“Cardiothoracic surgery is 19.57 to 1, and general surgery is 3.4 to 1.”

Of course, this is not the case in Korea. These were the competition rates for medical specialties in the U.K. in 2022. Unlike Korea, “vital departments” like cardiothoracic surgery and general surgery are popular among doctors in the U.K. Where does the difference come from?

Dr. Paul S.C. Kim, president of the Korean UK Medical Association (KUMA), cites "judicial risk" as the biggest difference. In the U.K., doctors are rarely criminally prosecuted for malpractice. Even if a civil suit is filed, the individual is not liable for damages. Dr. Kim is a specialist in anesthesiology and pain medicine who graduated from the University of Glasgow Medical School and is a fellow at University College London Hospital (UCLH).

Kim said that surgical specialties in the U.K., such as cardiothoracic and general surgery, are "hot" and highly competitive. People are willing to take second and third chances to specialize in surgery. The training period is also not short. In the U.K., doctors are licensed to practice medicine after graduating from medical school, but they have to undergo a two-year foundation program before they can treat patients independently. After this, they can become a general practitioner (GP) or a primary care doctor. Specialist qualifications require another seven to eight years of training. After medical school, qualifying as a specialist usually takes 10 years.

Nevertheless, millennials and Gen Z doctors in the U.K. want to become “surgeons” because they have less watch-keeping, which allows for a better work-life balance, Kim explained. Judicial risk is not a consideration for British doctors when choosing a specialty. They don't have to worry about criminal punishment or fines amounting to hundreds of millions of dollars in damages, as do Korean doctors.

Kim emphasized that the country must create an environment that encourages doctors to apply to these departments to prevent the controversial collapse of essential medicine in Korea. Otherwise, he said, no amount of medical school enrollment quota increase will help.

Korea Biomedical Review met Kim during his recent visit to Korea. As a former Seoul National University Hospital trainee, Kim was familiar with the Korean healthcare system and medical issues.

Question: Judicial risk is often cited as a factor that has made cardiology, surgery, obstetrics, and gynecology "shunned specialties" in Korea.

Answer: British doctors also face legal issues. However, it is extremely rare for doctors to be criminally prosecuted unless they are violent criminals or sex offenders. I've never heard of a doctor being criminally prosecuted for an unintentional medical error. The doctor is not personally liable if a civil lawsuit is brought and damages are awarded. The hospital, part of the National Health Service (NHS), pays. Most doctors also belong to the Medical Defense Union (MDU), so they have access to legal counsel and other support.

Everyone makes mistakes. Doctors are no different. Korean doctors, in particular, work long hours and see many patients daily. The risk of making a mistake is higher, and if a medical error occurs and I have to pay for it, I think I would avoid it, of course.

Q: What happens if a doctor misdiagnoses?

A: There is always a risk of misdiagnosis. If it happens, the hospital would look at the facts. But if the guidelines were followed, it's not a big deal. Misdiagnoses are rarely the cause of medical lawsuits by patients or their guardians. People trust the NHS and know how hard doctors work to save their lives. There is a lot of criticism of the NHS in the U.K., but it's a criticism that calls for a better NHS based on trust.

Kim cited self-policing within the medical profession as one of the reasons for the trust between doctors and patients. Rather than covering up for "problem doctors," the medical board draws the line to the point of being a little too strict and “weeds them out.” That's why there are no calls for CCTV in operating rooms.

Why are so many U.K. doctors leaving their country?

Kim also viewed the policy of expanding the number of medical school students differently from Korea. That’s because the medical environment is different. The U.K. has a nationalized healthcare system, and the NHS employs most doctors. The average workweek is 40 hours, shorter than that of Korean doctors. British doctors are not opposed to increasing the number of medical school students because they “realize a shortage of doctors in medical fields." However, they also agreed that "it's not a fundamental solution." According to the Organization for Economic Cooperation and Development's Health Statistics 2023, the U.K. has 3.0 clinicians per 1,000 people, more than Korea’s 2.6.

The U.K. is experiencing a severe outflow of doctors. "There are surveys that show that about 80 percent of British doctors have thought about leaving the country," Kim said. "It's easy to find doctors around you working abroad." The biggest reason for leaving the U.K. is wages. Junior doctors in the U.K. have staged nine strikes since last year to demand higher wages. A tenth strike is scheduled for Feb. 24 to 28.

According to the NHS, the average salary for hospital doctors in 2022 is £86,698 (142 million won), with junior doctors in their first year earning £37,000 and those in their second year earning £45,100. Salaries rise further as you move on to specialty training, with junior doctors in their eighth to tenth year earning an average of £77,100.

Q: Why isn't the number of doctors leaving for other countries declining?

A: The biggest problem is wages, frozen for almost 20 years. A first-year junior doctor is paid the same now as 20 years ago. Especially in London, the cost of living is so high that many doctors have to work part-time in private practice after their NHS career ends. Otherwise, it's hard to afford the cost of living.

The environment in which doctors are deprived of decision-making power also has an impact. It is constantly pointed out that expert opinions are not reflected in medical policies. Many complain about poor working conditions, such as watch-keeping rooms.

Q: Which countries do they go to?

A: They go to the United States, Canada, and Australia. They especially go to Australia, which recognizes U.K. medical licenses without separate examination. In the U.S. and Canada, they don't have to return to medical school but should take a separate licensing exam. In Australia, medical residents are paid more than consultants in the U.K. As a specialist, you can expect to be paid twice as much in Australia as you would in the U.K. (consultants are doctors who work in hospitals after qualifying as specialists).

Q: The junior doctors' strike is prolonged. What is public opinion in the UK?

A: Public opinion is supportive. Many people say they didn't realize doctors’ pay was so low. Patients are aware of the conditions and how doctors work.

Q: Is there a public opinion that doctors should work longer hours to address the long waiting times that plague the NHS?

A: No. I've never heard of it. The environment is different. Korea has become a medical leader by maximizing efficiency. Safety is the priority in the U.K., so it's a lot less efficient. There are a lot of checklists. It's all about finding a balance.

Q: Korea is trying to solve the problem of doctors avoiding essential care by increasing the number of medical school students. Do you think it can be a solution?

A: I don't think that increasing the number of medical students will solve the problem. If you don't fill the holes, the increased doctors will just fall through the cracks. Ultimately, I think giving doctors in essential fields some breathing room is important by easing the legal burden. That way, more people will apply, and more doctors will stay.