Fewer doctors are choosing to stay in the operating room. Junior doctors increasingly opt to open their clinics instead of remaining in university hospitals even after they win licenses as specialists after five years of additional training, including internships. Such a phenomenon is not limited to unpopular medical departments. It happens even in the orthopedic department, which boasts an application rate of over 180 percent yearly.

Dr. Jeong Hong-geun, chairperson of the Korean Orthopaedic Association (KOA) and a professor at Konkuk University Hospital, said that the current medical system is pushing orthopedic surgeons out of the operating room.

He cited the money-losing structure as the biggest reason. In university hospitals, orthopedics is a “deficit department.” KOA surveyed 10 university hospitals and found that the profit rate of orthopedic surgery was minus 53 percent. Some hospitals are downsizing wards and reducing operating room allocations. In other words, they are restricting orthopedic surgeries.

The reason orthopedics is losing money is its low medical fee. According to KOA, an artificial knee replacement costs about 700,000 won ($534) in Korea. In Canada and France, the comparable cost is about 13 million to 16 million won. Even the expense in China amounts to 923 million won, more than 12 times higher than here. The top 10 most common surgeries in orthopedics have an average deficit rate of 40 percent.

Young doctors open clinics after just winning license

Nor is there a sense of mission. Another reason young doctors are reluctant to remain in university hospitals is the risk of medical accidents while treating high-risk patients. The medical school professorship, which must treat patients and produce revenue while showing research performance, is no longer attractive to young doctors who value work-life balance.

It is also reflected in the results of a recent survey of medical residents conducted by KOA. While 58.8 percent of orthopedic surgeons plan to pursue a full-time orthopedic, only 21.6 percent said they would become a “surgical orthopedic specialist.”

Over the past five years, the share of orthopedic surgeons working in tertiary and general hospitals has declined, while that of clinics has increased.

According to data from the Health Insurance Review and Assessment Service (HIRA), of the 1,460 orthopedic surgeons in 2018, 251, or 17.2 percent, worked in tertiary general hospitals, and 255, or 17.5 percent, worked in general hospitals. In contrast, the number of orthopedic surgeons in private practice stood at 585, or 40.1 percent.

In 2022, however, the number of orthopedic clinics increased by 165 to 750, while that of orthopedic surgeons working in tertiary and general hospitals decreased. In 2022, 45.3 percent of the total 1,654 orthopedic surgeons were in private practice, up 5.2 percentage points from five years earlier. On the other hand, 251 orthopedic surgeons worked at tertiary care hospitals and 249 at general hospitals, a decrease of about 2 percentage points.

In the 'deficit department' of orthopedics, no young doctors will operate

In an interview with Korea Biomedical Review, Jeong criticized the medical system for pushing doctors to enter the non-reimbursable market. The health insurance payment structure, which does not reward doctors for difficult, high-risk surgeries, is causing more doctors to leave the operating room, he said.

“In the Korean healthcare system, doctors who work hard to operate and treat patients within the health insurance system are saddled with lawsuits and deficits and can only make by resorting to irregularities," Jeong said, calling it a “nonsensical system.” Noting that he stayed in the operating over the past three decades, Jeong said he felt skeptical when he saw junior doctors unwilling to perform surgery. Since taking office as the chair of KOA, he has held two public forums in the first half of this year to raise awareness of the reality of orthopedics in the shadow of “popular departments.” However, the government has remained silent, he lamented.

"Korean healthcare is in decline," Jeong said, pointing out that the country is doing better in orthopedics than any other country in the world, but that won't be the case in the future. "Fewer orthopedic surgeons are willing to perform surgery. You do a fellowship for a year or two after finishing residency and winning a license to learn the techniques. However, fewer young doctors are willing to do fellowships. It takes a long time and investment to be good at surgery, but junior doctors find little meaning in it.”

He said there will be fewer specialists in university hospitals in the future. In the past, doctors competed to become professors, but now fewer doctors are staying at universities to teach. It means that Korean medicine is declining, he added. Jeong emphasized that in this reality, an increase in the number of doctors will not result in more “orthopedic surgeons staying in the operating room.”

‘A medical paradise built on low price is bound to collapse’

“The general public must realize the seriousness of the situation. People think the remaining doctors do it because, but that is not the case. They stayed because they could not abandon patients,” Jeong said. “If doctors in other countries, like the U.S. or Japan, were in this situation, they would have stopped practicing far earlier.”

He also pointed out that patients are spending a lot of money on medical expenses, but it's not going where it needs to go.

“Patients pay millions of won for treatments with doubtful effectiveness, but the medical fee set by health insurance for surgery is only a few hundred thousand won. Patients spend money, but it’s not going where it should be,” he said. “We must set appropriate prices for proven medical practices by, for instance, charging far more than costs for difficult, high-risk surgeries. As they cannot produce revenue with reimbursed treatment, hospitals cannot help but resort to non-reimbursable services. If you practice under the government's health insurance system, you are in the red."

He said that under the Relative Value Scoring system, which divides a set amount of money among medical departments, nothing can change. Moreover, unlike pediatrics and obstetrics, orthopedics has a large patient population, so it is not easy to increase the fee-for-service rate because insurance operators think orthopedics get a larger share of the overall pie.

“We must raise prices to a normal level while controlling overtreatment,” Jung said/ “A medical paradise built on low prices is bound to collapse.”