In the past month, it felt like I was subjecting my body to accelerated aging experiments. For starters, sleep remained elusive. As I've emphasized before, sufficient sleep is crucial for maintaining healthy eating habits and maximizing the benefits of physical activity. Continuous sleep deprivation disrupts the natural release pattern of cortisol, the stress hormone. Consequently, the energy derived from food tends to be stored as abdominal fat, while muscle mass diminishes. Elevated cortisol levels negatively impact judgment, memory, and self-control, leading to a greater likelihood of indulging in "accelerated aging" foods. The repercussions of consuming such foods while simultaneously gaining weight and losing muscle are readily apparent, perpetuating a harmful cycle. Moreover, heightened cortisol levels stimulate the brain, making it difficult to both initiate and maintain sleep. Ideally, in cases of sleep deprivation, one should engage in exercise and activities to alleviate stress and enhance sleep quality. However, I found myself unable to do so.

Since the government underscored the necessity of expanding medical school enrollment to improve the healthcare system, the government and the medical community have failed to reach a consensus. Over the past month and a half, trainee doctors and fellows have walked off their jobs, and I am back to working 100 hours a week for the first time in 13 years. This trend extends to specialists at teaching hospitals nationwide. The Medical Professors Association of Korea (MPAK), has consented to cap workweeks at 52 hours weekly and limit routine responsibilities, such as outpatient care and surgeries, on days following on-call shifts. However, it is difficult to suspend outpatient clinics already inundated with thousands of patients awaiting hospitalization and surgery. Concerns mount regarding the well-being of sleep-deprived senior doctors and patient safety simultaneously.

As the government urges a unified stance from physician groups, the medical community staunchly maintains that meaningful dialogue hinges on a comprehensive overhaul of the entire healthcare reform plan. Public sentiment further exacerbates the division, with skepticism surrounding the authority of different factions of doctors who appear unwilling to negotiate, seemingly holding patients’ lives at ransom. In this frustrating deadlock, I can't help but reflect on the root cause: the government's decision to increase medical school enrollment quotas.

According to the government's argument, there will be a shortage of 10,000 doctors by 2035, and since it takes six years to produce a new doctor, it is necessary to increase the number of doctors by 2,000 per year. Of the three studies that the government relies on -- the Korea Institute for Health and Social Affairs report, the Korea Development Institute (KDI) report, and a report by Professor Hong Yun-chul of Seoul National University School of Medicine --, Professor Hong’s report is the only one that shows a shortage of 10,000 doctors by 2035. Alongside expanding the medical workforce, the government's four major healthcare reform tasks include strengthening local medical care, establishing a safety net for medical accidents, and improving the fairness of the compensation system. Additionally, the second National Health Insurance Comprehensive Plan, announced by the Ministry of Health and Welfare in February, offers insight into the problems the government recognizes in the current healthcare system and how it plans to address them.

If I had to summarize the future of healthcare requested by the Korean people in one sentence, it would be a system where patients have access to the highest quality care, when they need it, wherever they are in the country, at the lowest possible cost. The lack of access outside of the Seoul metropolitan areas, especially for life-threatening conditions, can be largely eliminated by the other three of the four healthcare reforms, with the exclusion of expanding the medical workforce. The overconsumption and oversupply of healthcare services in Korea is nothing new. Due to a fragmented care system, the number of outpatient visits per year is more than double the OECD average, and the proportion of people taking dangerously high amounts of medication is among the highest in the world. The second National Health Insurance Comprehensive Plan emphasizes patient-centered, value-based healthcare and the need to burst the bubble in Korean healthcare.

How many more doctors will Korea need in the future if the healthcare system is restructured to improve healthcare equity and eliminate bubbles? The answer lies in a 2020 report by Professor Hong Yun-chul which the Ministry of Health and Welfare used as the scientific basis for the 2,000 increase plan. According to the report, if by 2040, 30 percent of Korean doctors transition to primary care roles due to healthcare supply system modifications, the projected doctor shortage in 2040 would be a mere 2,600, even without augmenting medical student enrollment. This figure is notably small considering Korea's active physician count exceeds 110,000. However, by 2055, an oversupply of doctors is anticipated due to Korea's declining population. The report further suggests that maintaining an annual increase of 250 medical students would result in a doctor oversupply starting in 2050 while maintaining 500 annually would lead to an oversupply beginning in 2045. This analysis underscores the potential to significantly mitigate physician shortages through supply streamlining and adjustments for unnecessary demand.

A significant aspect we've overlooked is the improving health of Korean older adults, as highlighted in my previous columns. With the emergence of new medicines and medical technologies, there's potential for a substantial enhancement in the prognosis of chronic diseases. Advancements in treating conditions like dementia, diabetes, and heart failure are ushering in an era of longevity where individuals can sustain their quality of life despite illness. Professor Hong's calculations, however, did not account for these transformative developments; instead, they assumed a mere 0.5 percent annual improvement in physician productivity. This approach may have overstated the rise in healthcare demand stemming from the growing older adult population.

Considering all of these factors, it is difficult to argue that adding 2,000 more doctors is imperative for healthcare reform. Policy decisions necessitate evidence, and the assumptions employed for future projections hold significant weight. These assumptions are themselves liable to evolve as healthcare reform endeavors progress. To address the ongoing healthcare crisis, there appears to be an urgent need for dialogue and consensus-building processes aimed at shaping a better future for Korean healthcare, ultimately benefiting the people. Such efforts should aim to derive a rational assessment of doctor demand based on comprehensive considerations.

Jung Hee-won, a geriatric physician at Asan Medical Center, graduated from Seoul National University College of Medicine and trained at Seoul National University Hospital. During his med-school days, while practicing the horn, he realized the importance of muscle maintenance and became interested in sarcopenia. His main research interests include frailty, sarcopenia and establishing age-friendly health systems for acute hospitals. This column was originally published in Chosun Ilbo in Korean on April 10, 2024. -- Ed.