[WHY] Where have all the pediatricians gone in Korea?

Home > Why >

Published: 16 Sep. 2023, 06:00

[WHY] Where have all the pediatricians gone in Korea?

A pediatric clinic in Seoul early this year with a sign that reads it is shutting down. [YONHAP]

Korean parents are on the hunt for pediatricians.

Take Kim Ji-eun, a 34-year-old mother of two girls living in Seoul.

Her five-year-old daughter broke her arm, playing on a swing, one evening early this year. No large hospitals were willing to accept her either due to too many patients at the emergency room or the absence of pediatricians.

After two hours with the child in pain, she barged into the nearest large hospital which she was aware did not run emergency medical service for children.

"I had nowhere to go at that moment so I just went to the nearest large hospital, thinking they would not let my daughter die," Kim said to the Korea JoongAng Daily.

"Making multiple calls to hospitals and 911 to check availability, I was quite dumbstruck because I was in Gangnam, the middle of Seoul, where most of the infrastructure should be concentrated, but I could not find a single hospital that I could safely take my daughter to."

Kim's case is just the tip of the iceberg.

Korea is suffering from an unprecedented shortage of pediatricians.

The number of pediatric hospitals and clinics shrank by 12.5 percent last year compared to 2017, according to state-run think tank Seoul Institute's data, whereas that of psychiatric hospitals rose by 76.8 percent and anesthesiology hospitals rose by 41.2 percent.

This explains the so-called open runs to the pediatric hospital early in the morning — before 7 a.m. — to get an appointment with the doctor.

Large hospitals have either downsized or shut down the operation of emergency rooms for children due to a lack of workforce.

Only two hospitals in Seoul now run an emergency room for babies and children at night.

Medical students are shunning the subject.

Only 33 medical students applied for 208 posts opened for specialized pediatrics training this year, leaving the application rate at 15.8 percent. The rate previously stood at 74 percent in 2020, followed by 38 percent in 2021, according to the Korean Pediatric Society.

It says the pediatric department nationwide is being operated with only 39 percent of the quota.

"Pediatrics is considered a department with no future," says Lim Hyun-taek, chairman of the Korea Pediatrics Association to the Korea JoongAng Daily.

"If something's not done now, future babies and children of Korea will be deprived of their right to receive medical services."

Lim Hyun-taek, chairman of the Korea Pediatrics Association speaks during a press conference in March where he revealed a devastating state of pediatricians' working environment in Korea. [NEWS1]

Why are they shrinking?

Given that Korea has the lowest fertility rate in the world, it should be a natural phenomenon for the number of pediatrics to decline accordingly.

Last year, Korea's fertility rate, or the average number of children expected per woman, fell to 0.78, breaking its own record of 0.81 from the previous year. And the slide is accelerating.

Korea has had the world's lowest fertility rate since 2013.

But that cannot be the answer to everything because the application rate to obstetrics should shrink as well with fewer pregnant women, but that was not the case.

The application rate to obstetrics departments nationwide increased from 70 percent last year to 79 percent this year.

Even though Korea is faced with an ever-decreasing number of newborns, that does not mean the country does not need pediatricians.

Still, 16 percent of the country's population needs to see them when they are sick and that cannot be substituted by other specialists.

"Handling babies and children is very different to adults in terms of assessment and treatment," says pediatrics professor Baek Hee-jo from Chonnam National University Medical School to the Korea JoongAng Daily.

"Their illness can deteriorate faster [compared to adults] and assessing the seriousness of their state is also different."

Baek added that zero medical students applied for the pediatrics at the Chonnam National University Hwasun Hospital for four open posts.

Low compensation
Doctors assume a high sense of duty, but in the end, it is a means of income too just like any other job.

And in that sense, pediatricians do not find their jobs satisfying.

Pediatricians' annual income was the lowest among all medical subjects in 2020, receiving 108.8 million won ($82,000), according to the Ministry of Healthcare and Welfare.

That is less than one-fourth of cardiothoracic doctors who receive 458.4 million won per year, the highest among all specialties.

When compared with Japan, pediatricians earned an average of 184 million won in a year, according to the Economic Research Institute, 70 percent more than their Korean counterparts.

The medical fee for pediatricians in Korea has stayed stagnant for the past 30 years because the insurance system the medical fee is based on was devised in the 1970s when the average fertility rate hovered well over two. At the time, such low fees worked based on the economies of scale.

"Doctors get 10,000 won per patient today which means they have to see at least 80 patients per day to manage a hospital," says Lim.

"This medical fee used to work where there were a lot of babies and children, but it is a different story now. The birthrate is ever decreasing but how can you maintain a hospital with the same level of medical fee as 30 years ago?"

Vaccinations, which used to be a major source of income for pediatrics clinics and hospitals, are now entirely covered by the National Health Insurance, meaning that their prices are fixed.

"Rotavirus vaccination, which was the last remaining vaccination that wasn't covered by the government, has been absorbed into the National Health Insurance program this year and its price has been downgraded to 30 percent of the existing market price," Lim said.

A sign that reads the clinic is shutting down due to ill-willed report by the parents is hung up at the door of one pediatric clinic in Korea early this year. [FACEBOOK OF LIM HYUN-TAEK]

The so-called 'gapjil'

A pediatrics clinic in Gwangju shut down in July with a sign saying one of the patients' parents made an ill-willed report about the clinic to the local public health center, citing unsatisfying service from the nurse.

"It was my happiness and luck to have served as a pediatrician for the past 20 years but due to the malicious report of [one of the patients'] parents, the clinic will shut down as of Aug. 5," the sign read hung up on the door of the hospital.

"The four-year-old patient whose skin was infected came to my hospital after not getting better at another. At the second visit, the parents even said it was getting better but citing the lack of service from the nurse, the parents filed a false and malicious report. I thought no more medical service would be possible, not because of the patient but because of such a parent."

The report is said to have been made because the nurse did not explain enough about the portion of the medical fee that was not covered by the insurance.

Another pediatrics clinic was reported to have shut down two weeks later due to the same reason — a malicious report by the parents.

Online communities among moms also known as “mom cafes” are very active in Korea. Word-of-mouth on the platform is so strong that a couple of unhappy parents at the hospital can even make the clinics go out of business.

"There are a number of incidents where parents come up to the doctor saying they are an influential member of the mom cafe and ask for free medical services and when they get rejected, they write malicious postings about the clinic in return," says Park Eun-sik, a doctor at a Seoul-based hospital, in his column published on JoongAng Ilbo.

"In fact, I've witnessed cases where pediatrics clinics had to shut down due to such a reason [malicious postings]."

Authorities seize and search the intensive care unit at Ewha Womans University Mokdong Hospital in December, 2017, after four infants consecutively died of infection. [YONHAP]

A continued risk

It is not easy to carry on laborious work at a low fee without a strong sense of duty.

Pediatricians, like all other doctors, are driven by strong pride in taking care of vulnerable infants and love towards children.

But when a medical team at Ewha Womans University Mokdong Hospital's pediatrics department was indicted in 2017 for their negligence of duty leading to the death of four infants in the intensive care room, that sense of pride and duty was demolished.

The infants died of virus infection which led to blood poisoning and the suspected reason behind that was sharing of the same injector and leaving the medicine at room temperature for too long.

After five years of a long legal battle, the medical team was found innocent last year by the Supreme Court. But it was already after all potential pediatrics in the country witnessed that they could end up in jail for their medical service.

The negligence was acknowledged by the court, but there was a lack of evidence to prove the relevance between the negligence and the deaths of infants.

"An infants' intensive care unit is where a lot of deaths happen but when the result is bad, you go to jail. That's what the incident showed," says Lim.

"It was a witch hunt five years ago for people who were found innocent. Medical students, with all the drawbacks, will not want to take that risk coming to a pediatrics department."

Some 800 pediatricians and other physicians gathered at a forum dubbed "No kids zone" in June in order to change their medical specialty which is considered more profitable and less mentally laborious. [YONHAP]

Finding an alternative

Pediatric doctors are opting to alter their medical subjects to something that is more profitable and less mentally laborious.

In June, some 800 pediatricians gathered at one hotel in Seoul to participate in a symposium organized by the Korea Pediatrics Association dubbed "No kids zone" where they learned about Botox, obesity and diabetes among others to alter their specialties.

Increasing the medical fee to attract more soon-to-be-pediatricians is an urgent priority in order to prevent total collapse of Korea's medical service for future babies and children.

Pediatricians are asking for at least a fivefold increase in medical fees, but that is hardly likely to happen any time soon.

The task force team under the People Power Party dedicated to resolving the issue suggested applying different incentive rates for children depending on their age.

That is how Japan overcame its shortage of pediatricians when it was going through a severely low fertility rate 10 years ago.

Medical fees for those under three years old got up to 500 percent incentives based on the treatment. Those under six years old also had their medical fee increased by up to 70 percent.

Overall increases need to be considered further, according to the task force team, because that would lead to an increase in fees in other medical departments as well which will burden the national budget.

"There needs to be an approach that's pan-governmental and comprehensive rather than simple and one-sided solutions such as increasing the quota for medical schools," says Park Yang-dong, Chairman of the Korea Children’s Hospital Association.

BY JIN EUN-SOO [jin.eunsoo@joongang.co.kr]