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Medical interns and residents go on strike in front of Ajou University Hospital in Suwon, Gyeonggi Province, on Aug. 26. (Yonhap News)

“The increase in medical college admission caps and pursuit of the establishment of new public medical colleges is to be suspended until further notice as the COVID-19 outbreak in the Greater Seoul area stabilizes, and every possibility will be considered in subsequent discussions with the Korea Medical Association (KMA) by a consultative group once stabilization has been achieved. During the negotiation period, there will be no unilateral execution of policy measures, such as raising the admissions cap for medical schools.”

This hard-won tentative agreement was reached between the South Korean government and the KMA at around 3 am on Aug. 25. Just 22 hours later, around 1 pm on Aug. 26, it went up in smoke in the face of a collective outcry from medical residents, who insisted that they would not back down from their strike unless the policy proposal was withdrawn completely. Instead of inking the final deal with the administration, the KMA went ahead on Aug. 26 with a second strike scheduled to last three days. Having launched an indefinite walkout on Aug. 21, the residents are now ramping up their battle tactics as they collect letters of resignation to submit en masse to their respective hospitals. A government order mandating that residents in the Seoul Capital Area (SCA) resume their duties prompted a “blackout” in response, with participants cutting off all communication with the outside for a 12-hour period beginning at 7 am.

The content of the provisional agreement had both the government and KMA backing off from their previous demands. Under the detailed plan to raise admissions caps for medical schools announced on July 23 -- which included the introduction of a “regional physician system” -- the Ministry of Health and Welfare (MOHW) would have to notify the Ministry of Education (MOE) this month of the new admissions caps. In response to the growing outcry from physicians, however, Minister of Health and Welfare Park Neung-hoo backpedaled on the plan, announcing on Aug. 19 that the matter would be “pursued through discussions with the medical community once the COVID-19 situation in the Greater Seoul area has stabilized.”

The wording in the provisional agreement on Aug. 25 gave an even stronger sense of the provisional agreement being scrapped with its mention of its mention of policies being “suspended until the situation stabilizes.” The KMA, which had previously insisted that the entire announcement be scrapped before it would begin dialogue, took the first step in requesting dialogue on Aug. 23 with Prime Minister Chung Sye-kyun, cautiously opening up a potential exit route through a marathon session of working-level discussions with the MOHW that began that evening.

But the residents took a different stance. In an emergency general meeting of representatives at 7 pm on Aug. 25 at the Seoul Medical Association Center in Yeongdeungpo District, many of the resident representatives attending from different hospitals objected to the provisional agreement’s content and urged others to forge ahead with the strike. Commenting on the original background between the meeting’s organization, a KMA official explained, “While some of the KMA’s bargaining authority has been entrusted to the leadership, the Korean Intern Resident Association [KIRA] is different.”

“Not only that, but the medical college admissions cap issue is a more important and sensitive one for residents.”

The government was visibly disappointed after its hopes that it might allay concerns about a potential healthcare vacuum by announcing an agreement with the KMA and the cancellation of the strike before midnight on Aug. 26. Speaking on the morning of Aug. 26, Park Neung-hoo said, “It’s very dismaying that the position [of KMA] was overturned by the KIRA decision to strike.” After the blow to his leadership, KMA President Choi Dae-zip posted a Facebook message that day calling on younger physicians to “battle to the end without bending in your convictions.”

“I will be the one who goes to prison,” he pledged.

Meeting with reporters, Choi said, “It is unfortunate that the MOHW announced that there was an agreement between the government and the KMA.”

“The KMA did not end up accepting the plan suggested by the administration,” he explained.

A government official closely acquainted with the negotiation process explained, “From the outset, this battle has been spearheaded more by KIRA than by the KMA.” Indeed, KIRA has consistently run several steps ahead of the KMA strikes (first one on Aug. 24 and a second on Aug. 26-28) with collective actions such an initial strike on Aug. 7 and second indefinite strike since Aug. 21 that have also enlisted vital staff from emergency rooms and intensive care units.

A large number of medical students are also preparing to boycott state examinations and classes. The Korea Health Personnel Licensing Examination Institute (Kuksiwon) announced that 89% of those registered for a practical examination scheduled for Sept. 1 had canceled and requested refunds as of 6 pm on Aug. 25. At the Seoul National University College of Medicine, 47 professors and department heads released a statement in which they said they “cannot stand idly by while students boycott classes and the Korean Medical Licensing Examination [KMLE]” and insisted that “the administration and medical community should start the discussion process from square one once the coronavirus situation has fully come to an end.”

The strong outcry has been explained as being due to the fact that in contrast with physicians in their 40s and older who have already opened their own practices, medical students and residents today will be in direct competition with the additional 300 students per year that will be introduced through the government’s “regional physician system.” The regional physician system is a scholarship-based system to train separate physicians to provide essential and intensive treatment services for a 10-year period in regions seen as vulnerable in healthcare terms. That 10-year-period would also include a training period of five or more years as interns and residents.

With the first selections planned for 2022, the entering students would be just two years before the current group of first-year preparatory course students. A third year student in the regular course at one SCA medical school explained, “Based on the government’s plan, anyone who has completed their mandatory 10 years in the provinces [including their training period as an intern and resident] would be free to open up a practice in the Greater Seoul area or the region where they were a student.”

“You can only conclude that this will mean greater competition,” the student said.

Some observers are suggesting that a culture with a particularly strong sense of hierarchy has also played a role. A resident at one general hospital said, “Because you have people spending a really long time together from their admission to medical school through their training as interns and residents, and because these are people you will continue to see each other over years to come, the physician community has a tremendously strong sense of cohesion and mutual respect.”

“If one or two residents start tendering resignations in the different departments, the others will have a tough time making a different decision,” the resident explained.

Commenting on the resident’s battle, Jeon Jin-han, policy bureau director for the Association of Physicians for Humanism, said, “If this isn’t just a case of residents fighting to feather their own nests, then they should be calling for institutional reinforcements or presenting their own alternatives.”

“It’s not appropriate for them to be going ahead with their strike and simply demanding an unconditional withdrawal,” Jeon said.

By Choi Ha-yan, staff reporter

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