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The government ‘gives in’ every time there is collective action due to the hospital’s workforce structure relying on medical residents.

Experts say, “We need to reduce the proportion of majors and reorganize to focus on specialists.”

We also need strike preparation measures… “We need to consider institutionalizing PA nurses to replace some of the doctor’s work.”

The continued escape of medical residents

The continued escape of medical residents

(Seoul = Larose.VIP) Reporter Oh Jin-song = With medical residents leaving hospitals in droves in opposition to the expansion of medical schools, a medical crisis has become a reality, and there are concerns that the government may be ‘surrendering.’

Because large hospitals, which are mainly visited by seriously ill and emergency patients, have an abnormal staffing structure that relies too much on residents, the government has no choice but to give in every time residents leave the hospital.

If this situation is repeated in the future, our country will have a serious health care system in which only the demands of the doctor group are unilaterally met.

Accordingly, experts suggest that structural improvements should be made quickly, such as reducing the reliance on medical residents in large hospitals, reorganizing the hospital workforce structure to focus on specialists, and institutionalizing PA (Physician Assistant) nurses to create a ‘backup’ workforce in the event of a strike. do.

Disruption of normal medical treatment due to gap in residency

Disruption of normal medical treatment due to gap in residency

◇ 40% of doctors at large hospitals are ‘residents’… Every time there is a collective action, a ‘medical crisis’ occurs.

The Ministry of Health and Welfare announced that as of the 22nd, 7,863 people, or 69.4% of all residents, were confirmed to have left their workplace after submitting a letter of resignation.

Accordingly, Seoul’s major general hospitals, known as the ‘Big 5’ hospitals, are experiencing a ‘medical crisis’ by reducing surgeries by 30-50% and even postponing surgeries for cancer patients.

This isn’t the first time something like this has happened.

Residents caused a medical crisis by taking a collective leave of absence when the division of medicine was implemented in 2000, and also took collective action in 2020 when the government promoted the expansion of medical schools and the establishment of public medical schools.

As patient losses continued to increase and the medical system was on the verge of collapse, the government had no choice but to ‘surrender’ every time. They had to step back by withdrawing the policy or appease the residents by presenting various ‘carrot solutions’.

Residents holding signs opposing the government's expansion of medical school seats in 2020

Residents holding signs opposing the government’s expansion of medical school seats in 2020

The background to why medical residents exert such powerful power is the abnormal human resources structure of domestic medical institutions that are overly dependent on medical residents.

A resident is a general term for interns and residents who have received a medical license, but who ‘work and receive education’ at a teaching hospital to become specialists in a specific subject.

According to statistics from the Health Insurance Review and Assessment Service, the number of residents at the Big 5 hospitals is 2,745, accounting for 40% of all doctors (7,042).

In particular, at Seoul National University Hospital, residents account for 46.2% of the total. This was followed by Severance Hospital at 40.2%, Samsung Seoul Hospital at 38.0%, Seoul Asan Medical Center at 34.5%, and Seoul St. Mary’s Hospital at 33.8%.

The reason large hospitals rely on residents like this is because residents are relatively ‘cheap’ human resources.

According to the results of the 2022 survey of majors by the Daejeon Council, the average monthly wage of majors is only 3,979,000 won.

This is only the minimum wage in return for working an average of 77.7 hours per week.

Because of these low labor costs, large hospitals have been utilizing residents by assigning them to various tasks such as surgical assistance, emergency room operation, medical treatment assistance, and on-call work.

Vacancies in specialization, burden on the medical staff left behind

Vacancies in specialization, burden on the medical staff left behind

◇ “We need to reduce dependence on majors and reorganize to focus on specialists.”

Experts say that in order to improve the structure that is excessively dependent on medical residents, the hospital workforce structure should be reorganized to focus on ‘specialists’ who have completed both internship and residency training.

Shin Young-seok, a professor at Korea University’s Graduate School of Public Health, said, “Residents are both trainees and workers, but they have been playing more of a worker role. Now, we need to change this structure and move to a specialist-centered system.”

He added, “However, it is inevitable that costs will increase if more specialists are hired.”

In the past, with the enforcement of the Resident Act, the working hours of residents were limited to 80 hours per week, and a ‘hospitalization specialist’ system was introduced to fill the shortage of manpower. This means that if additional specialists are hired as was done at the time, costs will inevitably be incurred.

Professor Shin emphasized that for this purpose, it is necessary to increase the number of medical schools.

He emphasized, “We must solve the accumulated problems one by one,” adding, “To increase the supply of specialists, we must naturally increase the number of doctors, and increasing the number of medical schools is the first step.”

The government also announced plans to gradually change the human resources structure so that hospitals can be operated centered on specialists.

In the recently announced ‘Essential Medical Package’, the Ministry of Health and Welfare announced that it will encourage the hiring of specialists by calculating 1 resident as 0.5 when determining whether to secure medical personnel when establishing a new medical institution.

It was decided to expand the employment of specialists, compensate hospitals that reduce the delegated work of residents with ‘additional fees’, and also promote long-term contracts for specialists, parental leave, and guarantee of research years.

Patient heading to ambulance for medical treatment

Patient heading to ambulance for medical treatment

◇ A ‘backup’ system is also needed in preparation for strikes… “We need to discuss institutionalizing PA nurses”

Some say that in order to prevent repeated group actions by residents and the resulting damage to patients, non-face-to-face treatment should be expanded and medical assistants, such as PA nurses who take part of doctors’ duties, should be brought into the system.

This means that even if a group action occurs among majors, a ‘backup system’ must be created as a buffer to absorb the shock.

As mass resignations of medical residents continued, the government announced on the 23rd that it would temporarily expand non-face-to-face medical treatment.

Until now, non-face-to-face treatment was only allowed for first-time patients in medically vulnerable areas, weekends, and public holidays, and in principle, it was only allowed at clinic-level medical institutions and returning patients.

This time, non-face-to-face medical treatment has been fully expanded, making it possible for the time being to receive non-face-to-face medical treatment on weekdays even in areas that are not medically vulnerable or for the first time.

A medical expert said, “Even patients with mild symptoms or non-severe chronic diseases have been using large hospitals a lot. If they can see treatment and receive prescriptions non-face-to-face, the burden on large hospitals can be greatly reduced.” .

Busy nurses

Busy nurses

There was also a suggestion that a full-fledged discussion on ‘work division’ between health care professions should begin, such as training medical assistants such as PA nurses.

PA nurses perform tasks such as assisting doctors in surgeries, examinations, and emergency situations, and have virtually replaced some of the medical services of doctors.

It is known that more than 10,000 people are active across the country, but since it is not an institutionalized translation according to the law, it can be said to be on the border between legal and illegal.

The issue of PA nurses surfaced in May last year when the enactment of the Nursing Act was defeated, and nurses declared that they would not engage in ‘illegal medical practices’ and began fighting for compliance with the law.

The government announced that it would consider using PA nurses to respond to collective action by medical residents, and also decided to establish a specific protection system so that nurses can work with legal protection.

Professor Shin Young-seok said, “If you look at the cases of other countries, many of the areas of work that doctors used to do in the past have been transferred to other occupations,” and added, “If Korea also realistically divides work, we will be able to provide medical services to the people at low costs without losing medical quality.” “He said.


Report to KakaoTalk okjebo 2024/02/25 06:11 Sent

[의료대란 일주일]⑤ “I hope doctors talk and the government opens a way out.”
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