The Korean Surgical Society emphasized that the field of surgery is at a critical juncture, where its very existence is at risk. It argued that urgent, extraordinary measures are now required to support and sustain the surgical profession in Korea.

Internally, the society said it is considering reforms, such as restructuring the three-year residency program and coexisting with physician assistants (PAs).

The Korean Surgical Society made these and other points during a news conference held on Thursday as part of the “2025 Korean Surgical Society Fall Academic Conference.”

The society said the surgery crisis deepened after the government-doctor conflict: Out of 472 surgical residents in 2024, only 229 returned. Most of the 172 first-year residents left the field.

The society emphasized that the significant reduction in resident positions by 2026 will worsen the shortage of new surgeons, bringing surgery not just into crisis but to a moment of existential decision. The central argument is that the surgical field faces a turning point that could determine its survival.

The society pointed out the severe aging of surgical specialists. The average age is 53.1 years, up 3.6 years from 10 years ago. This is the highest among all specialties. Also, the number of specialists aged 40 or younger has dropped by 6.2 percent since 2014.

The society expects the 2019 move to a three-year residency, with a focus on capability-oriented training, to balance the types of surgeons. These include: surgical specialists performing high-complexity surgeries at major hospitals; general surgeons handling routine surgeries at hospitals and clinics; and surgical hospitalists specializing in surgical patient management.

However, since moving to the three-year system, the distribution of surgeons has barely changed. Sixty-seven percent are in tertiary hospitals, and 29 percent are in hospitals and clinics. There are only about 60 hospitalist surgeons nationwide. The society noted that it's difficult for them to meet the diverse societal demands that were the goal.

Therefore, the society argued it is essential to re-examine the current three-year training system to ensure it produces competent surgeons, a key aspect of their main argument. They announced a commissioned study on the outcomes of competency-based training.

Launching a review of the three-year training system, which requires debate from the public’s perspective

During the media event, Korean Surgical Society Chairman Lee Kang-young (Yonsei University College of Medicine) and President Lee Woo-yong (Sungkyunkwan University School of Medicine) emphasized that diverse discussions and improvements are necessary to resolve these issues.

Regarding the three-year training reform, Chairman Lee stated, “The surgical residency program is not primarily about the length of training; it is a process that defines what kind of person a Korean surgical specialist should be.”

He added that while protecting residents through legislation is important, ensuring the quality of training is equally crucial.

"Alongside the three-year evaluation, we must propose methods to ensure training quality while developing necessary competencies for surgical specialists. Recent environmental changes affect resident training. We must also explore ways to achieve intensive training," he said. "This issue is too big for our society to address alone, but someone must start the discussion. The research commissioned by the Korea Institute for Health and Social Affairs is being prepared for presentation at next spring's meeting."

When the three-year program was introduced, residents worked 80 hours a week, he noted. Now it's 60 hours. If hours decrease further, the problem is not the three- or four-year period, but whether proper education can be provided, Chairman Lee noted.

Chairman Lee stressed, “Our society's mission is to cultivate excellent specialists and provide quality healthcare to the public. Currently, the voices of the public are missing, even though the main argument is about securing the future of surgery for society's benefit.”

To introduce the ‘exam first, training later’ system, training quality is key

Chairman Lee also clarified his position on the recently controversial proposal to introduce “exam first, training later” for specialist certification.

He said, "There is a strong divide on the ‘examination first, training later’ approach. The society has stated that holding the specialist exam twice a year is impossible, so we agreed to hold one exam in February. However, it is crucial to verify that training quality is maintained."

The Evaluation Committee noted that it is not a structure in which the opinion of a single society alone determines the outcome. The biggest issue is guaranteeing that post-training is completed properly; beyond that, there are too many variables to discuss.”

Compensation for surgeons' ‘on-call time’ is essential

He stated that ultimately, fair compensation for surgeons is necessary to resolve these various issues. He particularly stressed that compensation for “on-call time” is crucial given the nature of surgery.

"There are several policy tools the government can use to support surgery. Fundamentally, surgeons must get the benefits they deserve. It's disheartening to discuss fee schedules, but considering the amount of standby time surgeons face, it's vital that this time is recognized," Chairman Lee said.

He continued, "Emergency room primary care is very important. However, during follow-up care, only the procedure is recognized. Waiting time receives no acknowledgment. Surgeons are not recognized for sacrificing personal lives."

Finding ways to coexist with physician assistant (PA) nurses

Regarding the division of labor between physician assistants (PAs) and trainee doctors, Lee stated that continued discussion and adjustment are necessary.

"We presented many opinions to the government during the revision of the enforcement decree for the PA nurses’ work scope, and they were reflected," he said. "These talks will continue, with a process of feedback and readjustment. Since there's already a broad framework for the professional roles of doctors and nurses, adjustments must fit within that scope."

He continued, "In the past, specialized tasks were clearly defined and nurses had distinct roles. If residents handled many of the tasks in between, now we need to decide who should do them. We must determine whether PA nurses are needed to support resident training capacity. Team-based work should be considered."

Finally, Chairman Lee emphasized, “(When discussing essential medical issues), we often talk about pediatrics and obstetrics. While birth rates are falling and deliveries are decreasing, the number of pediatricians and OB/GYNs hasn't decreased proportionally. However, the problems in surgery, thoracic and cardiovascular surgery, and other fields are on a different level.”

As people age, the number of elderly patients will increase. Cases of transplants, cancer, cerebral hemorrhage, lung cancer, esophageal cancer, and other illnesses will grow quickly. The shortage of surgeons, including thoracic surgeons, is a problem money cannot solve, he noted.

Lee warned, “We have less than 10 years left before surgeons may disappear completely, yet the seriousness of this crisis -- the main argument -- remains ignored. Surgery is like a frog in boiling water: the danger increases slowly until it's too late.”

He continued, “We shouldn't just focus on the frogs that jump out of the hot water because they can't endure it. We must also pay attention to the essential departments, like the frog that endures silently until it dies.”