- Korea's Healthcare System Overview① Number of Physicians
Whether Korea is suffering a shortage of physicians is one of the oldest issues in the medical community. While the government says so, citing health data from the Organization for Economic Cooperation and Development (OECD), doctors oppose to the government’s view, saying the number of doctors is growing too rapidly.
According to the Ministry of Health and Welfare, there were 101,450 doctors, 25,315 dentists, 19,959 Oriental medicine practitioners, 237,744 nurses, and 417,800 pharmacists in the country in 2017. The estimates included those in the non-healthcare sectors.
The number of people per doctor decreased from 588 in 2006 to 503 in 2010 and 440 in 2016. The number of people per nurse also fell from 502 in 2006 to 426 in 2010 and 287 in 2016. In 2017, the total population of Korea stood at 51.78 million.
According to the “2017 OECD Health Data,” Korea has 2.2 practicing physicians and 5.9 nurses per 1,000 people. The figures, which included Oriental medicine practitioners and nursing assistants, are much lower than the OECD average -- 3,3 doctors and 9,5 nurses per 1,000 people. Korea is in the lowest group among OECD members.
The university entrance quota, which is the criteria for new medical workers, is set at 3,058 students for medical schools, 750 for dentistry schools, 750 for Oriental medicine schools, 19,683 for nursing schools, and 1,700 for pharmacy schools. The quota for medical schools has been frozen since 2006. Only, nursing schools have seen their quota steadily increase over the past five years.
However, government officials are worrying that insufficient healthcare workforce will worsen in the future, considering the small number of new medical workers.
The health and welfare ministry said in May last year that Korea would be in need of 7,600 more physicians, 158,000 nurses, and 10,000 pharmacists by 2030. Also, the nation would be in excess of 3,000 dentists and 1,400 Oriental medicine practitioners, the government said, citing the study results of the Korea Institute for Health and Social Affairs (KIHASA). The institute assumed that Korea would maintain the number of doctors per patient at the 2012 level through 2030, based on the 256 working days a year.
Considering the study results, the health and welfare ministry plans to draw up a mid- and long-term supply measure to increase the number of new medical workers, rehire those in rest, and prevent career interruptions.
High physician density with low birthrate, quick aging
Physicians and nurses do not agree with the government, saying Korea does not lack in medical workforce.
The Korean Medical Association (KMA) says the number of physicians is growing fast, and Korea has a high physician density, compared to the size of the land, which makes it unnecessary to increase medical workers.
According to the KMA, Korea’s annual growth rate in the number of physicians per 1,000 people was 3.1 percent on average between 2013 and 2017, much higher than the OECD average of 0.5 percent. Korea’s physician density based on the land size was 10.9, which was the third highest after 16.9 of the Netherlands and 12.5 of Israel.
“The government has a wrong solution because it made a wrong diagnosis. What Koreans are uncomfortable about the medical workforce and what the government should worry about is that there is a wide gap between the largely concentrated medical workers in the Seoul Metropolitan area and big cities and those in provinces,” the KMA said. “The government should analyze the problem more accurately and adopt a strong policy to attract medical labor force.”
The Korean Nurses Association (KNA) also said that Korea suffers a shortage in nurses not because the total number of nurses is in deficit but because a lot of nurses leave the field because of harsh working conditions.
“Due to the poor working environment, Korean nurses’ average turnover rate was high at 33.9 percent in 2015. Their average length of continuous work is only 5.4 years, and the number of nurses on leave is about 100,000,” the KNA said. “So many statistics show that the problem lies not in the total number but the discrepancy between regions and between hospitals.”
Some experts say Korea is not short of doctors and nurses because the nation suffers severely low birthrate and fast aging.
According to Statistics Korea, the number of newborns fell below 400,000 last year for the first time, pushing down the birthrate to a record low of 1.05. The fertility rate refers to an average number of babies that a woman is expected to have during her lifetime between age 15 and 40. The percentage of 1.05 is far below the OECD average of 1.68 (as of 2015) and falls far short of 1.46 of Japan and 1.24 of Singapore, the countries also suffering from low birthrates.
“Because doctors have no retirement age, they can treat patients until they become 75 or 80. Low fertility rate and aging make physicians aged, too,” said Cho Young-tae, a demographer and a professor at Seoul National University's Graduate School of Public Health.
Cho pointed out that it would be difficult for Korea to cover medical reimbursements for more doctors about 20 years later, as national health insurance subscribers will shrink and insurance beneficiaries will grow. The insufficient supply of nurses is more serious than the issue of doctors, he went on to say.
“We’re not short of the number of nurses, but the imbalance between the demand and the supply is the problem,” Cho added.
In Korea, physicians usually make profits by seeing as many patients as they can, because of the low reimbursement rates under the national health insurance system. Cho claimed that the government should adequately reflect such circumstance when predicting demand and supply of medical labor force. Korea spends 7.4 percent of its gross domestic product (GDP) on healthcare expenses, lower than the OECD average of 8.9 percent.
“Because Korea has lower medical spending than the OECD average, Korean physicians have to see more patients than those in other countries. We should talk about whether the quality of Korean medical service is good or bad, considering the ratio of physicians to patients,” Cho added.