Increasing medical school enrollment quota and establishing new medical schools have become hot issues again. An old and tired topic has resurfaced in the run-up to next year's general election. Politicians and bureaucrats talk about increasing the number of doctors by at least 1,000, citing the OECD average when they discuss this matter.

The U.S., Canada, the U.K., and France have established new medical schools and increased enrollment quotas over the past decade.

In increasing capacity, the U.S. has been free from controversy, as Obamacare has brought 50 million previously uninsured people into the healthcare system. The number of new doctors needed for the 50 million people in the U.S. is about the same as the total number of active doctors in Korea, which is about 100,000, considering the nation’s population is slightly larger than that.

Even with the ongoing increase in U.S. doctors, there is still a month-long waiting period to see a primary care physician in America. As the next best thing, the U.S. has given physician assistants, nurse practitioners, and others prescriptive authority to share the burden of primary care. These steps might be better than nothing but are not a solution. The American Medical Association warns that these physician assistants generate more diagnostic tests than doctors. The public doesn't even know if they're doctors or assistants.

Canada's open-door immigration policy has pushed the country's population to 40 million, and an influx of doctors from foreign medical schools has met the shortfall in new medical schools.

In the U.S. and the U.K., the medical communities and medical school associations are leading the debate on physician supply, and there seems to be no friction with their governments or political circles. There are also no arguments for increasing physician numbers because they are below the OECD average. The OECD average of doctors per 1,000 people is not the answer to the question of the physician workforce. Instead, they offer other grounds, such as the emergence of a large group of people as healthcare targets, population growth, increased waiting times, and the growing number of people who do not have access to a primary care physician.

In the U.K., primary care physicians are the backbone of healthcare; everyone should have their own. The maximum number of people assigned to a primary care physician is 2,000. However, this number is increasing for some physicians who cannot get a primary care physician. This is because primary care physicians are no longer accepting new patients. The U.K. has a clear healthcare system and workforce management system, which makes it easier to forecast the number of doctors and justify the increase.

However, despite the increase, the waiting time to see a primary care physician is still about a week. Unlike in Korea, patients cannot see a specialist at will. The U.K. currently produces 7,500 doctors annually, but there are arguments that the number should be closer to 145,000. The reason for reluctance is that each medical student requires a minimum of 300 million won ($223,880) in public educational expenses. However, even with the increase in the number of doctors, the preference for part-time work, good pension system, migration, and turnover are offsetting the effectiveness of the increase. In the U.K., falling short of the OECD average is not a reason to increase the number of doctors. They have a clear rationale for their healthcare system.

France is also adding doctors because 5 million people in France don't have a primary care physician. This phenomenon is called a “medical desert,” and it's a big problem for French politicians. The increase hasn't helped this in medical school enrollment quotas. Since the Covid-19 pandemic, France has seen a crisis in public hospitals, and doctors’ complaints have risen, leading to chronic strikes. However, strikes are not followed by administrative orders, criminal charges, or threats of imprisonment like in Korea. Even by the OECD’s average standards, no country issues executive orders for commencing business like the emergency measures of the dictatorship era just because doctors are on strike. Korea’s labor rights are among the worst in the world, not just below average, but society is silent. Where is the OECD average for labor rights?

A new argument for more doctors has emerged, citing that Korean doctors have the highest income growth in the OECD. In developed countries that have increased their physician workforce, physicians’ incomes remain high, and they don't have this crazy idea that they should artificially lower physicians’ incomes or increase their physician numbers because their incomes are high. The argument seems that all countries with the highest physician incomes should consider increasing their physicians to lower their incomes. I wonder what the situation is for other professions and the self-employed. Maybe we should adjust national income growth and other economic indicators to the OECD average. Even the world's highest diagnosis rate in Korea must be brought down to the OECD average.

The government should be able to show how many areas have no doctors and what kind of doctor shortage there is, along with the true demand for more doctors and our healthcare system. It should investigate why we have 14 pediatricians for every 100,000 people, but our children cannot be hospitalized and wait long for pediatric care. Fourteen pediatricians per 100,000 people is a world-class level well above the OECD average, but it is like having no water at the end of a flood. By this logic, it seems that even if we produce a workforce with many doctors far above the OECD average, we will still be unable to solve anything in essential healthcare and watch it collapse into an unsustainable state or solve it fundamentally except for band-aid policies. The national economy is headed for a low-growth era, and it is doubtful that increasing the number of doctors is the right policy.

Before arguing that there is a shortage of doctors, the most important issue is to discuss and agree on a large-scale discourse about what the government, society, and the profession think good healthcare should look like. The government needs to identify the form of healthcare well suited to Korea, agreed upon by society and the medical community. It then should make a long-term action plan, calculate the true medical needs and required manpower accordingly, and develop a feasible plan to increase the number of doctors in the long run.

However, the government has failed to make a five-year plan under the Basic Health Care Act. More than 20 years after the law was enacted, the government has yet to submit a basic healthcare plan. This is due to the government's structural incompetence. Still, it is also because it is trying to solve various malformed systems that arise from the contradictory medical system of cheap and fast specialist-oriented treatment in an ad hoc manner. So, finding where and how to solve them isn't easy.

Indeed, the shortage of doctors due to the medical concentration of large hospitals makes it difficult to determine the true supply and demand of medical care. There is also no convincing solution to controlling people flocking to large hospitals in Seoul based on value-based choices.

The problem is even more complicated if we want to solve this problem by increasing the workforce. We need local doctors, but we also need local patients. Patients' free choice of healthcare providers and curbing and controlling healthcare consumption are necessary to establish a healthcare delivery system before increasing the number of doctors. However, these politically unpalatable issues are buried in the rhetoric of increasing the number of doctors. If the OECD average is the ideology of Korean healthcare, why is it rarely heard that healthcare consumption should be reduced to the OECD average?

Countries that have expanded their physician workforce and built new medical schools, or even countries like Greece, where the physician workforce is 6.7 per 1,000 people, well above the OECD average, still fail to address the large number of healthcare gaps, the concentration of physicians in metropolitan areas, and the unreliability of public healthcare. In the absence of measures to address the current collapse of essential healthcare, initiatives driven by the OECD ideology to increase the number of doctors or build new medical schools are likely to exacerbate the situation, as are empty airport facilities created by campaign promises by politicians.

Using and interpreting quantitative data based on various statistics in shaping medical workforce policies requires more care and caution. It requires scientific interpretation based on critical thinking about the authenticity of the data. Biased interpretation and social disruption due to political ideology rather than scientific interpretation are pitfalls that scholars must guard against.