Battle between doctors and nurses? Think again

Suh Kyoung-ho

The author is an editorial writer of the JoongAng Ilbo.

The Nursing Act that has been a hot-button issue for more than a year is set to go down the drain despite its re-submission for a full vote at the legislature, as it cannot override the presidential veto. Amid a heated debate over the issue, a column by physician Yang Chang-mo, who makes house calls in mountainous Gangwon Province, stood out. He drew attention to the fact that so many people are isolated from basic medical care in mountainous and remote rural areas.

The physician pointed out that the most important party — the patients — was absent in the conflict between the doctors and nurses over separate legislation for nurses. “The essence of the dispute should not be a fight between the two interest groups. It should be seen as the wrangling between physician- and healthcare-starved patients and the doctors’ association, which maintains that nurses must not provide services outside hospitals.”

Community clinics that can make house calls make up just 0.4 percent. If doctors cannot make the rounds themselves, nurses should be able to offer some home-based primary care. For nurses to make house calls, they need a permit from the hospital or an order from a nursing home. But doctors are hesitant to issue such documents for fear of medical accidents or other liabilities. Nurses from public clinics or community centers cannot even perform simple treatments like sterilizing bruises. Whether it be in the form of a revised Nursing Act or a revision to the Medical Act, there should be legal grounds for a home-based healthcare system.

The Korean Nurses Association is staging a “legitimate” protest to the presidential veto. In other words, authorized nurses refuse to do tasks in the hospital other than those stipulated by the law. The irony of the expression “legitimate” protest underscores the outdatedness in the current Medical Act.

The controversy over the Nursing Act has exposed the need for imperative changes in the medical community. Making house calls and home nursing must be expanded and telemedicine or remote treatment needs to become legal, and quotas at medical schools should be increased to address a shortage of doctors in the longer run.

An alliance representing public healthcare professionals, including doctors, demand the controversial Nursing Act be repealed in a rally before the National Assembly, May 3. After the majority Democratic Party railroaded the act through the plenary session of the legislature, President Yoon Suk Yeol vetoed it. [NEWS1]

Doctors’ concerns about the side effects from home-based care or remote treatment are understandable. But they need not be exaggerated. There must be ways where the public can gain easier access to medical services while preventing medical accidents. Lowering the liability of doctors can also be considered for remote treatment to help ensure easier access to medical services.

An increase in enrollment quotas at medical schools won’t immediately solve the urgent problem of dire shortages of doctors in essential fields such as pediatrics and emergency units. The Korea Medical Association opposes the increase because they think the problem lies in the over-concentration of doctors in high-paying popular fields, not in an absolute shortage of doctors. But doctors are few in number as well as poorly distributed. The increase in medical student quotas is an essential long-term solution. The bias towards certain fields stems from the disparity in income expectations. This is due to poor design in the incentive system. The overconcentration in particular fields could be eased if there are expectations that doctors will be enough in the future.

As a short-term measure, authorities must consider designating certain hospitals by region specializing in certain essential fields — such as cardiology — to prevent the collapse of core medical fields. The hospitals must keep up staffing in the field in return for receiving higher insurance reimbursements.

Doctors make up the core of the public healthcare system, but they have not demonstrated appropriate responsibility. Although they cite the interests of public health, patients and the public regard them as selfish and self-serving. “If the pursuit of interest by the mainstream cartel is tolerated, how can we expect innovation and a better future?” President Yoon asked at the graduation ceremony of Yonsei University in February. His comment was perceived to be pointing to the mighty unions. But doctors cannot be free from the criticism. If doctors cannot play their due role, they could invite presidential attention to fight the cartel of mainstream forces.