hankyoreh

Patients wait in line for treatment in wheelchairs outside the emergency room at Seoul’s Asan Medical Center on April 18, 2024, the two-month mark in the ongoing standoff between Korea’s junior doctors and government. (Kim Jung-hyo/The Hankyoreh)

Since losing her husband last month, Choi Hee-suk, 65, can’t help mulling over various what-ifs: What if interns and residents hadn’t abandoned their posts? What if he had gotten the treatment he needed sooner? 

Choi’s husband was diagnosed with stage 3 lung cancer in 2020 and received surgery at Samsung Medical Center, located in the Irwon District of Seoul. Three years later, his cancer returned, so he received treatment at the same Samsung hospital while going back and forth between Daegu and Seoul until March 2024.
 
When the conflict between physicians and the government became heated this past February, the couple began to worry about how it would affect their care plan. 

“We worried if my husband would be able to receive his next treatment and how we would cope after the hospital’s medical interns and residents had resigned,” Choi said. 
 
Choi’s husband’s condition grew worse on March 6 and he was admitted to a general hospital in Daegu. On the night of March 9, he had blood drawn and analyzed because he was experiencing severe coughing. Doctors at the general hospital told him that it would be best if he transferred to a bigger hospital.
 
Choi inquired about an emergency room at a university hospital in the area but was informed that her husband’s admittance would be difficult due to the lack of medical residents and interns. Her husband was transported in a private ambulance to Samsung Medical Center on March 10, where he was diagnosed with COVID-19. He died four days later.
 
“I knew that catching COVID-19 was dangerous for lung cancer patients, but I can’t help but wonder how things would’ve been different if medical interns and residents had still been working at the hospital,” Choi told the Hankyoreh, her voice shaking.
 
Agonized patients and families
 
When medical interns and residents at Severance Hospital handed in resignations en masse on Feb. 19, their absence inevitably led to disruptions in patient care. Thursday marked the two-month mark of the collective action by Korea’s trainee doctors, but the government and physicians are still butting heads. All the while, patients and their guardians are the ones bearing the brunt of the conflict, fretting over surgeries and treatment that have been delayed indefinitely.
 
Patient A, an individual in her 40s, was scheduled to receive her second surgery for her brain tumor at a hospital in the Seoul metropolitan area last February. A week or so before her surgery date, the hospital informed her that the procedure had been canceled due to the absence of medical residents and interns.
 
Patient A had no choice but to wait for a new surgery date. As she waits, she is being fed with a tube, worrying her family, who say her body continues to weaken and her face grows dull.
 
Patient B, an individual in his 70s, had been receiving treatment for liver cancer at a university hospital outside the capital area for the past few years. Then, in early April, his doctors had recommended that he undergo an embolization procedure to help treat his cancer. In the same breath, he was told that scheduling the treatment would be difficult due to the work stoppage by doctors. 

“Even my own doctor said that this might be the last I see of them, because they may resign too,” Patient B said. “That sudden uncertainty about my future made me break down and cry.”
 
Doctors more worried about the future
 
Health care providers say that the anxiety about what’s to come is hitting them as well. 

“Since Feb. 20, we have reduced the number of surgeries by one-third compared to 2023 due to the unavailability of medical staff in the anesthesiology and pain departments, and we have not been accepting new patients since April,” said Youn Hyun-jo, professor at Jeonbuk National University Hospital’s breast and thyroid surgery division. 
 
“Even though we tell patients with cancer that they need to be operated on as soon as possible, we are in an unfortunate situation where we cannot even set a date for them,” he added.
 
“Patients start being anxious from the minute they’re told they have cancer, so not being given concrete surgery dates only exacerbates their apprehension,” he went on. “Some patients leave my room crying while all I can say is ‘I’m sorry.’”
 
Kim Hye-ry, a doctor at Asan Medical Center’s pediatric hematology and oncology department, also called the situation “incredibly unfortunate.”

“We receive a rush of phone calls from concerned guardians whenever news about medical professors resigning is published,” she said. 
 
Health care providers treating urgent patients are working grueling hours to make up for the slack left by trainee doctors’ absence, but the worst may still be to come. 

“Since the mass resignations of medical residents and interns, I have been working more than 90 hours a week. I’ve been working such long hours since most hospitals with hematology-oncology departments that provide chemotherapy relied the most on medical residents and interns, so there aren’t many hospitals that the patients can go to,” a professor of internal medicine at a university hospital in the greater Seoul area told the Hankyoreh. 
 
“We’re attending to so many patients, it’s getting to the point where we’re worried that it will be detrimental to them,” they stated. “Some professors are quitting not to join in the collective action, but because they’re burnt out.”
 
Seo Hong-gwan, the president of the National Cancer Center, said, “If delays in chemotherapy are prolonged, it will without doubt have ramifications for patients’ health.”
 
Downsizing of emergency rooms
 
The situation is no different for those seeking emergency care. While the utilization rate for emergency rooms for mild cases has decreased after the medical residents and interns’ collective action, hospitals’ capacities to respond to emergency patients has also decreased.
 
“Recently, a patient who was vomiting blood from his throat was brought in an ambulance from Hamyang County, South Gyeongsang Province. He called several tertiary general hospitals in South Gyeongsang Province and Daegu, but he couldn't find a place to go, so he had to make a long, difficult journey,” said Kim Dong-eun, a professor of otolaryngology at Keimyung University Dongsan Hospital, in Daegu. 

“The mass resignations of medical residents and interns have made it more difficult than usual for emergency patients to receive treatment at hospitals,” he went on.
 
“The capacity of hospitals is less than half of what it was before the collective action, with the utilization rate of major hospital beds starting to fall below 50 percent,” said Lee Hyung-min, the chairperson of the Korean Emergency Medicine Association.
 
The government rushed to set up a patient transfer network between emergency rooms, but the lack of on-call doctors is preventing the network from fulfilling its purpose. 
 
The Ministry of Health and Welfare hurried to open four regional emergency medical situation rooms in the form of emergency operations centers on March 4, when they were initially looking to open the facilities in April and May. The centers help facilitate transfers between emergency rooms in four regions: the Seoul metropolitan area, Chungcheong, Jeolla and Gyeongsang. 
 
However, the operation centers are unable to help emergency paramedics figure out which hospitals to route their ambulances to, and the result has been situations in which ambulances bounce around from hospital to hospital without knowing which one will be able to admit the patients they carry. 
 
There should be an external emergency medicine specialist on call to do triage and help find hospitals able to treat patients based on their conditions, but the centers are unable to find such physicians due to the resignations of medical residents and interns.
 
Lack of access to emergency care has also led to patient deaths. On March 31, a woman in her 60s complaining of chest pain in Gimhae, South Gyeongsang Province, was turned away from the emergency rooms at all nearby hospitals. In the end, she was transferred to a hospital in Busan, where she died while waiting for surgery. On the same day, a 33-month-old baby who fell into a ditch in Boeun, North Chungcheong Province, died after being refused transportation to a tertiary general hospital.
 
While both the Ministry of Health and Welfare and the medical community expressed their condolences, they both stated that “the deaths were not due to the void in health care.” The government and the physicians did not budge, with Minister of Health and Welfare Cho Kyoo-hong saying, “The healthcare reform will go ahead as planned,” while Park Dan, the representative of medical residents and interns, pushed for a “reevaluation of the plan.”

By Kim Yoon-ju, staff reporter; Lim Jae-hee, staff reporter; Cheon Ho-sung, staff reporter

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