Are doctors really a special class?

Suh Kyoung-ho
The author is an editorial writer of the JoongAng Ilbo.

I was curious what medical doctors’ protest would look like, so I visited a rally held in Yeouido, western Seoul, a few days ago. Large placards, carrying slogans such as “We oppose medical reform that increases the public’s burden,” “End the essential medical policy package,” and “Start discussions on the increase of medical school admission quota from the beginning,” were displayed.

Some protesters wore black face masks bearing slogans that said, “Reconsider [the increase of medical school admission quota].” They carried mugshots of Vice Minister of Health and Welfare Park Min-soo and Kim Yoon, a professor of medical management at Seoul National University. Doctors have made the two figures “public enemies,” meaning they have been at the forefront of medical reform until now.

The protesters took a photo with an executive of the Korean Medical Association (KMA), who had made frequent TV appearances and who had been barred from leaving the country after facing a criminal complaint from the Health Ministry. He was the very executive who had defended the high salaries of doctors by saying, “Is it too much for a doctor, who opens a clinic at the age of 40 after internship, residency and fellowship programs, to earn 280 million won ($210,000) to the point that it should be condemned?” (The money is the average annual income a doctor with a private practice in the National Tax Service report.)

It felt uncomfortable to see that doctors were arguing as if they were victims of persecution. They likened the resident doctors to self-sacrifices. It looked absurd. The biggest victims are the critically ill who cannot get surgery in time.

Doctors criticized the medical school admission quota increase as populism by the government targeting the April 10 parliamentary elections. There is some truth to that. But what is clear is that 76 percent of the people favor the policy, according to a Gallup Korea survey. Populism has a side of anti-elitist character. Elitism is not all bad, but the public gets furious when it comes to elites trying to hold on to their benefits.

“Medical Reform. This is the last chance,” read an advertisement of the government on the front pages of newspapers that ran earlier this week. It is absolutely true. Korea is ranked at the bottom of the OECD list with 2.1 doctors per 1,000 people. The demand for doctors is rapidly increasing due to the aging population. Even if we increase the medical student quota now, specialists will not be available for another 10 years. This is not a task that can be put off.

Of course, increasing the quota is not the only solution. The government must have specific discussions with doctors to rationalize the prices of essential medical services and improve medical situations in rural areas. But none of these problems can be solved without increasing the number of doctors first.

One of the arguments by doctors is the “trickle-down theory.” The government hopes that increasing the number of medical students will encourage doctors to enter the unpopular field of essential medical services, but doctors claim that it will hurt the pride of doctors who already work in the fields of primary medicines with a sense of mission. They asked who would want to get medical treatment from the “trickle-down” doctors.

Doctors in this country seem to have too many “big worries.” They are concerned about everything from public health to finances of the national health insurance program, engineering university education and the deterioration of the medical industry. Due to the KMA’s concerns, many things were blocked. Remote medical treatment is still a pilot project, and legalizing tattoos has made no progress. Efforts to establish a law governing nurses failed. The measure to simplify the insurance claims process of medical expenses was finally passed by the National Assembly after 14 years. At this point, it is hard to take doctors’ arguments at face value.

Most of the doctors I know personally, such as my family doctor, friends and colleagues, are decent people. But as a group, they don’t seem to be. Is it perhaps because individuals may be moral, but a group tends to be more selfish, as philosopher Reinhold Niebuhr pointed out in “Moral Man and Immoral Society”?

Doctors contend that they oppose, at all costs, an increase in the enrollment quota for medical schools without an agreement with the doctors’ community. It is unreasonable for the stakeholders in the government policy to insist on an “agreement” with them, not a consultation. Their argument that doctors should be in charge of the supply of physician licenses makes no sense. “No privileged caste shall be recognized or ever established in any form,” our Constitution stipulates. Doctors cannot be an unconstitutional — and extraordinary — class with privilege in Korean society.