EXPLAINER - Why are South Korean trainee doctors on strike over medical school quotas?

Trainee doctors say the government needs to address pay and working conditions first before boosting the number of physicians, while authorities say more staff are needed to increase healthcare services in remote areas and meet the growing demands of one of the world's most rapidly ageing societies.

WHY ARE TRAINEE DOCTORS TAKING SUCH RADICAL ACTION?

Medical interns and resident doctors say they are underpaid and overworked and that their protest shows the system is broken because their absence results in surgical procedures being cancelled and emergency rooms turning back patients.

Industrial action by trainee doctors has been effective in the past, largely because they make up at least 40% of the staff at some major hospitals in Seoul.

Trainees usually work 80 to 100 hours, five days a week, or up to 20 hours a day, conditions they say need to be addressed by hiring more senior staff, and not increasing the number of trainees.

Jeong Hyung-jun, a medical doctor and policy director of public health advocacy group the Korean Federation of Medical Activist Groups, says younger doctors are also worried about increasing the number of medical students because it will mean more competition in an already cut-throat sector.

"The competition is already so fierce when they enter medical schools," he said.

WHAT IS IN THE GOVERNMENT PLAN?

The plan, announced in February, will increase the number of students admitted to medical schools by 2,000 starting in the 2025 academic year to bring the total to 5,000 from 3,000 now.

The health ministry says the increase is intended to fill an expected shortfall of 15,000 doctors projected by 2035, an estimate based on the fact that South Korea is one of the world's fastest ageing societies and demand for medical services, particularly by seniors, will continue to grow.

The medical community is also ageing and more doctors are expected to retire, it added.

The government plan will also increase investment and lift pay for doctors in regional and rural areas to maintain essential healthcare services there.

The government has already raised fees for doctors in essential services such as paediatrics, obstetrics and emergency medicine since last year and will inject more than 10 trillion won ($7.48 billion) to boost these fees further, Prime Minister Han Duck-soo said.

The government says doctors in essential disciplines are more often subject to malpractice suits and prosecution so it also plans to introduce new legislation to expand legal protection for doctors.

WHAT IS THE DOCTOR-TO-PATIENT RATIO?

With 2.6 doctors per 1,000 people, South Korea's doctor-to-patient ratio is ranked one of the lowest among developed countries, according to the latest data for the Organisation of Economic Cooperation and Development (OECD) countries. Top ranked Austria has 5.5 doctors per 1,000 people.

South Korean specialist doctors are, on average, some of the highest paid among developed countries, with an average annual income of $192,749 in 2020, according to OECD data. General practitioners, however, are lower paid in comparison.

There is significant disparity in specialists' income depending on their field, according to health ministry data. Paediatricians are the lowest paid, making 57% less than the overall average. Plastic surgeons and dermatologists in private practice are usually better paid.

WHY DO DOCTORS OPPOSE THE PLAN?

The medical community says there are already sufficient doctors, and cites the availability of healthcare to most people as an example of why the number of doctors is not the issue.

They also say that the number the government wants to boost medical admissions by is arbitrary and the authorities have not made public the basis for that figure.

Without addressing the underlying problem of pay and overwork, there is no incentive for the increased number of doctors to practice in essential discipline, they say.

Some analysts say the number of doctors per capita does not reflect the quality of healthcare. Access to medical care in South Korea is some of the best in the world, they say.

WHAT ACTIONS HAVE BOTH SIDES TAKEN SO FAR?

The government has issued a back-to-work order to doctors who have walked off the job and vowed to prosecute those who do not comply.

The government says it is open to dialogue and welcomes suggestions to improve its plan, while instructing military hospitals and police hospitals around the country to accept civilian patients.

The intensity of the standoff suggests disruptions to medical services could last for some time, even up to a year, Jeong, an expert in this area, said.