2024 South Korean doctors' strike

The 2024 South Korean doctors' strike is an ongoing strike in South Korea which began on February 20, 2024, when doctors in South Korea expressed dissatisfaction with the announcement of new government policies on significantly increasing the medical student quotas. Thousands of residents and interns have since resigned or refused to work, which has resulted in medical school professors working to cover for residents. This has forced non-urgent, less complicated patients to no longer be treated at tertiary care facilities, leading to concerns about large university hospitals running into financial trouble. There have been anxiety about patients being unable to receive timely treatment, but no direct patient deaths were attributed to the labor action. There were 2 deaths in the doctors working overtime to cover residents, leading to concerns about how long this can continue before more doctors start dying out.

Demographic change of South Korea
The demographics of South Korea indicate there will be a large increase in senior citizens who were born in the two baby boom generations of South Korea (1955-1974), causing a significant increase in demand for medical care in the country in the coming decades. However, the number of doctors per capita in South Korea has been one of the lowest countries in the world, recording 2.6 per 1,000 people in 2021, below that of the USA (2.7) and the OECD average (3.7). The fact that doctors in South Korea are aging as well makes the doctor shortage problem more serious.

The shortage of doctors is more acute in rural areas. In 2023, 69% of local medical centers of Korea could not fill their doctors quota, with Chungnam Seosan medical center being unable to hire enough radiologists despite offering an annual salary of 420 million won (about $300,000) with 4.5 working days per week. Gangwon Sokcho medical center also increased annual salary of emergency medicine specialists to 420 million won ($300,000) because they were unable to fill in the position with lower salary.

According to South Korean President Yoon Suk Yeol, the basic medical system is collapsing with many disciplines such as pediatrics, obstetrics, and gynecology, lacking manpower and thus many people are not able to receive timely treatment. He also cited the imbalanced distribution of medical services between urban and rural as one of the reasons to expand the enrolment of medical students. According to data from the Organisation of Economic Cooperation and Development (OECD), South Korea has one of the lowest doctor-per-patient ratios among its members, at 2.6 per 1,000 people, similar to Canada (2.8), USA (2.7), and Japan (2.6), but far below the average of 3.7 per 1,000. .

Admission quota of medical schools of South Korea
Since 2006, the admission quota of medical schools has been 3,058 per academic year. The number was decreased from 3,500 in 2000 which is the year where another strike of South Korea doctors happened. The strike was due to the proposed plan of government to strictly separate the job of physicians and pharmacists, which could cause a significant damage to the income of doctors. Residents and interns refused to work, and emergency rooms of local hospitals were also closed.

After the admission quota was reduced to 3,058, governments tried to increase the enrolment quota but failed due to repetitive strong opposition from doctors. In 2020, Korean government announced that they are planning to increase the quota from 3 thousands by 400, which again led to a doctor strike (2020 South Korean medical strike). As done in 2024, residents and interns declared their strikes and stopped working from the training hospitals. This plan was revoked because it was during the COVID-19 pandemic.

Repulsion from residents
The announcement of increasing medical school from the government immediately caused repulsions from the residents and interns because they have claimed that the welfare of trainee doctors must be improved first. According to the Korea Intern Resident Association, intern and resident doctors in South Korea work 36-hour shifts, in comparison to the United States where they work less than 24 hours. About half of these doctors would work no more than 60 hours per week on average in United States, while in South Korea it is common to exceed more than 100 hours per week. The average salary of residents of South Korea is about 70 million won (about $50,000) which is above the average salary of employees of South Korea but significantly below the average salary of employed specialists which is $200,000.

The fact that the number of increased quota was almost 60% of the original quota made the repulsion more significant. The fact that the increased number of admission will significantly lower the average salary of specialists is considered as another main reason why the training doctors immediately started their strike in February.

Skewed distribution of doctors in South Korea
It has been often pointed out by doctors and the government that it is not the number of medical school admissions but the government policy and laws about healthcare of South Korea that made the doctors move to the profitable field rather than the field for vitality of patients. In South Korea, physician assistants (PA) are illegal to do basic activity such as suture, and also tattoo artists are illegal according to law because their activities are invasive and therefore will hurt the health of citizens. Skin care treatments such as laser treatment and neurotoxin are only legally allowed to doctors, making general practitioners (medical students who passed Korean Medical Licensing Examination) work in the beauty market without being a training doctor.

On the other side, doctors believe that the shortage of manpower in some locations is not due to insufficient numbers, but rather to inadequate medical resources and treatment in those locations that made it difficult to retain staff. The Korea Times writes that even with the increased enrollment, new doctors may choose to go into more popular specialties or urban areas such as Seoul, where there are more patients along with higher pay. Meanwhile, rural areas in South Korea lack medical infrastructure, with patients often travelling long distances to large medical centers in Seoul. Therefore, the development of rural medical care has never improved, and doctors are even less willing to start their careers there.

Events by time



 * February 6

Yoon Suk Yeol's government announced they will increase medical school enrollment by 2,000 every year from 2025, setting the quota to 5,058. Doctors have collectively opposed Yoon's proposal, stating there are already sufficient doctors in major hospitals. However, the government moved forward with the plan.

Many doctors resigned collectively. Many undergraduate students in medical schools also went on strike and suspended their studies.
 * February 20

The government raised the crisis level of the country's medical system to "serious".
 * February 22

The Ministry of Health and Welfare announced that all clinics and treatment centers were allowed to provide telemedicine services, which was originally illegal in South Korea. In the past, the controversy about allowing telemedicine was a root cause of doctor's strike in 2014, and since then the services were considered illegal. It had been allowed to limited cases during the COVID-19 pandemic.
 * February 23

Ministry of Health and Welfare stated that among the 100 hospitals, 10,034 interns and resident doctors submitted resignation letters with 9,006 of them resigned. In response, the Ministry suspended the medical licenses of two leaders of the Korea Medical Association and ordered the return of 6,228 intern doctors. The government indicated that if they resumed their work by February 29, they would not be punished. On March 1, there were 565 doctors who had yet to return to their duties. The government stated that they would take action against those who refused to return to work by March 1 and threatened administrative sanctions and other possible judicial measures.
 * February 26

The Ministry announced that nurses would be able to assume some of the duties of doctors. On March 1, the Ministry issued a return-to-work order to 13 intern and resident doctors who formed the committee of the Korea Intern Resident Association.
 * February 27

The Korea Medical Association held a general meeting at Yeouido island located on the Han River in Seoul, condemning the government's pressure on the doctors and mobilizing doctors to continue the strike to stand against the government.
 * March 3

South Korean Prime Minister Han Duck-soo chaired a response meeting, acknowledging that a large portion of the doctors had yet to return to work. Han stated that the government would urgently prepare a budget to employ replacement doctors and reward those who stayed in the hospitals. Various committees under the government would also work to implement health care reforms.

In order to ensure that regional emergency centers were able to treat severe cases, the Ministry began to classify patients into critical and non-critical groups.

The Ministry announced that it would conduct a second inspection at 50 hospitals for the return of intern and resident doctors. If these doctors returned to their posts by then, they would not pursue further discipline. However, if they still haven't returned to work, they would face punishments on the following day. Those who did not comply with the government's order to return to work would have their medical licenses suspended for at least three months, delaying their qualification as medical doctors by more than a year. Further administrative sanctions would also be recorded in their employment records.
 * March 4

At 11:00 am local time, more than 11,994 intern and resident doctors remained absent, representing 92% of the trainee doctors. On March 11, the Ministry had issued a notice of suspension of medical licenses to 5,566 intern and resident doctors. The Ministry indicated that those who returned to work before the completion of notification process would be dealt with leniently.
 * March 8

Medical schools reported that they had received 5,445 applications.
 * March 9

On March 11, the government announced that military doctors and doctors from public health clinics would be deployed to hospitals affected by the strike.
 * March 11

Senior doctors and professors from 20 hospitals had indicated that they would submit their resignation letters from March 25 to back the strike. But instead, they began cutting back on hours spent in practice on March 25.
 * March 16

President Yoon gave a speech to the nation for almost an hour. He reaffirmed his will to expand the number of medical school admissions and appealed to the public for support.
 * April 4

"'As the president, I regret not being able to promptly address the public inconvenience... All rational people will agree that the country faces a shortage of medical doctors.'"


 * May 16

The high court of South Korea judged that increasing the quota of medical schools is necessary for the greater good.
 * May 18

The South Korean government issued a return-to-work order for private practitioners on Tuesday as more doctors including medical professors join the months-long strike to protest increasing medical school admissions.

Adjusting the increased quota
The government offered to adjust their healthcare reform plans to let medical schools determine their own admissions for the 2025 intake, lowering the designated quotas by up to 50% for 2025 while maintaining the original increased quota from 2026 onwards on April 19, 2024. However, the Korea Medical Association (KMA) rejected the proposal on April 24 and claimed that the increased quota must be completely rolled back.

Hiring doctors from foreign countries
As the strike remained unabated, the government in May 2024 sought to allow vetted foreign doctors to work in South Korea. In response, the head of KMA, Lim Hyun-taek, shared a screenshot of a news report of newly graduated Somali doctors in his Facebook with the text "Coming Soon.", a message connotating that doctors from foreign countries are inferior to South Korea doctors. Although it was subsequently removed, it was deemed as "racist" and "exploiting Islamophobia and stereotyping against developing countries".

The government's proposed plan was an extension of preparing the new medical environment for upcoming plural society of South Korea, which is already becoming reality since the number of people from foreign countries in South Korea reached 2.5 millions in 2024 and the ratio of international marriage of South Korea reached 10% in 2024 as well. A collaboration between South Korea and the Middle East/African countries from 2010s reported that over 130 doctors from Middle East are already working as specialists in South Korea in 2024 as a part of the official government program for international healthcare collaboration of South Korea. According to the news, these foreign doctors are overall satisfied with their hospital environment. Another interesting and successful story that overcame the barrier of different languages between doctors and patients is the plastic surgery market of South Korea. There is a significant number of patients visiting South Korea from other East Asia countries in order to have a plastic surgery, and they are assisted by interpreters as well as employees in the hospitals who are fluent in the languages.

It is also considered that lowering a hurdle of incoming overseas doctors is not only important to relieve immediate impacts of this doctor strike, but can also be a possible solution for the possible future where training doctors choose to be general practitioners to go to the beauty market.

Government
South Korean President Yoon Suk Yeol lambasted the strike and denied that the increase in medical students would lead to a decline in quality of medical education. He stated that the strike should not threaten the lives and health of the population, and that the proposed increase of 2,000 students is the minimum required. His government stated that if the doctors on strike did not return to work, their medical licenses would be suspended.

Professors of Medicine and The Korea Medicine Association
Medical professionals argue that the plan would impair the quality of medical education. However, commentators pointed out student-to-faculty ratio in Korea is one-third of Germany's and half of the United States, with each Korean medical professor handling 1.6 medical students on average.

Medical professionals and The Korea Medical Association pointed out that the planned enrollment increase will not be able to fix the immediate manpower issue as training doctors typically takes ten years. If a fresh medical student wants to qualify as a specialist, they must undergo a six-year study, a one-year internship and three to four years of residency training after graduation. This implies that not only the increased quota of medical schools but more immediate actions such as partially allowing doctors from overseas to work in South Korea is necessary.

Medical professionals also point to high rates of medical malpractice litigation. Approximately 750 South Korean doctors are criminally charged for medical malpractice every year. That is 14.7 times higher than Japan, 580.6 times higher than the United Kingdom, and 26.6 times higher than Germany. A 2019 study found that one-third of doctors had experienced a medical malpractice in the past 3 years. These litigations often occur in more critical medical specialties such as, emergency medicine, cardiothoracic surgery, gynecology, and pediatrics. A criminal charge due to medical malpractice does not lead to revocation of their doctor license according to the law of South Korea, but this can still be a significant threat to doctors in the specialties.

The Korea Medical Association believes that the root cause of the shortage in South Korea's medical services is not the lack of doctors, but the uneven distribution of medical facilities between urban and rural areas, poor labor conditions, and high litigation risks. Therefore, the union believes that increasing the number of doctors will not resolve the shortage or disparities.

Opposition parties and the public
Lee Jae-myung of the Democratic Party also opposed the strike and supported the increase in enrollment of medical students. Groups representing cancer and ALS patients have also called for the quick return of striking doctors. The Korean Buddhist order, Jogye Order had also urged the return of striking doctors on February 22. A Gallup Korea poll found that 76% of those polled supported the increase in enrollment, with only 16% opposing it. A survey published on March 5 by the Yonhap news agency found 84% of respondents supported adding more doctors, while 43% indicated that the doctors on strike should be sternly punished.

Unions
The Korea Medical Association stated that the right to strike and resign by doctors are protected by the constitution. The Korea Intern Resident Association wanted the government to withdraw the plan to increase the enrollment of medical students and cancel the return-to-work order.

Impact
Severance Hospital, Seoul National University Hospital, and many other hospitals were forced to cancel or postpone many surgeries. Some hospitals also decided to shorten the time to operate on patients or give priority to critically ill patients. There have been claims about bad outcomes to patients from the strike. One person on social media blamed the death of their grandmother as a result of the strike. There was another claim that a woman died due to a lack of staffing and beds, but it was later determined that this woman had end-stage cancer and already had advance directive to Do-Not-Resuscitate (DNR). There were real casualties among the doctors, however. An ophthalmology professor in his 40's died of brain hemorrhage on March 24, 2024 and an internal medicine professor in his 50's died of intestinal obstruction on April 20, 2024, causing significant concerns about health risks to the medical school professors who were overworked trying to cover for all of the resident doctors who have resigned.