The honor of saving lives. Specialized and professional. Above-average income. These are the keywords that attracted many to the job of being a doctor, regardless of country and age. However, few are aware of the discrepancy in workload and treatment between doctors in different areas of specialization such as Emergency Medicine (EM) or Radiology (DR). Most do not know the distorted structure of the Korean medical system that forces students to compete for popular specialties, while unpopular specialties suffer with the lack of medical residents applying for them. 

  On March 15, the Chosun Ilbo reported that the average monthly income of doctors in 2016 was 13.04 million won, which is 4.6 times more than 2.81 million won, the average monthly wage of ordinary salarymen in Korea. The article went further to state that doctors’ income relative to laborers’ average wage was much higher than that of other countries that are Organization for Economic Cooperation  and Development (OECD) members. Yet, do all doctors earn such a high income as the article has suggested? 

 The Fallacy of Average

  The astounding figure of 13.04 million won literally refers to the average of all doctors, whether they be employed doctors or private physicians, Plastic Surgery (PS) doctors or EM doctors. Because doctors have an extremely varied workload and income depending on medical departments and level of hospitals, the article stating mean income was harshly criticized online. There are countless numbers of detailed majors in medicine, which leads to thousands of different work environments. For example, three specialties—Dermatology (DR), Ophthalmology (OPH), and PS—are in the center of the spotlight to students majoring in medicine, because such specialties are known for bringing them huge fortune. Such preferences even led to different acceptance rates for residents. 

▲ Different competition rates for various majors

  While preferred majors are met with a surge of applicants, certain specialties are often avoided because their workloads are extremely demanding. “Why are certain majors called unpopular majors? Although doctors of such departments may have a feeling of satisfaction for themselves, they are not socially awarded with leisure time or appropriate rewards,” Jung Young Jin, President of the Korean Association of Surgeons (KAS), stated. He further pointed out that doctors specializing in General Surgery (GS) or Obstetrics and Gynecology (OB&GY) work extremely long hours—110 hours per week—during the resident period. 

Distorted Structure of Korean Medicine

  In order to understand the fundamental reason behind such discrepancy, one needs to take a close look at the medical fee system in Korea. Under the National Health Service (NHS) system, most costs for essential medical treatments are paid by the Health Insurance Corporation (HIC). Because it makes use of the nation’s tax, HIC put forth the “medical fee,” consisting of an account paid by patients and a deductible cost paid by the corporation. “According to the statistics from the Research Institute for Healthcare Policy (RIHP), the conservation cost of medical fee was approximately 78 percent. In case of specialties such as GS or ER, the ratio is below 70 percent,” Jung clarified. 

▲ Jung Young Jin, President of KAS

  When the conservation cost of medical fee is below 100 percent, the conclusion can be derived that doctors always face loss for just rightly treating the patients. Jung revealed how private doctors and large hospitals survive from such an irrational system. “For those private clinics focusing on GS or Internal Medicine (IM) which consist of mainly tax-deductible treatments, they first have to face enormous patients to avoid the loss. Or, because they cannot compensate the loss from such treatments, private physicians are then forced to venture into developing new non-deductible items, such as infusion of nutrients or ultrasonography, to name some.”

Jung Young Jin, President of KAS

  From the perspective of a polyclinic, the loss made from departments such as IM and GS are compensated with the profit from specialties with more nondeductible medical care. Not only that, such distorted structure forces hospitals to make profit from managing funeral halls or cafeterias, according to Jung. Unfortunately, conservation costs of operations conducted in intensive care units (ICU) or an Emergency Room (ER) range only from 40 percent to 80 percent, making them burdensome for the hospital. For regional emergency medical centers that only focus on severe emergency patients, it is extremely difficult to balance the profits and loss, without receiving enough monetary support from the nation.

Normalizing the Structure

  It goes without saying that the structure of “more patients, more loss” is irrational. In order to deal with this problem, Jung stressed that medical fees be normalized. By doing such, the aversion toward deductible cures and favoritism to non-deductible treatments are surely to be balanced. This, in turn, would also balance the discrepancy between popular specialties and unpopular specialties that stem from different ratios of deductible and nondeductible therapies. “ What is important, is to foster an environment in which proper treatments are guaranteed for doctors working in unpopular specialties,” Jung stated. 

  Not only guaranteeing proper medical fees, but it is also important to give more support to doctors working in ER or regional emergency medical centers. Professor Lee Kook-jong of the regional emergency medical center of Ajou University is one of the most renowned doctors in Korea for successfully performing surgery for bullet wounds on the Captain Seok Hae-gyun and a North Korean soldier who defected. In contrast to his reputation however, he revealed his life of having to work endless 36-hour shifts in an interview with Hankyeoreh. Considering that a large portion of patients visiting such emergency medical centers are blue collar workers, such a distorted structure cannot avoid the criticism of hurting the weakest of the society.

  So far, the doctors in the toughest situation have been performing medical treatments under the widespread perception that the acts of saving lives cannot be converted in terms of money. Yet, for both the doctors and the patients, an environment in which the doctors do not have to face financial loss for treating the sick has to be created at least. Doctors such as Professor Lee have to endure an enormous workload every day, just to ensure the survival of patients on the verge of death. One needs to be aware that the capitalist logic applied to hospitals and merely cosmetic promises to provide institutional support could lead to a collapse of Korean medicine. When this happens, it is the weakest of the society who would have to bear the disastrous results.