The Ministry of Health and Welfare has released the studies it used as the basis for increasing the number of medical school enrollment quotas by 2,000 per year.

These studies include the Korea Development Institute (KDI)’s "Projection of the Spillover Effects of Population Change on Labor, Education, and Healthcare Sectors Reflecting the 2021 Future Population Projections," the Korea Institute for Health and Social Affairs (KIHASA)’s “Comprehensive Plan for Healthcare Manpower and Mid- to Long-term Supply and Demand Estimates," and Professor Hong Yun-chul (Seoul National University College of Medicine’s Department of Preventive Medicine)'s "Study on the Adequacy of Physician Manpower to Prepare for the Future Society.”

The ministry has stated that it used these studies as the basis for the 2,000 additional medical school students. Still, it hasn't revealed exactly which parts of the studies it relied on. The problem is that nowhere in the conclusions of these studies does it say that a “2,000-per-year increase is necessary.”

Instead, the studies commonly included arguments the medical community has made against increasing the number of medical school seats, such as "it is urgent to find ways to attract medical personnel to specialties experiencing difficulties in recruitment" or "it is urgent to improve practices using medical services and healthcare delivery systems instead of limiting the debate to doctors’ demand and supply.”.

KDI study differs sharply from government's plan to increase by 2,000 per year

The KDI study was included in the “Projection of the Impact of Population Change on the Labor, Education, and Healthcare Sectors Reflecting the 2021 Future Population Projections,” published by the Presidential Committee on the Low Birthrate and Aging Society in February last year, in which Dr. Kwon Jung-hyun led the healthcare section.

"This study does not discuss the appropriate size of the healthcare workforce but instead focuses on examining how the workload of physicians changes when the current system and labor supply level are maintained in response to changes in the demand for healthcare services due to demographic change,” Dr. Kwon said in an introduction.

From the start, Kwon said the study did not look at how many doctors would be needed in Korea in the future and how they should be recruited.

On June 27, 2023, Kwon also presented his findings at the “Expert Forum on Estimating the Supply and Demand of Doctors” held by the Ministry of Health and Welfare, noting that about 22,000 to 30,000 more doctors will be needed by 2050.

However, if the demand for medical services in Korea decreases, reflecting the improvement of health with higher education level, the number of additional physicians required decreases to 8,500, Kwon pointed out. He added that the number of doctors needed in the future varies greatly depending on the viewpoint and study design.

Regarding future replenishment of the medical workforce in the future, he said that although it is inevitable to increase medical students for a certain period, "expanding the number of medical school enrollments by 5 percent per year from 2023 to 2030 and maintaining the 2030 level after 2030" is the closest to meeting the required number of doctors by 2050. In this case, the medical school enrollment quota in 2020 is 4,518.

Dr. Kwon suggested that even if medical school enrollment increases yearly from 2023 to 2030, the final enrollment in 2030 should be 4,518 and maintained at that level. However, the government's plan to increase medical school enrollment to 5,058 starting in 2025 significantly differs from Kwon’s proposal.

Besides, Dr. Kwon said that even this should be adjusted according to the projected demand for medical services after 2050 and that it is necessary to regularize the adjustment of medical school students based on medical supply and demand projections.

In particular, Dr. Kwon expected that specialties, such as cardiothoracic surgery and general surgery, which are currently facing difficulties in recruiting new doctors and are expected to see a decrease in the number of doctors, will see a significant increase in the number of additional doctors due to the expected increase in the demand for medical services in these specialties.

"It is urgent to come up with a plan to attract medical personnel to specialties struggling to recruit," Kwon said, agreeing to the medical community's argument against expanding the number of medical students.

KIHASA study points to excess of doctors depending on treatment days and volume

Another study that the health and welfare ministry cited as a basis for increasing the number of medical students is the "Comprehensive Plan for Healthcare Manpower and Mid- to Long-term Supply and Demand Estimation Study" conducted by Professor Shin Young-seok of the Korea University Graduate School of Public Health, while he was working at KIHASA in 2019.

The study used healthcare service data from 2010 to 2018 to estimate the demand for medical care in 2025, 2030, and 2035 and medical supply data from the same period to estimate the supply of medical personnel to examine the future shortage.

It presented estimation results using various models targeting all physicians, such as the average growth rate, logistic, log, and ARIMA models (Section 3, Supply and Demand Estimation Results, pp. 232~242).

Among them, the results of estimating the total supply and demand of doctors using the “Average Growth Rate Model” showed that when the volume of medical treatment is 100 percent, the physician workforce will be short by 1,020 in 2025, 11,128 in 2030, and 33,877 in 2035, assuming 240 days of medical treatment. Based on 255 days of medical treatment, there will be a shortage of 212 physicians in 2025, 8,037 in 2030, and 29,641 in 2035. However, based on the treatment days 265, there will be an excess of 276 physicians in 2025, a shortage of 6,775 in 2030, and a shortage of 27,084 in 2035, according to the study.

On the other hand, assuming 240 and 255 days of practice, an increase in treatment volume of 110 percent and 120 percent was estimated to result in a surplus of physicians.

When the total supply and demand of physicians was estimated using the “Logarithmic Model,” it was found that at 100 percent of the treatment volume, the physician workforce would be short by 446 in 2025, 3,907 physicians short in 2030, and 10,696 short in 2035, assuming there are 240 treatment days. Based on 255 treatment days, the physician excess will be 328 in 2025 before reaching shortages of 2,182 in 2030 and 7,824 in 2035. Based on 265 treatment days, there will be an excess of 796 physicians in 2025 and shortages of 1,140 physicians in 2030 and 6,089 in 2035.

On the other hand, assuming 240 and 255 days of practice, an increase in treatment volume of 110 percent and 120 percent was estimated to result in a surplus of physicians.

The “ARIMA Model” estimated the total supply and demand of physicians and found that when the volume of medical treatment is 100 percent, the shortage of physicians is 2,294 in 2025, 7,168 in 2030, and 14,631 in 2035 if the number of medical treatment days is 240 days; 1,412 in 2025, 5,251 in 2030, and 11,527 in 2035 if the number of medical treatment days is 255 days; and 879 in 2025, 4,094 in 2030, and 9,654 in 2035 if the number of medical treatment days is 265 days.

On the other hand, this model also estimated overstaffing when the number of treatment days was assumed to be 240, 255, and 265, and the treatment volume increased to 110 percent and 120 percent.

The "Logistic Model" differs from the other model estimates, showing an overstaffing in all estimates when practice volume is 100 percent.

Specifically, the physician workforce is overstaffed by 3,696 in 2025, 6,702 in 2030, and 8,966 in 2035 if the number of days is 240; 4,226 in 2025, 7,803 in 2030, and 10,681 in 2035 if the number of days is 255; 4,546 in 2025, 8,468 in 2030, and 11,716 in 2035 if the number of days is 265; and 4,546 in 2025, 8,468 in 2030, and 11,716 in 2035 if the number of days is 265.

However, assuming 240, 255, and 265 treatment days, the shortage was estimated at 80 percent and 90 percent of the treatment volume.

When the government announced the size of the medical school enrollment quota increase on Feb. 6, it said, "The size of the medical school admission quota was determined based on the supply and demand forecast for 2035, which is 10 years away, and about 15,000 more doctors are needed – 5,000 more doctors to secure the current number of doctors working in medically vulnerable areas at the national average level and 10,000 more doctors, considering the growing medical demand due to the rapid aging of the population.

If the government claims there will be a shortage of about 15,000 doctors in 2035 based on Professor Shin's estimates, it needs to be more specific about which parts of these models it relied on and why it did not.

In particular, Professor Shin participated in the Korean Society of Preventive Medicine's “2024 Winter Symposium” on Feb. 15, saying, "The government's announcement to increase the number of medical students by 2,000 every year to 10,000 in five years is concerning."

If it needs to increase by 10,000 students, it can increase to 1,000 students per year for 10 years, but suddenly increasing to 2,000 could make the problem bigger, he said.

He also said that bold reform policies are needed to increase the number of medical school students, expressing doubt about whether the government has thought about it comprehensively.

'Excess of physicians’ predicted after some time of medical student increase

Another study the government relied on was the "Study on the Adequacy of the Physician Workforce to Prepare for the Future Society," published in 2020 by Professor Hong Yun-chul of the Department of Preventive Medicine at Seoul National University College of Medicine.

According to Professor Hong, the study was "an estimate of the future physician workforce based on the assumption that the physician workforce was adequate as of 2018. The study could be the target of criticism that the baseline year is too early to be used to increase medical school seats starting in 2025.

The study found that under both scenarios - assuming that the supply and demand for doctors is properly balanced as of 2018 or assuming a large decline of 75 percent in physician productivity among those over 65 years old - there would be a shortage of doctors starting in 2021, even if the number of medical school and medical school enrollments increased by 1,500.

While the numbers are closer to the government's plan to increase the number of medical school students by 2,000 per year, Professor Hong said, "There may be an excess of doctors after a certain period, so there is a need to adjust the elasticity of the increase and decrease in seats accordingly.”

Hong concluded his study by saying, "Based on OECD data for 2018, Korea has fewer clinical physicians than the OECD average, but the number of outpatient visits per capita is 16.9 per year. This indicates that it is not only a problem with the supply of doctors, but also with healthcare consumers’ behavior and the urgent need to improve the healthcare delivery system.”

That was in line with the medical community's argument against increasing the number of medical schools.