From the article: … I’d like to see a more in-depth article about this, given that other reporting says that it is about increasing the number of medical students. I’m guessing that part of the...
From the article:
South Korea raised its health alert to the highest level on Friday after a mass walkout by trainee doctors this week, while the prime minister said public hospitals would extend working hours to respond to growing strains on the medical system.
Almost two-thirds of the country’s young doctors have walked off the job to protest a government plan to admit more students to medical schools, forcing hospitals to turn away patients and cancel procedures, and raising fears about further disruption to the medical system should the dispute drag on.
…
Emergency departments in South Korea’s biggest hospitals have been squeezed since trainee doctors began leaving the job this week in protest at the government plan.
The doctors taking part in the protest say the real issue is pay and working conditions, not the number of physicians.
I’d like to see a more in-depth article about this, given that other reporting says that it is about increasing the number of medical students.
I’m guessing that part of the issue might be disparities between new doctors and established, older doctors, who are paid much more?
Brazil faced a physician's revolt when we opened our border to some much-needed Cuban doctors. They couldn't handle losing their privilege, basically. They are completely detached and essentially...
Brazil faced a physician's revolt when we opened our border to some much-needed Cuban doctors. They couldn't handle losing their privilege, basically. They are completely detached and essentially form a social and economic class of their own.
At face value that's a pretty wild reason to walk-out. In theory, this should reduce the strain on individual medical professionals as the number of patients and emergencies are spread out....
At face value that's a pretty wild reason to walk-out. In theory, this should reduce the strain on individual medical professionals as the number of patients and emergencies are spread out.
However, I can definitely see the rationale that would lead to problems in compensation and devaluing medical personnel. I'm not sure what the medical education system is like in South Korea, but given how much debt people take on to become a doctor in the United States I would certainly want very nice compensation. I know there are some loan forgiveness programs for primary care physicians in the U.S. - I wonder what the economic burden is in South Korea?
Also, as an aside, I always find it frustrating when the general public throws shade when medical professionals, and other professions like teachers, end up striking. Many people that pursue such careers are doing it in part out of passion. If these jobs are so important to the community that striking or mass exodus is super disruptive maybe we can meet the basic demands unions ask for. Additionally, maybe we can structure in adjustments so that these people aren't burning out?
That doesn't seem to be the root cause as noted in the article. Adding in more doctors isn't going to address compensation. It might help some factors of working conditions if doctors are...
That doesn't seem to be the root cause as noted in the article.
"The doctors taking part in the protest say the real issue is pay and working conditions, not the number of physicians."
Adding in more doctors isn't going to address compensation. It might help some factors of working conditions if doctors are stretched thin. However, there are other concerns that go beyond how many hours you work/patients under your care.
I agree with skybrian - I'd like to see more in-depth reporting on this before coming to a conclusion.
The government says the increase in the admission quota is needed to address a shortage of doctors
But doctors have claimed that the move would rather compromise the quality of medical education and services, calling on the government to seek ways to better protect doctors from malpractice suits [...] among other things
The government's plan [...] has drawn support from the public, which has been frustrated with long wait times to see doctors.
[they] demanded that the government go back to square one with its quota hike plan, establish a panel to discuss the increase and decrease in the number of doctors and expand the recruitment of medical specialists in teaching hospitals.
also called on the government to reduce the legal risks caused by medical accidents and improve the working environment of trainee doctors.
“We cannot accept adding 2,000 slots at once [from current 3,058] as there are concerns about whether the education systems are prepared (for the increase)”
Yes, the news I’ve read makes the doctors sound pretty unsympathetic, but I don’t feel like we’re getting much depth. This kind of organization seems unusual for doctors. I wonder how it happened?
Yes, the news I’ve read makes the doctors sound pretty unsympathetic, but I don’t feel like we’re getting much depth. This kind of organization seems unusual for doctors. I wonder how it happened?
Medical licensing boards and professional associations commonly lobby for less competition as well as increased requirements for healthcare in the US. They have a vested interest in limiting the...
Medical licensing boards and professional associations commonly lobby for less competition as well as increased requirements for healthcare in the US. They have a vested interest in limiting the scope of practice of nurse practitioners, psychologists, and anyone else that performs a job a licensed medical doctor could do instead. This is also why it's so difficult for doctors to immigrate, even between countries with equivalent or stricter training requirements.
I would push back against that. It's not that doctors are lobbying to limit the scope of mid-levels and psychologists, it's that midlevels are actively trying to lobby to increase their scope of...
I would push back against that. It's not that doctors are lobbying to limit the scope of mid-levels and psychologists, it's that midlevels are actively trying to lobby to increase their scope of practice beyond their training and knowledge levels and the physician lobby groups are trying to (rightfully) push back against that, but the lobbying groups for physicians are way less effect than other medical professionals
And that's a valid talking point from licensed medical doctors, but I know many people that are satisfied with the standard of care after seeing a nurse practitioner as their primary care or...
And that's a valid talking point from licensed medical doctors, but I know many people that are satisfied with the standard of care after seeing a nurse practitioner as their primary care or general practice medical professional. I also totally understand specialists having a monopoly on their limited scope of practice.
I'm just not sure someone needs the full range of medical school and residency to diagnose simple infections and forward people to specialists as needed. I have NPs and MDs in my family, so I've certainly heard these debates before.
Very valid, but that severely underestimates what a fully trained primary care physician does. A fully trained physician will reduce Healthcare costs and utilization by appropriately referring to...
Very valid, but that severely underestimates what a fully trained primary care physician does. A fully trained physician will reduce Healthcare costs and utilization by appropriately referring to specialities problems that need a specialist or treating conditions that can be treated by a doctor. NPs, on the other hand, increase costs and inappropriate utilization by over ordering imaging and over prescribing antibiotics(second source). Quality of referrals are [lower](https://www.mayoclinicproceedings.org/article/S0025-6196(13) by NPs and PAs than MDs and DOs, which leads to actually increased burden on the Healthcare system and increased costs for patients.
A primary care physician is much more than someone who "treats simple infections and refers to specialists", and that misperception is costing the Healthcare system as a whole and leading to worse outcomes for patients. It's perfectly fine if you're happy with your care by a midlevel, but the facts show they're much more likely to miss things and cost you more.
Sorry, this is a touchy subject for me because just this week we had a patient nearly die because the primary care NP didn't even order a UA for them when they had urinary complaints, only gave them a flu and covid swab and then sent them home. They came into the ED with pyelonephritis (a kidney infection) and could have died, but certainly led to increased utilization and cost on the system which could have been avoided if they had a primary care physician over an NP
There is ongoing controversy about whether advanced practitioners provide comparable care to physicians, within their scope of practice. A study on a very large population of Veterans...
There is ongoing controversy about whether advanced practitioners provide comparable care to physicians, within their scope of practice. A study on a very large population of Veterans Administration patients indicates comparable outcomes from NP supervised treatment, at reduced cost.
I'll admit a strong personal bias in favor of advanced practitioners. I've had the experience of a serious misdiagnosis by an overworked MD, who handwaved away labs and physical findings (swollen joints, fatigue, anemia, sharply elevated ANA and CRP = "just perimenopause, have some antidepressants") that an NP later found concerning enough for specialist referrals. I sustained permanent damage, including joint replacements, that could easily have been prevented with earlier treatment. I'm currently seeing a PA with a rheumatology specialization who's supervised by a remote MD, because I'm living in an area that doesn't have enough MD specialists.
I'm sure there are advantages to highly trained MD's and specialists for complex cases, but the vast majority of patients need to see someone in primary and urgent care who's able to pay attention long enough for proper screening and diagnosis.
In the South Korean healthcare system which is the original topic of discussion, there are half as many MDs per unit population as in the U.S. Primary care specialists, including pediatricians, are significantly underpaid (as little as 45% of median physician income). 40% of hospital care is provided by medical trainees, interns, and residents, who are barely paid enough for food and shelter while working 80 - 100 hour weeks. I can certainly understand that they'd be protective of maintaining professional standards, but the reality is that they need better working conditions, higher pay, and more hands to alleviate the shortage of workers.
***South Korea has a governmental single-payer system, but privately run hospitals and clinics. I've seen commentary indicating that urban hospitals are full of the latest technology, but remote regions and primary care have been deprived. Physicians gravitate towards highly paid specialties like cosmetic surgery. There's a serious shortage of pediatricians, not just because it's one of the lowest-paid specialties, but because medical students don't want to be competing for patients in the face of a declining birth rate. Would-be parents are reconsidering having children because care is so scarce.
I went through your first two links and I appreciate the information. I was on the pro-NP-more-responsibility train in the past, but not strongly and this gives me a lot to think about. I would...
I went through your first two links and I appreciate the information. I was on the pro-NP-more-responsibility train in the past, but not strongly and this gives me a lot to think about. I would say I am indifferent at the moment because I understand the system is way more complex and there will be ripple effects (and now I have something concrete I can point to) in making a shift like that.
However, I would like to point out that the first two links don't necessarily prove that the costs to healthcare or burden is greater. It's possible that over ordering imaging is fine if the bottleneck was in available physicians or if the cost of increased imaging is lower than the cost of a patient waiting or paying for a higher trained professional. And on antibiotics, my perception is that physicians took a long time to learn that lesson too, so over time we may see the same with NPs.
It seems like a few developed countries are struggling with doctor retention/shortages lately, I wonder why... Oh. Nevermind. As someone who has family working in the UK NHS, I fully support their...
It seems like a few developed countries are struggling with doctor retention/shortages lately, I wonder why...
The doctors taking part in the protest say the real issue is pay and working conditions, not the number of physicians.
Oh. Nevermind. As someone who has family working in the UK NHS, I fully support their strike for better pay and working conditions.
It seems particularly blind to ignore these demands - people who pursue medicine are smart and capable of evaluating if this profession will treat them well. If not, what's the incentive to stick around rather that persue a better paid, less stressful job?
It is difficult to evaluate the particular socioeconomic conditions of South Korea. But we are talking about an increase of 2000 doctors (65%) a year in a country of 51.63 million. Maybe there are...
It is difficult to evaluate the particular socioeconomic conditions of South Korea. But we are talking about an increase of 2000 doctors (65%) a year in a country of 51.63 million. Maybe there are legitimate underlying conditions doctors would rather see resolved first. But that increase doesn't seem that menacing.
If anything, it looks like they have a genuine scarcity of medical doctors. Here's some data on that.
Good that they stand up for themselves. The government chooses to increase the risk for the patients by acting in this way. Increasing working hours in an already unhealthy work-life balance is...
Good that they stand up for themselves. The government chooses to increase the risk for the patients by acting in this way. Increasing working hours in an already unhealthy work-life balance is insane.
There’s ample evidence that working with sleep deprivation leads to more risks. It’s just malpractice waiting to happen.
Increasing the student influx now, will not help the current situation of scarcity, which also poses the problem: Who will train these extra people? The overworked junior doctors? And if it effects anything, it will be 4-8 years in the future.
These are the results of political choices: Do you want a socialist health care in which doctors are motivated to work in public hospitals with healthy working hours, normal compensation. Or do you keep going with a winner takes all system, which incentivizes private practice, places an inhumane amount of workload on the junior doctor workforce, and in which health care is seen as a product.
Well, I don’t really know the state of South Korean health care, but probably a safe bet that they don’t really regulate which patients may ask for evaluation at the ED, resulting in a lot of time...
Well, I don’t really know the state of South Korean health care, but probably a safe bet that they don’t really regulate which patients may ask for evaluation at the ED, resulting in a lot of time and energy spent triaging. Some care could be better delivered by a family medicine doctor instead of in a hospital.
A better work-life balance to keep doctors in the work force longer should be a given. If you squeeze the last bit of life out of freshly graduated doctors, their replacements - even if in larger numbers - will not necessarily last longer, no? It will not fix the problem, but ignoring this factor will exacerbate the problem sooner than later.
In my own locale, I don’t see strikes (yet), but I feel like the willingness to put up with inhumane working conditions grows less and less each generation, making it increasingly difficult to fill positions in hospitals, which in turn results in better working agreements in some situations - but not all.
Just my hypothesis, but I think the concern is that the education system would not be scaled accordingly (teachers in schools, but also internship quantity and quality).
Just my hypothesis, but I think the concern is that the education system would not be scaled accordingly (teachers in schools, but also internship quantity and quality).
From the article:
…
I’d like to see a more in-depth article about this, given that other reporting says that it is about increasing the number of medical students.
I’m guessing that part of the issue might be disparities between new doctors and established, older doctors, who are paid much more?
Brazil faced a physician's revolt when we opened our border to some much-needed Cuban doctors. They couldn't handle losing their privilege, basically. They are completely detached and essentially form a social and economic class of their own.
This news reminds me of our own troubles.
At face value that's a pretty wild reason to walk-out. In theory, this should reduce the strain on individual medical professionals as the number of patients and emergencies are spread out.
However, I can definitely see the rationale that would lead to problems in compensation and devaluing medical personnel. I'm not sure what the medical education system is like in South Korea, but given how much debt people take on to become a doctor in the United States I would certainly want very nice compensation. I know there are some loan forgiveness programs for primary care physicians in the U.S. - I wonder what the economic burden is in South Korea?
Also, as an aside, I always find it frustrating when the general public throws shade when medical professionals, and other professions like teachers, end up striking. Many people that pursue such careers are doing it in part out of passion. If these jobs are so important to the community that striking or mass exodus is super disruptive maybe we can meet the basic demands unions ask for. Additionally, maybe we can structure in adjustments so that these people aren't burning out?
Although in this case, the basic demand is... gatekeeping medical careers despite requiring more supply to meet demand for a critical service?
That doesn't seem to be the root cause as noted in the article.
Adding in more doctors isn't going to address compensation. It might help some factors of working conditions if doctors are stretched thin. However, there are other concerns that go beyond how many hours you work/patients under your care.
I agree with skybrian - I'd like to see more in-depth reporting on this before coming to a conclusion.
Yes, the news I’ve read makes the doctors sound pretty unsympathetic, but I don’t feel like we’re getting much depth. This kind of organization seems unusual for doctors. I wonder how it happened?
Medical licensing boards and professional associations commonly lobby for less competition as well as increased requirements for healthcare in the US. They have a vested interest in limiting the scope of practice of nurse practitioners, psychologists, and anyone else that performs a job a licensed medical doctor could do instead. This is also why it's so difficult for doctors to immigrate, even between countries with equivalent or stricter training requirements.
I would push back against that. It's not that doctors are lobbying to limit the scope of mid-levels and psychologists, it's that midlevels are actively trying to lobby to increase their scope of practice beyond their training and knowledge levels and the physician lobby groups are trying to (rightfully) push back against that, but the lobbying groups for physicians are way less effect than other medical professionals
And that's a valid talking point from licensed medical doctors, but I know many people that are satisfied with the standard of care after seeing a nurse practitioner as their primary care or general practice medical professional. I also totally understand specialists having a monopoly on their limited scope of practice.
I'm just not sure someone needs the full range of medical school and residency to diagnose simple infections and forward people to specialists as needed. I have NPs and MDs in my family, so I've certainly heard these debates before.
Very valid, but that severely underestimates what a fully trained primary care physician does. A fully trained physician will reduce Healthcare costs and utilization by appropriately referring to specialities problems that need a specialist or treating conditions that can be treated by a doctor. NPs, on the other hand, increase costs and inappropriate utilization by over ordering imaging and over prescribing antibiotics (second source). Quality of referrals are [lower](https://www.mayoclinicproceedings.org/article/S0025-6196(13) by NPs and PAs than MDs and DOs, which leads to actually increased burden on the Healthcare system and increased costs for patients.
A primary care physician is much more than someone who "treats simple infections and refers to specialists", and that misperception is costing the Healthcare system as a whole and leading to worse outcomes for patients. It's perfectly fine if you're happy with your care by a midlevel, but the facts show they're much more likely to miss things and cost you more.
Sorry, this is a touchy subject for me because just this week we had a patient nearly die because the primary care NP didn't even order a UA for them when they had urinary complaints, only gave them a flu and covid swab and then sent them home. They came into the ED with pyelonephritis (a kidney infection) and could have died, but certainly led to increased utilization and cost on the system which could have been avoided if they had a primary care physician over an NP
There is ongoing controversy about whether advanced practitioners provide comparable care to physicians, within their scope of practice. A study on a very large population of Veterans Administration patients indicates comparable outcomes from NP supervised treatment, at reduced cost.
I'll admit a strong personal bias in favor of advanced practitioners. I've had the experience of a serious misdiagnosis by an overworked MD, who handwaved away labs and physical findings (swollen joints, fatigue, anemia, sharply elevated ANA and CRP = "just perimenopause, have some antidepressants") that an NP later found concerning enough for specialist referrals. I sustained permanent damage, including joint replacements, that could easily have been prevented with earlier treatment. I'm currently seeing a PA with a rheumatology specialization who's supervised by a remote MD, because I'm living in an area that doesn't have enough MD specialists.
I'm sure there are advantages to highly trained MD's and specialists for complex cases, but the vast majority of patients need to see someone in primary and urgent care who's able to pay attention long enough for proper screening and diagnosis.
In the South Korean healthcare system which is the original topic of discussion, there are half as many MDs per unit population as in the U.S. Primary care specialists, including pediatricians, are significantly underpaid (as little as 45% of median physician income). 40% of hospital care is provided by medical trainees, interns, and residents, who are barely paid enough for food and shelter while working 80 - 100 hour weeks. I can certainly understand that they'd be protective of maintaining professional standards, but the reality is that they need better working conditions, higher pay, and more hands to alleviate the shortage of workers.
***South Korea has a governmental single-payer system, but privately run hospitals and clinics. I've seen commentary indicating that urban hospitals are full of the latest technology, but remote regions and primary care have been deprived. Physicians gravitate towards highly paid specialties like cosmetic surgery. There's a serious shortage of pediatricians, not just because it's one of the lowest-paid specialties, but because medical students don't want to be competing for patients in the face of a declining birth rate. Would-be parents are reconsidering having children because care is so scarce.
I went through your first two links and I appreciate the information. I was on the pro-NP-more-responsibility train in the past, but not strongly and this gives me a lot to think about. I would say I am indifferent at the moment because I understand the system is way more complex and there will be ripple effects (and now I have something concrete I can point to) in making a shift like that.
However, I would like to point out that the first two links don't necessarily prove that the costs to healthcare or burden is greater. It's possible that over ordering imaging is fine if the bottleneck was in available physicians or if the cost of increased imaging is lower than the cost of a patient waiting or paying for a higher trained professional. And on antibiotics, my perception is that physicians took a long time to learn that lesson too, so over time we may see the same with NPs.
This is not necessarily good content, but maybe it's a good place to start.
https://www.thestar.com.my/aseanplus/aseanplus-news/2024/02/23/yoons-approval-rating-climbs-after-south-korean-doctors-strike
https://www.taipeitimes.com/News/world/archives/2024/02/21/2003813867
https://old.reddit.com/r/southkorea/comments/1avfcfi/why_are_south_korea_doctors_resigning/
https://old.reddit.com/r/korea/comments/1aynwip/south_korea_a_nation_of_52m_people_have_only/
It seems like a few developed countries are struggling with doctor retention/shortages lately, I wonder why...
Oh. Nevermind. As someone who has family working in the UK NHS, I fully support their strike for better pay and working conditions.
It seems particularly blind to ignore these demands - people who pursue medicine are smart and capable of evaluating if this profession will treat them well. If not, what's the incentive to stick around rather that persue a better paid, less stressful job?
It is difficult to evaluate the particular socioeconomic conditions of South Korea. But we are talking about an increase of 2000 doctors (65%) a year in a country of 51.63 million. Maybe there are legitimate underlying conditions doctors would rather see resolved first. But that increase doesn't seem that menacing.
If anything, it looks like they have a genuine scarcity of medical doctors. Here's some data on that.
Should we take their word for it though? I doubt they would just come out and say “hey, this is a cash grab and a push to entrench our interests”
https://www.erieri.com/salary/job/medical-doctor/south-korea
122,954,179 KRW average salary or USD$92k.
Is that unreasonable? I don’t know enough about the Korean economy or the cost of medical training there to know.
Good that they stand up for themselves. The government chooses to increase the risk for the patients by acting in this way. Increasing working hours in an already unhealthy work-life balance is insane.
There’s ample evidence that working with sleep deprivation leads to more risks. It’s just malpractice waiting to happen.
Increasing the student influx now, will not help the current situation of scarcity, which also poses the problem: Who will train these extra people? The overworked junior doctors? And if it effects anything, it will be 4-8 years in the future.
These are the results of political choices: Do you want a socialist health care in which doctors are motivated to work in public hospitals with healthy working hours, normal compensation. Or do you keep going with a winner takes all system, which incentivizes private practice, places an inhumane amount of workload on the junior doctor workforce, and in which health care is seen as a product.
What would solve the scarcity problem, if not increasing supply? Won’t doing anything else just exacerbate the issue?
Well, I don’t really know the state of South Korean health care, but probably a safe bet that they don’t really regulate which patients may ask for evaluation at the ED, resulting in a lot of time and energy spent triaging. Some care could be better delivered by a family medicine doctor instead of in a hospital.
A better work-life balance to keep doctors in the work force longer should be a given. If you squeeze the last bit of life out of freshly graduated doctors, their replacements - even if in larger numbers - will not necessarily last longer, no? It will not fix the problem, but ignoring this factor will exacerbate the problem sooner than later.
In my own locale, I don’t see strikes (yet), but I feel like the willingness to put up with inhumane working conditions grows less and less each generation, making it increasingly difficult to fill positions in hospitals, which in turn results in better working agreements in some situations - but not all.
Just my hypothesis, but I think the concern is that the education system would not be scaled accordingly (teachers in schools, but also internship quantity and quality).