[Viewpoint] Hobbling the doctors who heal usOne of the audience members during a lecture of mine last spring asked me a solemn question. He introduced himself as a doctor in his early 40s who operates a small clinic in Gangjin, South Jeolla.
“I manage my clinic with all my heart. But the work is extremely hard. Please tell me clearly why I cannot stop thinking about shutting it down day after day.”
The doctor’s hardship is actually shared by all except a few clinics and hospitals. Critics may say the complaint is an exaggeration, but that is the reality.
After the serious disturbance in the medical community in 1999, medical schools around the nation began teaching a new course, titled “Medical Service and Society.” Since the medical community was shaken by the separation of the practices of doctors and pharmacists, it started measures to communicate with society. I feel sad when I teach this course to aspiring doctors.
“Instead of paying attention first to professional consciousness as a doctor, it is more important to pay attention to the management know-how of a successful supermarket owner,” I tell them. The students become extremely disappointed. They have been praised for their talent and competed hard to enter the gateway to medical science. What an insult!
Unfortunately, they will soon realize that what I tell them is the cold reality. More and more media report that foreign patients are flocking to Korea for medical treatment. With such reports, the state-of-the-art buildings built by large private hospitals create the mirage that the nation’s medical service is competitive.
Korea’s medical service is actually amazing because a patient can always buy quality medical service at a low price. And yet, patients rarely pay attention to the dark shadow on this glamorous reputation, which forces a doctor to lose his desire to treat patients.
In fact, the medical system is collapsing. This is because past administrations paid so much attention to patients’ rights and financing state health insurance while asking doctors to fix problems in the system on their own. And there are endless problems. Basic medical science is in crisis.
No doctors want to practice obstetrics and gynecology, pediatrics and surgery. Patients flock to hospitals in the capital region; hospitals outside Seoul and university hospitals are suffering from losses. Everyone envies doctors, but their professional reality is devastating.
According to a survey by the Korea Medical Association, a doctor at a private clinic treats about 60 patients a day, working 56 hours a week. They work 16 hours more than legal work hours. To open a clinic, an average of 540 million won ($432,000) is invested, and the average debt is about 390 million. Almost all doctors who open private clinics suffer from extra work hours and debt. Such a doctor sees annual revenues of 420 million won, and net profit before taxes is about 100 million won.
A doctor in England, a model in public medical service, treats about 10 patients a day and receives the equivalent of more than 100 million won in annual salary from the government. In Korea, a doctor will earn about 20 million won a year with 10 patients a day. This is because the fees are too low. If we raise them, the people’s burden will increase, and no administration wants to take such a risk. The only way for a doctor to survive under these conditions is to treat as many patients as possible by extending work hours. This makes a doctor in Korea little better than a manual laborer.
The people turn a blind eye to our doctors’ sad reality and to the fact that the quality of medical services has gradually worsened, eroding patients’ right to health.
On May 8, the government announced measures to upgrade Korea’s service industries, but they had nothing to do with the serious situation in the nation’s medical service sector. Furthermore, two bills that will further restrain doctors are awaiting approval. One bill aims to save on pharmaceutical costs by making doctors pay for any drugs prescribed beyond the standard of the Health Insurance Review and Assessment Service. Another bill holds doctors fully responsible for the burden of proof in medical disputes when treating foreign patients. Both measures, if approved, will add heavy burdens on the shoulders of already exhausted doctors.
They may be important for politics, but the policies are just sugarcoated with the slogan of “advancement”; they provide no solutions to the real problems. Such moves will only diminish the reputation of the administration. If it wants to build a medical heaven with its advancement project for the medical community, then the problems of the medical service system and providers must be fixed first.
So many issues need urgent attention: First, clinics and hospitals around the nation must be saved so patients do not all come to the capital region. Medical facilities and providers should be balanced among the regions. Second, the government must stop the longtime practice of holding doctors financially accountable to make up for snowballing losses of the state-run health insurance due to expanded coverage and increased illnesses of senior citizens. Third, the government and the taxpayers must pay for the costs of improving public medical services. Lastly, doctors should be encouraged to promote medical justice and improve service quality.
Koreans pay only 2.5 percent of their monthly salaries for state health insurance but still expect service on par with England, where the people pay 15 percent of salaries for insurance.
This treatment of doctors must end. That is the only way for the nation to rescue its collapsing medical service.
*The writer is a professor of sociology at Seoul National University. Translation by the JoongAng Daily staff.
by Song Ho-keun