hankyoreh

A person walks into a medical school building in Seoul. (Yonhap)

South Korean President Yoon Suk-yeol made official his plans to increase the admission cap for medical schools nationwide. But he has deferred making any announcement of concrete plans, including how high the new cap will be.

Even if the increase in medical school admission cap is taken as a constant following its imminent announcement, South Korea’s healthcare system will still have to wrestle with issues that include a sharp rise in medical expenditures amid a population aging trend and the preponderance of large-scale hospitals in the greater Seoul area.

In three installments, the Hankyoreh is looking at the most controversial issues where different sides are at odds in the debate over the medical school admission cap.

As South Korean President Yoon Suk-yeol makes official his plans to increase the cap for medical schools nationwide from its current annual level of 3,058 — where it has remained in place for over 17 years — the biggest focus of attention now is on how high the new number will be.

In the debate over the specific scale, the Korean Medical Association has insisted that there is “no shortage of physicians.” The possibility remains that the association may attempt collective action, using the public’s lives as leverage.

But in the absence of adjustments to the medical school admission camp, South Korea’s current health expenditures — representing the total amount spent by citizens on healthcare in a year — has more than octupled from 25 trillion won in 2000 to 209 trillion won as of 2022.

The supply discrepancy that has emerged as the number of doctors has failed to keep up with demand has exacerbated the staff shortage in certain regions and in essential health service areas where residential conditions are poor or the workload burden is high.

Amid the discussion on full-fledged healthcare reforms to promote the public’s health while deterring unnecessary use of healthcare services, many experts have suggested the medical school admission cap should be increased by at least 1,000 from its current level. These experts have proposed an approach where the cap is increased and then readjusted later on to reflect the changing healthcare environment.

An examination Sunday of physician supply estimates shared by state-run think tanks and experts since 2020 showed a predicted shortage of 20,000 physicians in a decade or so relative to the demand for healthcare services.

The Korea Institute for Health and Social Affairs (KIHASA) projected a shortage of 27,232 physicians by 2035. Other researchers have also predicted shortfalls by 2050: 22,000 or more according to the Korea Development Institute, 26,570 according to Seoul National University medical school professor Hong Yun-chul, and 28,279 according to Seoul National University College of Nursing professor Kim Jin-hyun.

These estimates reflect factors including current health service usage volumes, the number of active physicians, age distribution trends, and changes to the population structure.

“If we consider the population structure and healthcare environment in 2035, which is when [the incoming medical students selected in 2025] would be entering the healthcare workforce, we should be increasing the cap to over 4,000 per year [as of the 2025 academic year], or 1,000 more than the current medical school admission cap of 3,058 per year,” Shin Yeong-seok, a research professor at the Korea University Graduate School of Public Health who took part in the KIHASA study, told the Hankyoreh.

“There might be issues with education if the [cap] were increased suddenly by 2,000 to 3,000 students a year, but I think an increase of around 1,000 would be feasible under the current medical school environment,” he added.

In terms of the sustainability of a new cap set at 4,000 incoming students per year or more, Shin proposed “creating a system where we observe each year how the healthcare environment is expected to change in the next 10 years and reflect the results of those new estimates in immediate adjustments to the cap.”

A similar opinion was shared by Kim Jin-hyun, who teaches public health economics and nursing management at the SNU College of Nursing.

“We would need to increase the medical school admission cap by 1,000 to 1,200 to be able to train military, police, firefighting, industrial accident, and physician scientist [personnel] while increasing staffing in a way that allows national university hospitals to play a key role in regions and establishing medical colleges at regional national universities that don’t have national university hospitals,” he said.

Jeong Hyoung-sun, a professor of health administration at Yonsei University who previously performed a 2011 study estimating the appropriate number of physicians during the Lee Myung-bak administration, similarly said the medical school admission cap should be increased by 1,000 to 1,500 students.

“Over a decade ago, the research showed the need to increase the cap by 500 to 600 students a year, and since the number of medical school graduates relative to the population has continued to decline [since then], the only way to sustain things for the foreseeable future is to increase the medical school admission cap by 1,000 to 1,5000,” he advised.

Kim Yoon, a professor of health policy and management at SNU, said, “For us to increase the presence of physicians in regions where the number per 1,000 people falls below the national average [2.18 as of 2022] so that it reaches the national average in the next 15 years, we would need to increase the medical school admission cap by at least 3,000, or three increases of 1,000 students each per year.”

Other analysts advised a course of incremental increases in the cap rather than one big increase of 1,000 students or more in the 2025 academic year.

During a June expert forum on physician supply estimations, Korea Development Institute research fellow Kwon Jung-hyun predicted that South Korea could achieve the number of physicians it needs by 2050 if it increased the cap at a rate of 5% annually over a seven-year period.

According to this approach, raising the cap by 153 (5% of the current 3,058 students) to 3,211 in 2025, by another 161 (5% of 3,211 students) the following year, and so on would lead to a final cap of 4,303 after seven years, representing a cumulative increase of 1,245 from the present level.

By Lim Jae-hee, staff reporter; Park Hyun-jung, staff reporter

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