This pediatrician found greatest reward in children’s laughs. The government trampled on that simple wish.

"We are very sorry that we will be unable to be by your side."

That's what the Department of Pediatric Nephrology professors at Seoul National University Hospital (SNUH) wrote in a notice to patients informing them of their resignations on Aug. 31. Only two professors are now working in the department.

Pediatric nephrology is a subspecialty of pediatric medicine, with only 35 specialists in the entire country. According to the medical community, SNUH is the only hospital in Korea with a dedicated pediatric dialysis unit, and half of about 100 pediatric patients who receive dialysis for chronic kidney disease are treated at SNUH. 

That also explains why their resignation date is set for Aug. 31, four months from now. The idea is to transfer as many patients as possible to other hospitals before their resignations and to hand over as much as possible to those who remain at the hospital.

In a telephone interview with Korea Biomedical Review on Tuesday, Professor Kang Hee-gyung, one of the two professors in the department, expressed concerns that the shortage of subspecialists will be exacerbated by the government's increase of medical school enrollment quota and essential medical care policy.

“Every year, we had hoped that there would be applicants next year if we can hold out this year," Professor Kang said. However, her wishes were dashed as trainee doctors resigned to protest the government's policies. "This is a field to which I've dedicated my whole life. I don't want to leave," Kang said, suppressing tears.

Question: Why did you post a notice in the clinic when you decided to resign?

Answer: Last year alone, I saw 6,000 outpatients. When I resigned, I thought it was necessary to arrange the patients, so I posted a notice last month. I have written the necessary referral forms for all my patients, but I am worried that the referred doctors will remain at the hospital. In addition, patients treated in other departments at Seoul National University Hospital will have no choice but to stay, so I will have to find a successor. The reason for deciding the resignation date on Aug. 31 is to provide enough information to the medical staff who will remain at the hospital and exchange information.

Q: The government says it wants to save essential healthcare, but doctors in essential care are the first to resign.

A: When President Yoon Suk Yeol visited Seoul National University Children's Hospital last year, I had high hopes, saying, “It will get better soon. Let's hang in there.” However, when I saw the government's policies, I wondered, “Will this help?” Still, I thought there must be a reason for this.

However, I lost all hope as I listened to the government's statements before trainee doctors resigned in February. Pediatricians’ income is really small. They may be paid the least money among all doctors. But they stayed in the hospital because it was "rewarding.” The government has trampled on that. When I saw the government's public advertisements, I was shocked. To see the government ask doctors to "return to the people," I asked myself what I was standing on call next to a patient.

The government insists on implementing a wrong policy that hasn't been consulted with the field workers. Remaining in my position means that I agree with and recognize this. I can't do that, so I decided to resign.

Q: There is also a concern that if the trainee doctors do not return, the pediatric department may lose its ground for existence. Especially for pediatric nephrologists, who are a minority, I think there is more of a sense of crisis.

A: It is needless to say. Pediatric nephrologists are very few. There are only 35 pediatric nephrologists, including those who work in provinces. Fewer and fewer trainee doctors want to be trained in pediatric nephrology because hospitals are not hiring them. As a result, pediatric nephrologists are not being recruited by teaching hospitals.

The low number of pediatric nephrologists is because it is not attractive. If there is an emergency pediatric dialysis patient, they have to be on call 24/7. We had two professors and one full-time doctor at Seoul National University Hospital to take turns, but it was difficult for a small hospital. There are fewer patients. Doctors get feedback from the hospital on their revenue generation, and pediatric nephrologists are always at the bottom of the list.

I thought that if I could make it through this year, next year, I would have doctors who wanted to specialize in pediatric nephrology, but now that the trainee doctors are gone, I don't know who will come in. The doctors who are left are accustomed to being on call, but no one knows how long they will last.

Q: What policies do you think are needed for physicians?

A: First of all, we need to put protections against judicial risk in place. Doctors should not be held liable for unavoidable bad outcomes despite their best efforts. Young doctors don't apply for pediatrics; even existing doctors leave because they fear lawsuits. They fear that their family will be destroyed if they are sued. If you become a professor, you have to take responsibility for the mistakes of trainee doctors. There is also an atmosphere of expecting godlike perfection when you are not a god.

The essential healthcare policy package includes enacting the Special Act on Handling Medical Accidents but excludes fatal accidents. When you must pay 1.7 billion won ($1.2 million) in compensation for medical accidents, your salary is doubtful to cover the claim. Doctors who practice pediatrics find it rewarding to see their pediatric patients smile. At the very least, they should be able to practice safely.

The quality of life for doctors should also be improved. Since there are no pediatricians, we need to hire inpatient hospitalists to run the wards. However, few doctors apply for the hospitalist position, so the salary is usually high. On the other hand, younger pediatric professors are expected to write papers, do research, teach students, and see patients, but their salaries are much lower. Many doctors have left the field because they don't want to be professors.

Q: What policies should be promoted to revitalize pediatric nephrology?

A: Medical fees must be raised to a realistic level. I know that one nurse can take care of four patients for adult dialysis patients. However, for pediatric patients, it takes two nurses to care for one patient. Fees should be higher than now, but it's not reflected.

We must make it a condition that pediatric nephrologists must be consulted when performing Continuous Renal Replacement Therapy (CRRT), which removes water and waste from the blood for 24 hours straight in the ICU. This will be helpful because pediatric nephrologists have studied the principles properly. And I think this would encourage hospitals to hire more pediatric nephrologists because they are on call 24 hours a day. So, there should be at least two in one hospital. However, as the number of pediatric patients decreases, we should consider splitting the round-the-clock coverage among doctors from different regional hospitals.

Q: What are your plans after resigning?

A: I want to live a life like a human. I have a lot of papers that I've been saving to read because I want to study more while seeing patients. But when I read them, I'll be upset that I didn't do enough for my patients, and I'll think, "If I had known this before, I could have treated them better." If time and energy allow, I'd like to write a textbook on pediatric kidneys. I've dedicated my life to it and want to contribute to it.

I don't want to leave the hospital. I can do a little better, but with the government forcing doctors to kneel and follow the wrong policy, how can I be part of something going in the wrong direction?

Q: What would you say to your fellow professors?

A: Everyone's situation is different. Many feel they shouldn't leave their patients even if they think, "This is not right," and others feel they can't hand them over. Whatever the choice, I would say, let's hang in there because we are going through a tough process, and let's sublimate our despair so that this tower that we have worked so hard to build can somehow be maintained. For a better tomorrow, I believe we are all in this together, no matter where we are or our choices. We know we are doing our best, so I can only say, "Cheer up.”