University hospitals are grappling with their worst management crisis since junior doctors began striking to protest the government’s expansion of medical school seats. The absence of these trainee doctors has severely disrupted hospital operations, leaving many institutions struggling to navigate an unprecedented situation. As the crisis stretches beyond 10 months, concerns are mounting over the possibility of a wave of bankruptcies.

University hospitals, operating under an emergency management system for over 10 months following the resignation of a significant portion of staff, have resorted to extending unpaid leave for employees, including nurses. Despite measures such as consolidating and closing wards to downsize operations, these efforts have failed to stem the decline in revenue.

The nation’s four largest hospitals are no exception. Seoul’s major tertiary hospitals—Seoul National University Hospital, Asan Medical Center, Seoul St. Mary’s Hospital, and Severance Hospital—are also grappling with management challenges following the resignation of trainee physicians. Combined, these "Big Four" hospitals recorded a deficit of 213.5 billion won in the first half of this year alone.

According to data from the Ministry of Health and Welfare obtained by Rep. Han Ji-ah of the People Power Party, Seoul’s four major tertiary hospitals reported a combined net loss of 213.5 billion won from January to June this year.

Seoul National University Hospital recorded the largest net loss among the four major hospitals in the first half of this year, amounting to 162.7 billion won. This marks an increase of 51.63 billion won compared to its net loss of 111.16 billion won during the same period last year. Similarly, Asan Medical Center posted a net loss of 21.6 billion won in the first half of this year, pushing its year-on-year cumulative net loss to 96.5 billion won.

Severance Hospital faced a similar situation, transitioning from a profit of 73.71 billion won in the first half of last year to a loss of 16.03 billion won this year, resulting in a year-on-year net loss of 89.74 billion won. Likewise, Seoul St. Mary’s Hospital reported a loss of 13.09 billion won in the first half of this year, further widening its net loss by 30.68 billion won compared to the same period last year.

The primary cause of the financial difficulties faced by university hospitals is the exodus of junior doctors. This migration of physicians from university hospitals to small- and medium-sized general hospitals has created a vicious cycle of declining revenue. Notably, the departure of anesthesiology and pain medicine professors has further exacerbated the situation, as their absence has made it challenging to maintain surgery schedules.

A director of a university hospital in Seoul remarked, “The government is providing significant support to second-tier hospitals, prompting clinical professors specializing in anesthesiology and emergency medicine to move to those facilities. Most university hospitals are struggling because they cannot secure enough anesthesiologists to perform surgeries. This creates a vicious cycle that inevitably leads to financial difficulties.”

The brain drain at university hospitals has significantly impacted medical research, as the remaining professors face increased workloads, leaving them with little time for research and academic writing. This has raised concerns that the decline in research output could result in “zero papers” being published next year.

In an editorial in JKMS Volume 40, Issue 1, scheduled for publication in January 2025, Editor-in-Chief Yoo Jin-hong (Department of Infectious Diseases, Bucheon St. Mary's Hospital) stated, “The aftermath of the decline in medical research activities due to the 2024 doctor-government conflict is spreading faster than expected.” He also noted that the number of submissions to JKMS has “begun to decrease noticeably.”

According to Yoo, in 2023, before the announcement of the medical school expansion policy, JKMS published an average of five to six articles per week. However, the journal is now struggling to publish even three articles per week. Since August, the number of submissions has sharply declined, and the final number of articles published this year is expected to be about 20 percent lower than last year.

Yoo predicted that the situation will worsen next year. He explained that this year's submissions were written before the parliamentary conflict, and he fears there will be no new submissions next year. Since it typically takes at least a year to write a paper, Yoo noted that no new research or thesis writing has begun in medical schools nationwide, and the impact will likely be felt in the publication numbers starting in mid-2025.

At this rate, Yoo warned, Korean medical research could lose its competitive edge on the international stage. "The academic foundation of Korean medicine is weakening and showing signs of decline," he said. "The medical ecosystem is collapsing due to reckless policies promoted by the government. In the end, not only the medical community but the entire Korean scientific community will suffer."