Kyung Hee University Medical Center (KHUMC) has announced to its members that salary payments may be suspended shortly. I knew this situation would come someday, but I didn't expect it to come like this.

University hospitals, which once seemed never to fail, are collapsing. Everyone knows that the situation at KHUMC is not unique to that hospital but applies to all university hospitals, and sooner or later, there will be a second or third KHUMC.

Should this be a temporary phenomenon caused by the strike of interns and residents and consequent disruption in medical care? Will the university hospitals revive if medical residents return and hospital management is normalized regardless of the government’s reinforcement of an increase in the medical school enrollment quota? No, they will never do so.

These hospitals could be compared to people destined to die of an illness, but suddenly, downfall and trauma occurred. In that case, you just don't know whether they die of the illness or the trauma from the fall.

I was a hospital director during the best university hospital management period in Korea's history. Patients were overflowing, and profits were at an all-time high. However, there was always a nagging feeling of uneasiness because, in a nutshell, I felt that I was enjoying the benefit of an unjustifiable system.

Until now, university hospitals have been at the top of the healthcare system but “ignored the zeitgeist.”

University hospitals were supposed to provide hospitalization-based care for severe illnesses without disrupting the ecosystem of primary and secondary medical institutions. However, they were trying to accommodate all the patients that came in, regardless of their severity, while crippling the healthcare delivery system. There was no consideration for primary and secondary healthcare institutions, no consideration for sustainable health insurance, and no consideration for overtreatment based on non-reimbursed care.

In short, they were the ones who made Korean healthcare an unsustainable system, and I expected that they would get the blow at some point.

When would that be? Around 2028, I thought. By then, policymakers would be scrambling to find a problem, and they would scapegoat university hospitals. That's what I expected. So, were university hospitals evil? No, they were not. In a way, they were complacent, not realizing they would be the final scapegoat for the disastrous consequences of a failed policy.

The government hasn't changed its health insurance policy for decades, which was built on ridiculously low fees. It hasn't tried to fix a structure that was broken from the start and has been allowed to remain so to keep premiums low.

University hospitals have learned to live with the mess. Have universities accumulated wealth by grinding the souls and bodies of specialists, as they say? Honestly, was the general public the group that has benefited the most from the sacrifices of interns and residents, enjoying the best healthcare worldwide and paying low insurance premiums?

Have the people ever wondered how that was possible? I believe that university hospitals will remain in ruins even if the current situation is resolved because of the healthcare reform plan, which is masked by the issue of expanding medical students.

The government says it will reform healthcare with more medical students and boldly implement issues that have been neglected for decades. These policymakers seem to have been enlightened all of a sudden. They've become so brave. They're going to make history that no one else has been able to try. They said they are going to do it once and for all.

Korea needs to reset its healthcare. However, if we do it in one fell swoop like the incumbent administration is doing, the results will be disastrous.

Let's say you have a great drug. If you take it over 10 years, it's a good medicine, but giving the 10-year dose all at once will kill the patient. They would immediately implement the reforms, which should have been done slowly while watching the market change. They are determined to normalize the delivery system and eliminate the mix of uncompensated and compensated care. They’re going to reorganize university hospitals into specialty-centered, critical access hospitals. They may be right, but these reforms can be done incrementally, not revolutionarily.

What will happen if hospitals are run under the banner of reform? Becoming specialist-centered is easier said than done, but where will the workforce come from? Can we afford the labor costs of such hard-earned specialists? Can we replace medical residents' relatively low-cost labor with expensive specialists who cost several times as much? Can we break the custom of examining and treating severe and mild cases as they come and reorganize them justly? If the reform plan is implemented, various tests and treatments will be very limited, and we will not be able to afford them because the amount of money invested will not be recovered. The fixed costs will remain the same.

Right now, the problem is the gap in care due to the absence of interns and residents. Still, because these reforms will be carried out in conjunction with the issue of expanding medical school admissions, the devil is opening his mouth on the other side of the realistic wall caused by the absence of specialists.

In short, the renaissance of university hospitals is over, and the dark ages are just around the corner. Reform takes practicability as security. The cure might have been done, but the patient could be dead. Looking at the current situation, I don't know what the government’s goal is.