Korea's public health doctor system on the brink of collapse
The time is coming when “no one will become a public health doctor.”
According to the Korean Association of Public Health Doctors (KAPHD), 1,537 medical students enlisted in active duty or social service last year. This April, 512 public health doctors will leave the military.
In contrast, the number of new public health doctors is 250, down 61 percent from last year. “The number will drop to 200 next year, 150 the year after, and 100 three years later. The public health doctor system is slowly dying,” according to Lee Sung-hwan, the head of KAPHD.
Lee Sung-hwan, who was re-elected as the 39th president of KAPHD on Tuesday, mentioned the “demise of public health doctors” in his inaugural speech.
“The time has finally come when no one talks about serving as a public health doctor or military doctor,” Lee said. He pointed out that it is the result produced jointly by “inefficient regional healthcare, the central government that has been silent to the KAPHD’s appeals, and local governments that have relied on public health doctors without taking any alternative measures.”
According to the Health Insurance Review and Assessment Service’s 2023 Public Health Center Medical Treatment Performance, 791, or 64.4 percent, of the 1,228 public health centers nationwide had an average of five or fewer patients per day. Some 42.7 percent (524) had three or fewer patients. On average, 170 health centers, or 13.8 percent, had zero patients.
Public health doctors say many of these health centers are “competing with private medical institutions.” According to KAPHD’s survey, as of the second half of 2022, 41.3 percent (526 public health centers) had a clinic or hospital-level private medical institution within a one-kilometer radius. When expanded to a four-kilometer radius, the number rose to 64.2 percent (819).
In the last 2024 KAPHD survey, 57.8 percent of public health doctors believed that placing public healthcare institutions was inappropriate, with more than half (54.2 percent) citing “overlapping functions with private healthcare institutions” as the reason. “The government should not deploy public health doctors near private medical institutions or reduce their number,” said 67.3 percent of public health doctors who participated in the survey.
Meeting with Korea Biomedical Review after the inauguration, Lee pointed out that “the situation where public health centers are in competition with private medical institutions is a problem.” He added that this is also not in keeping with the purpose of the public health service, which is to provide medical care in places without medical doctors.
“If the government places public health doctors in these areas and forces them to do traveling care, the medical gap with ‘doctor-less’ areas will grow. Even in the city center, some people are in desperate need of basic primary care services, such as the homeless and those living in shanty towns. This is where the public health system should intervene. However, the central and local governments are delaying raising the efficiency of healthcare institutions, citing public opinion and civil complaints.”
“Public health doctors who have worked in remote or rural areas have a high interest in community healthcare and a strong tendency to view community healthcare positively after discharge from the military. Many doctors interested in community healthcare are also convinced by their work in public healthcare,” Lee said. “The way to create a sustainable community healthcare system is for public health doctors to work in places that ‘need them.’”
Question: The problem of dispatching public health doctors has been repeated recently, including during the Covid-19 pandemic and the ongoing medical crisis. Couldn't this be prevented by revising the operating guidelines?
Answer: I don't think it can be solved by simply revising the guidelines, but shortening the current six-month maximum dispatch period to three months and changing the allow-related provisions will help.
Q: Shortening the length of service is a key issue for KAPHD. However, some say the service period should not be shortened further, citing the “shortage of public health doctors.”
A: If we don't shorten the service period based on that logic, avoiding public health doctors and military doctors will only aggravate. Last year, 1,537 medical students enlisted as active duty or social service personnel. That's a 570 percent increase from the previous year. Even if last year was a special case, the trend is bound to continue.
Q: Nevertheless, what is the next best option if the government says it can no longer shorten the service?
A: If we can't shorten the service, we must improve the treatment. Some analyses have shown that better treatment at the ROTC, non-commissioned officers, and officer ranks is directly related to higher enlistment rates. Local governments spend about 10 million won ($6,825) per public health doctor annually. They allocate zero won to recruit private medical personnel. So, public health doctors are poorly paid and heavily burdened with work. The support for public health doctors should be “overwhelmingly” improved, even if it is not comparable to private doctors.
One way to do this is to flex the system. One year out of the three years of service could be recognized as internship experience or a dispatch to a training hospital could be considered a training period for junior doctors.
Q: The government has dragged the situation to the “demise of public health doctors” but maintains that increasing medical students and physicians will solve all regional, essential, and public healthcare.
A: Even if you increase the number of doctors by 20,000 or 30,000, it will not create doctors who work on the islands. It's not even possible to have a doctor on every island. I said that the era of public healthcare is ending, but we still need a public healthcare system. Even now, public health doctors are saving countless lives in medically underserved areas nationwide. The discussion on improving the public health system will not end up as meaningless.