As Korea grapples with an ongoing medical crisis, the public's perception of the healthcare system grows increasingly critical.

Reports of overcrowded emergency rooms, insufficient medical staff, and deteriorating patient care dominate headlines.

The government has responded by increasing the medical school admission quota, aiming to address the shortage of medical professionals, particularly in underserved regions.

However, amidst the clamor for reform, the voices of those on the front lines—the physicians—are often overlooked or misrepresented, while many media outlets have portrayed the occupation as those who only care about making money.

In this critical juncture, Korea Biomedical Review sat down with Professor Chung Hyun-jung of the Department of Pediatrics at Konkuk University Medical Center.

As a physician working on the frontlines in the hospital's pediatric emergency center, Chung provides unique insights into a profession facing unprecedented challenges and why physicians are opposing the government's decision to increase the medical school admission quota.

The exodus of pediatric emergency physicians

Chung started off by painting a stark picture of a specialty on the brink of collapse.

"To use an analogy, it's as if water that was barely kept from boiling at 99 degrees Celcius has now been forced to boil over," Chung said. "Pediatric emergency medicine was never a popular field, but now we've reached a point where we're certain no new doctors will enter the field, making me one of the last doctors to work in the field."

The exodus of experienced physicians from pediatric emergency medicine is particularly concerning.

"Even senior doctors with three to eight years of experience in pediatric emergency medicine have all left now," Chung notes. "There were never many pediatric emergency physicians to begin with, but now they're all escaping one by one."

At 38 years old, Chung finds herself among the youngest in her field.

"I'm part of the youngest cohort in pediatric emergency medicine," she said. "In my current workplace, we haven't had any first-year residents join for a while, and in pediatrics, after this year's fourth-year residents graduate, there will be no one left."

Chung points to several factors contributing to this crisis.

Notably, among them is the immense legal risk faced by physicians. She cites the infamous Ewha Womans University Mokdong Hospital case from 2017, where several doctors and nurses were indicted following newborn deaths despite eventually being acquitted.

"When you set up police lines and say someone must be held responsible for events that weren't the fault of medical staff, even when there's evidence of providing the best possible care, who would want to do this job?" Chung asks rhetorically.

The case, Chung contends, have created an environment of fear and hesitation among doctors, particularly those in high-risk specialties like pediatric emergency medicine.

"The impact of these rulings goes far beyond the individuals involved," she says. "It makes every doctor wonder if they could be next, even when they're providing the best care possible under challenging circumstances."

Undervaluation of pediatric care

The professor also highlights the low reimbursement system that goes along with severe undervaluation of pediatric care in Korea's medical system.

"At my previous hospital, despite seeing the same or slightly more patients than the adult emergency room, the pediatric ER earns less than half the revenue," she said.

Chung stressed that this financial disincentive makes hospitals reluctant to invest in pediatric emergency services.

Chung explains the structural issues behind this disparity.

"The fees for pediatric care are inherently lower, and we don't typically perform many of the so-called 'money-making' procedures or tests that are common in adult care," she said. "As a result, it's structurally impossible to generate significant revenue, which makes hospitals very hesitant to increase staffing or resources for pediatric emergency care."

Chung stressed that the government's proposals to increase initial consultation fees for young children starting next year are seen as insufficient, given the broader financial constraints.

Caring for pediatric patients requires far more effort than adult patients.

"The effort required to care for one baby is far greater than that for seeing five adult patients," she says, citing challenges such as communication barriers, uncooperative children, and the need for sedation during imaging tests.

Notably, Chung emphasizes the lack of proper compensation for the additional manpower required in pediatric care.

"It takes more than two assistants just to perform a single intravenous injection, but we are not properly valued for this work," she laments, questioning whether this issue will be adequately addressed given current public sentiment.

Absence of specialized support

The crisis in pediatric emergency medicine is worsened by the declining number of pediatric subspecialists, according to Professor Chung. This lack of specialized support severely limits the capabilities of emergency departments.

"The government seems to think that just boosting emergency departments is enough, but emergency medicine alone has its limits," Chung said. "We need strong backup departments to truly shine."

Chung's hospital, which is considered fortunate, has only one pediatric surgeon and one pediatric radiologist supporting a team of 10 pediatric emergency medicine doctors. Many hospitals don't even have a pediatric critical care specialist.

This shortage of specialized support creates significant challenges in providing comprehensive care. Chung recounts a case of a child with febrile seizures who went into cardiac arrest, and no hospital in the Seoul and Gyeonggi region was willing to accept the transfer. The child was intubated and treated in the hospital's emergency room intensive care unit.

"If the child had another cardiac arrest, we would have been solely responsible," Chung said. "If major problems arose, we'd face criticism for not transferring the patient, even though we had no options."

The absence of specialized support also affects relatively simple procedures like treating intussusception, a condition where part of the intestine slides into an adjacent part. Due to the small risk of intestinal perforation and potential legal issues, many hospitals now refuse to perform the procedure, despite it being relatively simple and safe.

'Government's proposals are insulting to vital care physicians'

Chung expresses frustration that the government's proposed solutions, such as increasing medical school admissions and offering higher salaries for doctors in underserved areas, fail to address the root of the problem.

"The government talks about a 'trickle-down effect,' saying that if we increase the number of medical students, some will eventually go into vital fields, such as pediatrics," she said. "However, it's an incredibly irresponsible statement."

Chung stressed that those in the field have always known that vital specialties involve difficult work for less pay.

She criticized the government's approach of simply increasing medical school admissions without addressing the fundamental issues driving doctors away from critical specialties.

Chung also highlighted the lack of proper education protocols in place to accommodate the proposed increase in admissions.

"If the government can provide evidence supporting the need for 2,000 additional medical students, we will accept it," she said. "However, they have not presented any concrete plans on how these students will be trained and who will be responsible for their education."

Medical education requires specialized faculty for each discipline, and it takes significant time to train these educators, she added.

The government's attempt to attract doctors to underserved areas by offering higher salaries also falls short.

"The government and some parts of the public seem to believe that doctors not accepting high paying salaries of sometime over 400 million won ($292,226) at underserved areas is about the money," she said. "However, it's not about the money as doctors are unwilling to take on these roles because they would be solely responsible for an entire region, with no support system behind them."

System reform needed to resolve overburdened emergency room issue

Chung also didn't shy away from controversial topics, addressing the issue of emergency room overuse by non-critical cases.

"The threshold for visiting university hospital emergency rooms is extremely low," she explains. "For minor emergencies, patients should be willing to pay higher fees, and access to tertiary hospitals or specialized centers for non-critical cases should be restricted."

This would allow truly severe cases to receive appropriate treatment, she said.

To illustrate this point, Chung shared a personal experience from her time at Seoul National University Hospital.

She illustrates this with her experience while working at Seoul National University Hospital in the past, where a parent brought a child with a mild fever directly to the ER. When asked why, the parent replied, "This is the closest place, and for me, this is my local pediatrician."

Chung argues for removing "fever above 38 degrees Celcius in children under eight years old" from the national list of emergency symptoms.

"Most of these are viral infections," she explains. "Widespread misconceptions, like 'fever of 40 degrees Celcius will melt the brain,' have led to a' fever phobia' in our country."

These misunderstandings strain emergency resources. "We end up arguing with parents about treating such cases, exhausting staff and diverting resources from truly critical cases," Chung says.

Chung also opened up her thoughts on the government stance on the "open run" in pediatrics and the "go-around" in emergency rooms as justifications for increasing the number of medical students.

However, Professor Chung argues that these issues are more complex than they appear.

"The term' open run' is used to describe the long lines of children waiting to see a pediatrician during specific times, usually before school or work," she said. "However, outside of these peak hours, the department is often quiet."

Similarly, the "go-around" in emergency rooms is not simply a matter of doctors refusing to accept patients.

"It's not about refusal; it's about the inability to accept patients due to a lack of resources and support from other departments," Chung clarifies. "Emergency medicine specialists can provide initial treatment, but we rely on other departments to take over the patient's care."

When those departments are understaffed or overwhelmed, and the emergency department has to bear sole responsibility, emergency physicians have no choice but to limit the number of patients we can accept, she added.

The solution?

To address these issues, Chung advocates for several urgent policy changes. "We need to reduce legal risks, adjust medical fees, and ensure that frontline practitioners are involved in policymaking," she asserts. "In creating policies, frontline practitioners are completely excluded."

Recently, the government formed a Special Committee for Medical Reform in April, but the medical community was left out, she added.

Chung stressed that people who have no idea about the actual situation are putting their heads together, saying things like, 'If we increase admissions by 2,000, they'll naturally go into necessary fields.

"When the medical community asked what the government's plan was to address the shortage of professors to teach the increased number of students, they suggested hiring 1,000 more," she said. "But when there were no candidates, they proposed that doctors from private clinics should come and teach."

It seems that the government is making these statements without truly understanding the situation on the ground, she added.

Professor Chung warns, "Policies created in this manner are poison to the health of the nation and a waste of taxpayer money."