Public healthcare still failing rural areas after decades, doctors warn

Public healthcare is once again in the spotlight, following a pledge by Democratic Party of Korea presidential candidate Lee Jae-myung to improve the system.

But doctors with decades of experience in regional and public healthcare say they are under increasing pressure. They argue that promoting public medical schools as a solution only obscures the system’s long-standing structural problems.

Dr. Kim Dae-yeon, director of the KCOMWELL Taebaek Hospital who previously served as the director of Suncheon Medical Center, participated in a panel discussion on the forum “Problems of Public Medical Schools and Search for Alternatives” held by the Korea Medical Association's Medical Policy Research Institute on Monday.

“I chose the profession of a doctor to serve. If there had been a public medical school, I would have enrolled,” he said. “I have been working as a doctor in the public service and public-related fields for more than 20 years, but I have been treated poorly and not rewarded for my work.”

“Doctors who work in public healthcare have a sense of mission to care for patients at the expense of money from the beginning. However, their self-esteem is falling. They don't feel rewarded anywhere,” he said. “This is why people keep leaving. The number of people practicing public medicine is decreasing.”

Citing his time as director of Suncheon Medical Center, he said, “Suncheon Medical Center had more beds than the local demand. We have to compete with private medical centers, but we cannot invest aggressively and are asked to prioritize public interest over profit.”

Kim explained that regional medical centers that evacuated hospitalized patients during the Covid-19 pandemic to respond to the pandemic are now facing deficits because local patients are not visiting them. He pointed out that the government gave monetary compensation to private medical centers to attract private participation. When the private sector started coming in, public medical centers were left out (of Covid-19 treatment) without proper compensation.

“In such an environment, building new public medical schools and hospitals in the region and training doctors to practice public medicine will not solve the problem,” he said. “The Taiwanese and Japanese public medical school models have failed to achieve their original goals. I don't think we have any reason to experience their failure.”

50 years on, rural healthcare still lags — and needs ‘multiplayer’ doctors

Dr. Cho Baek-hwan, director of Jinan Medical Center, who attended the forum as an audience member, found the solution to the problem of regional healthcare not in creating new public medical schools but in improving the training system. The idea is to train “multiplayer” better suited to the local medical field than specialists.

“I am returning to where I worked as a dispatched doctor in ‘doctorless village’ during my training 50 years ago,” said Cho, who was appointed to Jinan Medical Center after retiring as a professor at Jeonbuk National University Hospital. “Even though 50 years have passed, the medical problems in rural areas have remained the same. Despite being the country with the largest number of hospital beds in the Organization for Economic Cooperation and Development (OECD), there are strong demands to build additional university hospitals in the capital. At the same time, rural areas are being told to build public medical schools.”

“The experience of training in other fields, such as urology and cardiovascular and thoracic surgery, during my training, helped me to pioneer the field of organ transplantation at Jeonbuk National University Hospital,” said Cho, a surgeon. “In addition, an emeritus professor who regretted that the medical center did not have a dermatology department passed on his expertise in dermatology over the years, and now I can handle outpatient dermatology without much difficulty while working as a medical director.”

Therefore, Cho emphasized that this country should solve the problem of rural healthcare disparities, and the new system should improve the fundamental aspects. He suggested a training program that “dramatically reduces the length of training but focuses on high-frequency treatments or procedures.”

“We should be cautious and open the door to multidisciplinary, or multidisciplinary, specialization in underserved areas for a while,” he said.

One or two new public medical schools will be established whether the medical community likes it or not

Some argue that opposing the creation of public medical schools is counterproductive.

Cho Seung-yeon, former director of Incheon Medical Center, said, “Since the candidate has made a presidential pledge, one or two public medical schools will be established in some form or another. (Rather), we should ensure that (the public medical school policy) works properly from the beginning.

The discussion of public medical schools was initially about converting national medical schools like Seoul National University College of Medicine into public medical schools, but it was concluded that it was impossible to convert the existing system, so Cho noted that the idea of creating a public medical school model from scratch came up.

“The government funds national medical schools and conducts scholarship programs. However, did they have the capacity and will to cultivate medical students with a public (healthcare-oriented) heart?” he criticized. “Among the 40 medical schools (including the national medical colleges) currently training doctors, are there any doctors who have a sense of mission and want to work in rural or medically underserved areas?”

“Our medical community can come up with hundreds of reasons why we shouldn't do it (creating public medical schools), but politicians can come up with one or two reasons why we should. It's a vision, it's a mission,” he said. “I don't think public medical schools are the solution to all problems. But what medical societies and the medical community need to do now is to have a voice and influence to ensure that (policy) doesn't go down the wrong path.”