducing the increase from 2,000, they should present a unified plan to the government based on solid scientific evidence, not collective action. We can discuss any more reasonable and rational plan. Government policy is always open. If better opinions and rational evidence are presented, government policy can change for the better. However, attempts to impose their will through force without proper logic and evidence are unacceptable. Illegal collective actions must stop immediately, and rational proposals and evidence must be brought forward. The government is proceeding with legitimate policies after thorough review, and cannot stop or suspend them based on force without evidence. Some ask why insist on 2,000 and not gradual increases. If gradual increases were possible, why have no governments increased quotas even by one in the past 27 years? Gradual increases require larger increases in later years, causing annual conflicts like now. For example, aiming for 20,000 increases in 20 years with gradual increases would require 4,000 increases in the final year. For predictability and fairness among medical school applicants, it is more reasonable to increase quotas evenly each year. Yielding to interest groups' threats and agreeing to reduce quotas by 351 has caused the current severe doctor shortage. We cannot repeat the mistakes of the past 27 years.

Citizens,

Medical care is directly linked to citizens' lives. Illegal collective actions by some doctors pose a serious threat to society. For 27 years, no government has succeeded in increasing doctor numbers and reforming medical care despite 90% public support. Previous governments lost all nine battles, and doctors' occupational cartels have become stronger.

We can no longer afford such failures. The state grants doctors exclusive rights to practice medicine to protect every life. This monopoly carries heavy responsibilities to protect citizens' lives and health. Therefore, doctors must comply with medical laws. Yet, after announcing the medical school quota increase, the Korean Medical Association declared a total strike. The government immediately issued orders prohibiting collective actions and incitement to the association's executives. It strongly urged immediate cessation of any collective actions threatening public health and safety.

Since February 19, residents have begun collective withdrawal from workplaces. The government issued orders prohibiting collective leave and maintaining essential medical services to all 221 training hospitals and individually ordered doctors who left to resume work. Nevertheless, over 90% of residents have left patients' sides. The government has repeatedly inspected training hospitals and urged residents to return, but they have refused. If doctors abuse their monopoly rights, neglect duties, and hold citizens' lives hostage through illegal collective actions, the state must respond according to law and principles. No one can have privileges and rule over citizens, especially doctors handling lives.

The government is proceeding with license suspension administrative actions against 8,800 residents who violated work resumption orders under Article 59, Paragraph 2 of the Medical Service Act, following medical and administrative procedure laws. However, this will take time. Administrative procedures require prior notification and opportunity to submit opinions before suspension notices. Notifications are sent by registered mail. Most residents deliberately refuse to receive prior notifications. In such cases, notices must be resent up to three times, and if refused, public notification can be made. Second prior notifications have been sent to most residents. All procedures follow the law.

Residents,

Instead of refusing notification delivery, please return to medical sites now. As president, do I want to sanction or punish you who will save many lives and protect many citizens' health? You are a very important future asset of Korea. Please remember the expectations citizens have for you and your public duties. Please return promptly to the medical sites where patients are waiting.

Citizens,

Some doctors now even refuse the government's 'unconditional dialogue' proposal. The Korean Medical Association demands dismissal of the Minister and Vice Minister of Health and Welfare over quota increases. Haven't they discussed doctor increases dozens of times with the Ministry? They even threaten government intervention in general elections and call for regime change. Such behavior threatens not me as president but the citizens.

What is politics? Politics is solving citizens' problems. If politicians yield to interest groups' resistance despite knowing structural problems causing citizens' anxiety and inconvenience, politics does not exist. It is not a normal state. I have devoted myself to solving several reform tasks I promised citizens. Reforming structural and chronic problems is the role of the government elected by the people.

I do not pursue reform because I do not understand political gains and losses. I have seen citizens suffer for a long time. If no one pursues reform solely for citizens and national interest without considering gains and losses, this country has no future. From my public service days to now as president, I have never taken the easy path. Even unpopular policies I want to avoid, if necessary for citizens and national interest, I have boldly implemented.

In 2022, during the Cargo Solidarity's collective transport refusal, many said it was an 'unwinnable fight' and 'compromise was necessary.' But I issued work resumption orders to 932 people according to law and principles. We did our best to protect good truck drivers from violence and eventually resolved the situation.

When dealing with construction site violence, unions and supporters resisted, calling for regime change and impeachment. If I had retreated then, construction of buildings and industrial facilities would have been severely disrupted, harming our economy and jobs, ultimately hurting citizens.

Regarding sound fiscal policy, ruling party and supporters opposed it. Many said it was impossible with upcoming elections. Without sound fiscal policy at government launch, inflation would not have dropped to 2-3%, government and corporate bond yields would have soared, and financial market stability in a high-interest era would have been impossible.

When trying to improve damaged Korea-Japan relations, there were concerns about approval ratings inside and outside the party. But now nearly 10 million citizens from both countries visit each other annually, and corporate cooperation and competitiveness have improved. There was considerable opposition and resistance when dismantling the private education cartel and promoting Neulbom School. Policies for children and future generations cannot be subject to political gains and losses.

Normalization of nuclear power policy faced strong resistance from anti-nuclear forces. But the nuclear ecosystem revived, revitalizing all industrial ecosystems. Advanced industries like semiconductors are impossible without nuclear power. Many opposed, saying "It's the right policy but will lower approval ratings" or "Is it necessary now?" Medical reform is the same.

But citizens,

How can a president ignore issues involving citizens' lives and health due to political gains and losses? No government has solved this politically and left it neglected until the desperate situation now. I believe this is a crisis of democracy. I know well why citizens elected me and placed me here. I know we must not compromise or yield to vested interest cartels against citizens' universal interests.

Citizens,

Many doctors still uphold their duties and protect citizens. Thanks to them and your cooperation, emergency medical systems are maintained. I deeply thank doctors, nurses, nursing assistants, and all medical staff on the front lines. The government will do its best and provide sufficient financial support to frontline medical staff.

Residents away from hospitals,

I will create a proper medical system through reform. I will invest massively to make Korea's medicine and medical industry globally competitive. If you want to take collective action, do so not opposing doctor increases but when I fail to keep my promises to you.

Residents,

Please stop collective action and return. The doctors I met in medical sites were dedicated. Medical organizations should promptly sit at the table with the government to discuss what is best for citizens' lives and health. Medical reform must be achieved through broad cooperation among doctors, nurses, nursing assistants, and other medical professions. I have already proposed establishing a presidential special committee for medical reform. A social consultative body involving citizens, the medical community, and government is also welcome.

Citizens,

The president must be humble to citizens and bow deeply to the socially weak. However, I am the president with constitutional duties to protect citizens. If there is anything causing citizens hardship or distress, I must fulfill my duties firmly. Doctor increases are only the minimum necessary condition in medical reform, with more sufficient conditions to follow.

Citizens,

Now is the time for courage. The driving force for policy implementation and success is ultimately your support and backing. When citizens and government join hands to pursue legitimate policies, only then can policies succeed and all citizens benefit. The government earnestly asks for your support and backing to complete medical reform for citizens. I and the government will lower our stance further and listen more to the voices of the socially weak and citizens. We will not miss even the smallest voice and will devote all efforts to what benefits citizens.