[Interview] ‘Pediatric care will revive, so don't give up and stay with us’

“I hope there will come a day when the government says, 'Stop building children's hospitals.' Going further, I dream of a society where doctors practice essential care and have reasons to do essential care competitively.

These are the words of Dr. Kang Hoon-chul, president of Severance Children's Hospital, a hospital established by professors who advocated for building a children's hospital.

Severance Children's Hospital is the first children's hospital opened by a Korean private university hospital. It is based on the Christian spirit and the pride in having its roots in Jejungwon, “the seed of modern Korean medicine.”

Dr. Kang, who took office in September and began his term as the hospital's president, frequently mentioned “vision” during a recent interview with Korean Biomedical Review. “I have a vision,” he said when explaining his goals as a hospital director and discussing his prospects as a pediatrician.

Kang said, “We shouldn't turn a blind eye or give up even in the face of worsening realities."

So, he envisions an independent children's hospital the size of a university hospital with all the functions of pediatric care. He also plans to develop a pediatric center for rare, serious, and difficult diseases, which he considers a “must-have.” In this way, he wants to make a strong statement that pediatric care should never be abandoned.

“We're still here and trying,” he said, hoping society would join him now.

Dr. Kang is an expert in pediatric neurology, having served as head of the Department of Neurology at the Children’s Hospital and director of the Hanim Precision Medical Center. He has been involved in hospital and university management as vice president of Yonsei Medical System's Future Strategy Office and vice dean of Yonsei University College of Medicine. He is an authority on rare genetic pediatric cranial neurological diseases.

Question: You specialize in pediatric neurology and care for patients with rare diseases. What made you decide to major in pediatric neurology?

Answer: First, I love kids. There are many pediatricians in my family. My dad was a dermatologist. It was the '80s, so it was still very much a military culture, which is how it was, but pediatrics had a soft ward atmosphere, and I thought, “Oh, I'd love to spend my life here taking care of kids.”

Q: What was your father's reaction to applying for pediatrics?

A: He looked at me and said, “You're not going to make any money in pediatrics.” But he supported my decision, knowing I wanted to. I remember him saying, “There's only one good thing about pediatrics. You can't get any worse here. You can't be more disappointed. So do whatever you want.

Q: Given the state of pediatrics, your father’s prediction that “it can't get any worse” seems to have proved wrong.

A: Most of the children's hospitals at national universities are running deficits in the billions to tens of billions of won. Private hospitals don't even build children's hospitals in the first place. Even if they do, they must close.

If hospitals fail to provide adequate care, people say they don't have a sense of mission and are just chasing profits. However, a sense of mission is a basic emotion for anyone in any profession. You can't ask for it only for doctors. And making a lot of money doesn't explain everything. Being respected is also important. Looking cool also matters. And you need to develop yourself as a professional to stay in the field. Only when these three things are met will the field continue. Pediatrics don’t have those three things right now.

Support for pediatrics must be ‘perennial,’ not just ‘provisional'

Q: Private medical organizations are feeling the pinch even more. Aside from a sense of mission and pride, how has Severance Children's Hospital survived?

A: We're a “shared” children's hospital. It's often said that essential medical specialties, like pediatrics, are unprofitable, so our predecessors decided to keep the profitable specialties within the children's hospital if pediatricians did hard enough. So, we didn't have ophthalmology, ENT, pediatric cardiology, and hematology-oncology. It's a model that's probably unique in the world. It's a gimmick to keep the hospital open for a long time. It's made us the only children's hospital in the country that records a surplus. Even so, we're also struggling because we're losing trainee doctors due to medical turmoil resulting from the government-doctor conflict.

Q: The government has promised various supports to save essential medical care and recently introduced a pilot project for post-de-facto compensation for the Children's Public Care Center. How do you feel about this in the field?

A: Severance Children's Hospital was also designated as a public specialty care center and promised state support, but the support is insufficient when examined closely. The pilot project for the post-de-facto compensation also did not consider the characteristics of private medical institutions, so the gap between the amount of support the hospital expected and the compensation calculated by the government was considerable and difficult to narrow. Fortunately, this time, support worth about 3 billion won ($2.18 million) was confirmed, but it needs to be supplemented. National and private hospitals should receive appropriate investment and support without bias. It’s easy to speak about “several trillion won investment” and “emergency support,” but they are difficult to achieve and do not guarantee effectiveness. What is needed is not “one-time support” to get over the hump but “always-on support” to protect and nurture the pediatric medical field with a long-term perspective.

‘My vision is to make Severance Children's Hospital an independent institution’

Q: During your term, you said you would like to move beyond a ‘shared’ hospital and move toward building an 'independent' one.

A: That is my vision and dream. You can say it's crazy, but it's not a pipe dream. Different countries have different concepts of children's hospitals. However, in the U.S., children's hospitals affiliated with leading universities, such as Harvard and Johns Hopkins, are comparable in size to university hospitals in Korea. In preparation, we plan to develop programs to improve the quality of pediatric care and strengthen communication and cooperation within the hospital to strengthen the capacity of medical staff.

Q: You also mentioned revitalizing donations as preparation for establishing it. Still, will such a big project be met through donations?

A: The culture of giving to hospitals is more developed than you might think. Hospitals are usually where people are inspired to donate outside of their connections or religion, and there is no place where people are more motivated to give than in a hospital. Unfortunately, Severance Children's Hospital hasn't been able to mobilize donations as much as the main hospital. We didn't have “something” attracting donations. Now, we're moving forward with the vision and goal of becoming a children's hospital that stands alone.

Q: Still, donations alone can only take you so far.

A: You're right. It's hard without institutional support. However, we all know now. Patients and medical staff, the media, the government, and the public agree that pediatric care, among other essential medical services, cannot be left as it is. The public’s values shape institutions. There's a shift in thinking that we can't just keep putting it on the back burner; instead, we must invest in it, protect it, and nurture it.

It's difficult because of the government-physician conflict. However, the public sentiment has also shifted to protecting pediatric care. So, you must move and prepare first, and then the opportunity will come.

Q: What other activities will you focus on besides preparing to build a standalone children's hospital?

A: As the director, I value the atmosphere in the hospital. It's not just our hospital; everyone doing essential care right now is feeling defeated, so we're trying to organize various events in the hospital. I want to continue to have opportunities for members to interact with each other or get some fresh air.

We're also going to increase our contact with the media. We need to let them know we're still here and tell them that we're still trying, not to forget us because we have a vision. Pediatric care is not a lost cause, and even if there’s nothing we can do about it anymore, please don't stop paying attention.

Once the outline of a standalone children's hospital is established and the hospital's management is more stable, I would like to properly implement services that the hospital “visits” patients, including home healthcare. For example, a service that uses big data analysis to inform patients registered with the hospital of health precautions, prevention, and treatment in time. This visiting service is becoming increasingly crucial for severe and relatively mild cases.

Q: You also opened the Hanim Precision Medical Clinic at Children's Hospital in May.

A: If pediatric care is the core of essential medical care, rare genetic diseases are the core of essential medical care within pediatric care. It was an essential part of a children's hospital, so I worked with Jeon Young-han, chairman of Hanim Corp., to set up a small space in the hospital.

At Severance Hospital, all the doctors deal with hereditary diseases. We don't just diagnose but also treat. The advantage of Severance Hospital is that it connects all the necessary fields. We have a rehabilitation center, we can collect cases, we can do research, we can publish papers, we can do the “showy job,” and thankfully, the donations keep coming in.

On the other hand, it's difficult to make money. It's not that we don't do it because it's difficult. If it's a serious disease, if it's profitable, the hospital will try to do something about it. But it's difficult because it's not easy, it's a lot of work, and you end up in disputes and lawsuits.

When pediatrics goes down, the rest of healthcare also goes down.

Q: Will pediatrics ever recover?

A: Yes, I believe it will. I've said it before, but our society has realized that everything is intertwined. If pediatrics, an essential healthcare service, goes down, everything else goes down. If healthcare collapses, the government collapses, and people's daily lives collapse. I hope this realization will lead to voices saying that “temporary support” is insufficient. Only when we turn it into “perennial” support can we begin to see a solution.

Q: A word to your colleagues and juniors struggling in the field.

A: Pediatric care is always challenging and sacrificial but also rewarding. I hope you never lose sight of how worthwhile hard work is. Pediatric care is at the heart of essential healthcare, and rescuing it is no longer an option. Pediatric care will revive; until then, let's make it better for our young patients.

Q: What would you do if you were to go back to medical school now that things couldn't get any worse?

A: I'd be a pediatrician again, although my dad wouldn't let me.