[NOTEBOOK]How to heal the nation's doctors

Twenty-one months after the government forced a separation of the roles of physicians and pharmacists, the JoongAng Ilbo has found some very troubling changes in our health care system. Due to a lack of surgeons, a patient in a coma could not undergo critically needed surgery, and the level of medical services in rural areas has deteriorated badly. The phenomena arise partly from medical students' dislike for specialties that involve hard work and stress, and partly from physicians' dislike for practicing in rural areas. Because medical clinics are earning higher profits since the government instituted its medical reforms, large numbers of doctors have left the hospitals and opened their own clinics.

It is unfortunate that the medical sector is becoming like a stock market or a real estate market that just follows the money. Medical doctors of course have the same desire to make money and have a relatively easy life, just like members of the general population, but since they deal with patients' lives, the consequences are very serious. If the current trend continues, I am afraid that medical institutions will be weakened, which in turn will result in maltreatment of seriously ill patients and the collapse of medical research here.

The government, which has the power to adjust medical fees, is primarily responsible for this system failure. Since the national health insurance system was introduced, doctors have complained about low medical fees, and when the separation of the roles of doctors and druggists prohibited doctors from selling medicine, discontent among physicians exploded. Then the government appeased the doctors by raising medical fees, which led to the exodus from hospitals to start new businesses and the collapse of the medical system as a whole. Because the entire problem stemmed from the issue of medical fees, the solution can also be found there. The government can raise medical fees for specialties that students avoid in order to lure talented doctors into both serving critically ill patients in large hospitals and into research.

But the recent increase in medical fees ultimately led doctors to abandon hospitals for their own clinics. The doctors forced the changes in the medical fee structure; the new structure is not working well either, so it is time to find a more fundamental solution to the issue of compensation for medical services.

One possibility is to find a social consensus on an appropriate level for medical fees. According to the Organization for Economic Cooperation and Development, the average income of doctors divided by the average income of all workers is 5.2 in the United States, 4.2 in New Zealand, 4.1 in Germany - those countries have the highest income disparities - and 2.3 in Britain, 1.9 in France and 1.5 in Sweden, at the more egalitarian end of the OECD spectrum. It would not be unreasonable, therefore, to guarantee doctors four to five times the average wage in Korea since these doctors are distinguished professionals who deal with lives and put years of effort into preparing themselves for their duties.

So what is the present situation here? Unfortunately, even the Health Ministry does not have accurate figures for the level of medical compensation. Last year, the average Korean worker earned 1.75 million won ($1,320) per month. In June, 2000, the Korean Medical Association estimated the average monthly income of doctors at 6 million won, but last month it revised that figure to 3.85 million won. But Seoul-based specialists in internal medicine last year reported average monthly gross incomes of 20 million won. Physician income levels, therefore, seem to range from about 2.2 times to 11 times average pay.

The government must establish a long-term policy to make the incomes of physicians more widely known, and doctors must cooperate to ensure that their income is being earned in a socially responsible manner. Since the 1960s, American doctors have voluntarily reported their income by region and specialty every year.

The confusion in the Korean medical system will continue unless medical fees can be adjusted transparently and in a way that is acceptable both to doctors and to the public. What we do not need is a continuation of recent wide swings in medical policies.

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The writer is city news editor of the JoongAng Ilbo.

by Lee Deok-nyung