What Is the Problem About Expansion of Medical School Seats?

The medical community is continuing to express its intention to strike while the government finalizes the increase in the number of medical school seats by 2,000. Professors at school of medicine all over the country demand a reconsideration of the unilateral decision to expand medical school admissions, submitting letters of resignation. Professors in Pusan National University (PNU) School of Medicine also resist the decision and are collecting resignation letters (reported by “Channel PNU on March 29th, 2024). “Channel PNU” interviewed Yoon Sik (Prof. of School of Medicine, PNU) in his office on March 26th to hear the medical community’s perspective on this issue.

Q. What is the biggest problem with the increase of 2,000 medical school seats from the perspective of medical professionals?

A. The biggest issue is that this expansion could pose a collapsing of the healthcare system in Korea. Healthcare conditions are the result of various interacting systems. The overall medical level encompasses factors such as quality of medical care, patient accessibility, satisfaction with treatment, treatment capability, etc. And these factors include the number of doctors. Korea is known for its high medical standard, which means a balance between the number of medical personnel and medical infrastructure. In this context, if medical school seats increase without plan and consultation with the medical community, it could lead to the collapse of the healthcare system.

Q. Is there an expectation that increasing medical school admissions could improve regional healthcare or essential medical services?

A. Even with an increase in medical school admissions, it is difficult to achieve actual improvement in regional healthcare due to the concentration in the capital region. Local talent is flowing to Seoul, and even if regional universities increase admissions, it is expected that these graduates will engage in medical activities in the capital area. So it is uncertain that there will be practical reinforcement of regional healthcare. The lack of infrastructure in local medical institutions is also a problem. Even if medical personnels are produced, there are not enough medical facilities to accommodate them. It is also an issue that patients using the infrastructure are insufficient because of the lack of population in the region. Ultimately, the way to solve the regional healthcare problem is to eliminate the concentration in the capital region and develop regional hub cities to attract population. 

Expanding medical school admissions does not present an effective solution for essential medical services. Essential medical services are often considered unpopular specialties within the national healthcare system, and avoided by medical personnel. Doctors receive insurance premiums as compensation for their medical activities, but essential medical services are undervalued compared to their hardships. Moreover, doctors in essential medical fields may face legal disadvantages in medical accidents. Additionally, since essential medical services are fields that individuals choose to pursue voluntarily, the government cannot force them to participate. Ultimately, even if admissions are increased, it is challenging to provide practical incentives to allocate personnel to essential medical fields.

Q. If the medical school’s seats are expanded, what changes will appear in the educational environment?

A. Currently, the medical education is highly specialized, requiring thorough preparation for any expansion. As medical schools have practical sessions for each lecture, preparation such as facilities, tools, and professors must be prepared. Systematic education is necessary for smooth learning, but there is no preparation for the increased seats currently. There is even a lack of space to expand classrooms and practical rooms. There is also a shortage of educational workforces, even if the limited number of teachers is increased immediately. Medical school faculty are divided into basic professors and clinical professors. Basic professors need to prepare for about 10 years and clinical professors need to complete a preparation process as well. It takes four to five years of education for assistants who are in charge of practical sessions.

The number of body donations for student practice is also insufficient. Bodies are solely donated based on the donor’s noble intentions, making it difficult to obtain them. The current number of body donations matches the current number of students, but if too many individuals are around one body, it becomes impossible for each student to practice on the whole body. Due to these reasons, medical education becomes inadequate, leading to the production of incompetent doctors, which ultimately harms the public.

Q. PNU hospital is also experiencing a medical gap due to the departure of specialists. How do you view these medical gaps?

A. These medical gaps are being addressed by professors like clinical professors. However, due to the reduced workforce, surgeries and patient intake is lower, and overall operations are being scaled down. The problem is that Korea’s medical system excessively relies on medical personnel with specialized training compared to other advanced countries. This is because residents receive lower pay, which is necessary for sustaining hospital operations. In conclusion, what is needed is an increase in faculty members, reducing the reliance on residents. Since the increase in enrollment also contributes to a higher proportion of residents, expanding the number of professors within the hospital is seen as a solution to the medical gap issue.

Q. Despite strong opposition from doctors, the decision to increase enrollment has been made. How do you think we should proceed in the future?

A. The government should cancel the expansion and reconsider and rationalize the decision regarding the enrollment increase, starting from the allocation of quotas. While PNU’s enrollment is increasing by 75 students, Chungbuk National University’s enrollment is increasing by 151 students (four times the original). Considering that Busan has a larger population than Chungbuk, there is no need for such a large allocation to Chungbuk National University. It is necessary to make rational judgments regarding issues such as regional population shortages, educational conditions, and the distribution of physicians. Quota sizes should be determined, and distribution should be rationalized, taking into account regional conditions and circumstances. If representatives from the medical community and the government can announce the enrollment increase after reaching a consensus through discussions, it is likely that there will be no controversy.

Reporter Yoon Ji-Won

Translated by Ha Chae-Won