The plan to expand medical education has led to strikes by medical students and doctors at a time when South Korea is seeing a resurgence of coronavirus cases.
The clinical section of the licensing exam originally scheduled for 1-18 September has been postponed by a week, Korean Vice Health Minister Kim Kang-lip told media on 31 August.
According to the Korean Medical Student Association, just over 93% or 2,832 out of 3,172 final-year students at six-year medical colleges and four-year medical graduate schools who registered for the 2021 medical licensing exams normally held in September and October had cancelled their applications as part of the boycott.
Medical students also refused to attend clinical training and said they would boycott classes as well amid fears that this could impact training for several years. Some 84% of trainee doctors have taken part in strikes that began on 21 August, according to government figures released on 31 August.
Medical students began an indefinite strike after phased walkouts from 21 August over government plans announced in July to increase the number of medical school admissions by 4,000 between 2022 and 2031, a rise of around 400 students a year, in particular to improve rural health care. Current medical places have been restricted to some 3,058 a year since 2006.
The government also announced a new school of public medicine with an intake of 50 students a year, the introduction of telemedicine and proposals to allow medical insurance to cover more traditional medicines.
The Korea Association of Medical Colleges on Monday urged the government to delay the clinical exams for at least two weeks, or until the COVID-19 situation stabilises. The written portion of the exam will normally be held in January 2021.
Some trainee doctors agreed to volunteer their services for COVID-19 treatment during the strikes.
The country has seen three-digit daily increases in COVID-19 cases for the past 20 consecutive days with a total of 20,000 cases in its second wave, which started last month. South Korea had been widely praised for successfully containing the number of cases during its first wave earlier this year as cases subsided in April and early May. Schools had been reopened in May.
On 25 August the authorities ordered the closure again of all schools in the Seoul area, with remote learning continuing until 11 September, the education ministry said. Universities have extended their online classes.
More students for rural areas
The government said that under its plan, which it said would enable it to cope with future epidemics, around 300 of the extra 400 medical trainees a year would be for rural provinces, with tuition fee waivers and scholarships on condition they stay for 10 years.
Another 100 students of the increased intake would be required to specialise in fields such as epidemiology, trauma and biomedical research areas that are currently less popular among medical students due to heavy workloads.
The main reason for promoting this policy is to secure doctors where they are needed, Health Minister Park Neung-hoo said.
Currently only around 10% of registered doctors work in public health due to poor conditions, while doctors are concentrated around Seoul and other cities, increasing competition for hospital jobs.
Students said rather than increasing the numbers, the government should use the money to improve the dire conditions and pay of existing medical students and junior doctors and divert some of the funds intended for training additional students to cash-strapped rural hospitals. They argued the problem is not a shortage of doctors in rural areas but rather a need to tackle underlying issues behind poor healthcare in the regions.
Currently, some students have already been admitted to medical schools with lower grades as regional doctor candidates who must work in a provincial area for 10 years including the training period. Critics say this has led to a two-tier system, while regional doctors complain of working with poorer facilities and conditions in rural areas compared to their city counterparts.
Kim Ki-deok, vice-president of the Korean Medical School Students Association, who is among those boycotting the licensing exam, said the boycott was equivalent to a one-year strike by trainee doctors.
Kim noted the governments plan to open a new public medical school came in less than three years after it forced the closure of Seonam University medical school, which Kim said faced difficulties in hiring professors and establishing a training hospital.
Some 49 Seonam University students were scattered to neighbouring medical schools to attend classes, he said.
Seonam University was also dogged by quality issues and poor management and financial issues, according to government audits.
The proposal to set up a medical school specialising in public medicine is not new. A previous government plan set out in 2016 to build a national university of public health an area that is not lucrative for private hospitals was strongly opposed by the medical community and had to be abandoned.
Pressure as doctors threaten to join strikes
The government has been under significant pressure as the Korean Medical Association (KMA), representing some 130,000 doctors, held a three-day walkout at the end of August protesting at the governments proposals, and have warned of an indefinite strike from 7 September. Doctors have been covering for striking medical students interning in hospitals.
Hospitals have complained about the strain on emergency and intensive care units and concerns as the number of COVID-19 cases were rising.
Professors at university hospitals are also warning of collective action to support striking trainee doctors. At the prestigious Seoul National University (SNU), professors joined striking SNU medical students this week. Around 83% of SNU medical students were on strike on Monday.
Bolstered by surveys that indicated that 58% of the public do not support the medical strikes, Health Minister Park Neung-hoo issued an unprecedented order this week to force all residents (postgraduate medical students) and fellows (graduate specialist medicine trainees) working in Seoul and the neighbouring areas of Gyeonggi and Incheon to return to work immediately.
We tried our best to negotiate to prevent a collective strike by the doctors associations amid the serious possibility of a mass contagion of COVID-19, but the KMA and the Korean Intern Resident Association rejected the governments compromise and went through with the strike, Park said at an emergency press briefing on Wednesday.
Now the government has no choice but to issue a commencement-of-business order and other necessary legal measures for the sake of protecting the peoples lives and safety.
Park warned that violations of the order could be punished with a jail sentence of up to three years, or a fine of up to KRW30 million (US$25,200) and medical licence revocation. The threat has angered doctors who appeared more willing to join the strikes in support of students.
Despite its outward hardline stance, the government appeared to be softening. The government already unconditionally halted forwarding policies on expanding the medical school admissions quota to the education ministry until after the COVID-19 crisis, a senior health ministry official, Yoon Tae-ho, said in a 1 September media briefing.
KMA President Choi Dae-zip said: The government is threatening to accuse us and press charges against us, pushing the medical community into a corner, and added: In this situation, doctors cant have a dialogue with the government.
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