Taking a number and waiting in line has become the norm in neighborhood pediatric clinics in South Korea as the country suffers from a lack of pediatricians. This shortage has troubled the nation for quite some time, and it is believed to be the result of Korea’s rapidly declining birth rate. As a result, medical students are beginning to exclude pediatrics from their choices of majors, and interns are no longer applying for pediatric residencies out of fear that they will be out of jobs in days to come. It can be observed from this that low birth rates and the declining popularity of pediatrics are negatively affecting each other in a vicious cycle.

Medical students’ application rate for pediatrics has been on a gradual decline over the years. According to the Korean Hospital Association and the Ministry of Health and Welfare (MOHW), the application rate across the nation was 101 percent in 2018, meaning that there were more applicants compared to the number of openings. However, it faced the most severe plunge across 26 medical specialties as application rates fell to 80 percent in 2019 and eventually dropping to 15.9 percent in 2023. Consequently, as the situation worsens, major hospitals such as Gachon University Gil Hospital suspended pediatric hospitalization, while Gangnam Severance Hospital and Ewha Womans University Mokdong Hospital all either reduced or suspended night shifts as well as emergency room (ER) treatments for pediatric patients. In other words, it is getting increasingly difficult for children to receive the medical attention they need at local hospitals.

Delving into the Reasons

Against the backdrop of sharply declining birth rates in South Korea, the field of pediatrics in medical science is becoming less sought-after, with general demand gradually decreasing. In general, practitioners, pay doctors, resident doctors, and clinical professors at university hospitals are all in a dire crisis. According to the Korea JoongAng Daily, only 33 resident doctors signed up to specialize in pediatrics across 64 hospitals nationwide in 2023, barely filling up 30 percent of the maximum capacity for the quota of 207 vacancies. It was also mentioned that Lim Hyun-taek, chairman of the Korean Pediatric Association (KPA), commented that “Medical students say they avoid pediatrics not because they do not like the department but because there is no future.”

One difference that sets pediatricians apart from doctors in other majors is how they must handle young patients instead of adults. Professor Ryoo Eell (Gachon University, College of Medicine) mentions that acts of doing oral check-ups or using the stethoscope on children is especially challenging as children oftentimes are unable to fully articulate their pain verbally. However, pediatrics is a relatively underpaid medical field because doctors can only receive appointment fees, and all other additional fees are covered by Korea’s National Health Insurance Service (NHIS). Professor Ryoo says that the system does not provide doctors with any compensation for the time spent in answering various concerned parents’ questions. He also adds that pediatrics is the only department that has faced a decrease in medical expenses, and average costs have dropped 24.7 percent over the last ten years. Hence, due to pediatrics’ lack of tangible merits, doctors are gradually showing a preference for specializing in fields that are the cash cows of medicine, such as cosmetic surgery and dermatology.

It's Not Just Pediatrics

This shortage in specialists does not only exist in the field of pediatrics. Coined to be the “Major 5” of healthcare specialties, the vital care departments, namely internal medicine, surgery, obstetrics and gynecology, pediatrics, and psychiatry are most directly related to saving human lives. However, these fields are currently facing a shortage of doctors as they are deemed to be more burdensome than other medical fields, hence viewed unfavorably by current medical students. Professor Ryoo raised an example that recently became well-known across news outlets of how a medical staff was slapped in the face when explaining to a guardian. He says that this kind of treatment is not rare for all healthcare providers, including nurses, radiologists, and clinicians in all departments. He also stated that doctors in the fields of clinical practice that directly deal with life and death in Korea face more criminal lawsuits compared to in other countries, which is why young doctors are avoiding clinical care in general.

A shortage of doctors in these indispensable fields might lead to more patients not receiving the medical attention they deserve in time, and it may lead to unforeseen consequences. One such example would be the unfortunate death of a nurse at Asan Medical Center who suffered a cerebral hemorrhage during her shift. Even though Asan Medical Center is regarded as one of the largest general hospitals in Korea, she was not able to be treated or receive surgery immediately as there was no neurosurgeon available.

Embracing Changes

According to the Korea JoongAng Daily, the Korean Pediatric Society (KPS) called for financial support from the government to cover the costs of running more pediatric ERs and neonatal and pediatric intensive care units (ICUs), while also asking for a raise in inpatient costs. Subsequently, according to the Korea Biomedical Review, Cho Kyoo-hong, the Minister of the MOHW, recently announced that they are currently considering increasing the enrollment quota in medical schools. However, the idea of expanding the freshmen student body is facing backlash from the medical community as it may not be able to solve the root cause at hand.

Professor Ryoo added on to this, saying that the increase in quota may backfire as it seems to be overlooking the fact that it takes around 12 years for a doctor to be a properly trained specialist; in other words, the current problem faced in Korea’s healthcare is not a lack of general practitioners but a lack of professionals specializing in fields such as emergency medicine. He hopes to bring to attention that because of the low fee-for-service in pediatrics, many specialized medical equipment used by pediatricians are old and outdated compared to other departments.

The dropping of crude birth rates, which have once again reached an all-time low of 4.5 births per 1000 people according to Yonhap News Agency, reveals that the various financial support schemes provided by the government are ineffective. Though the shrinking birth rates may be to blame for the fall of pediatrics, it also undoubtedly brings out concerns along the lines of “who would want to give birth in this condition where healthcare is not guaranteed for my child?” Therefore, there is an urgent need for the Korean government and relevant authorities to quickly embrace the undeniable winds of change in Korea regarding the specialization preferences of doctors, and eventually come up with relevant policies to help resolve the issue at hand.