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hello!
If you hold on today and tomorrow, it will be the Lunar New Year holiday before you know it.
After the New Year's Day, we will now welcome the New Year on both the solar and lunar calendars, so I'm really going to keep my head upright and put my New Year's resolutions into practice.
Last week it was warm, but this week it got really cold, right?
It is said that a strong cold wave will hit during the Lunar New Year holiday, so I hope you are doing well.
It's sad to be sick from the new year.
Speaking of taking care of yourself, readers, when was the last time you went to the hospital?
Last year, I went to the hospital for the first time in a while, and I remember being surprised by the number of people there.
There were times when it was difficult to get a doctor during lunchtime, so I had to turn around a few times.
By the way...
Have you ever had this happen while you were away from the hospital?
There are no doctors (!) or there are no medical departments (!!).
The story prepared by Mabu News today is the story of the medical vacuum due to the shortage of doctors.
What if you go to the hospital and there is no doctor?
I want to see a doctor, but the pediatrician doesn't have a doctor.
In the first half of 2023, there were a total of 207 majors who needed pediatrics at training hospitals across the country.
But only 33 of them applied.
The competition ratio was 0.16 to 1.
But wait, what is a training hospital and what is a resident?
To understand this clearly, you need to know the process of becoming a doctor.
I'll clean up for a while.
To become a doctor, you must either study at medical school or go to medical school.
After studying at a medical school or medical school and obtaining a medical license, you go through an internship at a training hospital.
A training hospital is a hospital that trains and educates doctors.
The word training may be unfamiliar to you, but it is training when you are training your mind.
In training hospitals, medical skills and academics are honed and trained.
If you select and study a major subject for 3 to 4 years as a major at a training hospital and pass the specialist qualification test, you will acquire the qualification of a specialist in that major subject.
In other words, “33 out of 207 pediatric majors at training hospitals across the country were supported” means that there is a serious shortage of young doctors who will be in charge of pediatrics in the future.
In fact, the phenomenon of avoidance of children and adolescents is not a thing yesterday or today.
Already in the past, the number of majors applying for pediatrics has been decreasing little by little.
So, in December of last year, there was no pediatric specialist at Incheon Gachon University Gil Hospital, leading to a situation where pediatric inpatient treatment was stopped.
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The shortage of doctors is not unique to pediatrics.
With the recruitment data of majors conducted in the first half of this year, we showed the competition rate of major subjects.
Is it perfectly split up and down?
The top is the subject that received more applicants than the number of seats, and the bottom is the subject that did not.
Among the major subjects, the subject with the highest competition rate was ophthalmology.
See ophthalmologist's over-applicants section.
The ophthalmology department had a recruitment quota of 95, but the number of applicants was 166, and the competition rate was 1.75 to 1.
Following ophthalmology, the Department of Rehabilitation Medicine recorded a high competition rate of 1.61 to 1, with 155 applicants applying for a quota of 96.
Departments of ophthalmology, rehabilitation medicine, plastic surgery (1.59 to 1), and dermatology (1.41 to 1) are proud of the number of applicants.
On the other hand, departments of pediatrics, family medicine, surgery, thoracic surgery, and obstetrics and gynecology are recording an under-quota.
If you look at the subjects that do not meet the quota, unfortunately there are many essential medical subjects.
In order to become a general hospital, it is essential to have the main medical departments stipulated by the Medical Act.
For example, in a hospital with 100 to 300 beds, three of the four departments of internal medicine, surgery, pediatrics, and obstetrics and gynecology are required.
However, if you look at the recruitment results for the first half of 2023, all of the four subjects, except internal medicine, are underserved.
Among them, the situation in pediatrics is the most serious.
The Department of Pediatrics received a disastrous report card with only 16% of the 100% quota being filled by applicants.
I want to see a doctor, but there is no doctor in my town.
There are also differences by subject, but a bigger problem is regional differences.
In fact, even if it is a subject to be avoided, it does not mean that there are no doctors at all.
The problem is that even if there is, it is concentrated in the metropolitan area.
Since the majority of essential medical subjects are avoidable subjects, it is difficult to receive treatment for essential medical subjects outside the metropolitan area.
Mabu News looked at the data directly to see how serious the situation was.
The data looked at by Mabu News are data from the health care big data open system operated by the Health Insurance Review and Assessment Service.
Among the open APIs provided by HIRA, I analyzed all 76,238 hospitals across the country, which subjects were treated, and how many doctors there were by subject, using the detailed information service by medical institution.
Open API call time is January 16th.
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The figure above is a graph showing the distribution of doctors in four major medical subjects (internal medicine, surgery, pediatrics, and obstetrics and gynecology) among the essential medical subjects.
More than half of doctors in all four subjects were concentrated in the metropolitan area.
The subject with the highest concentration in the metropolitan area was obstetrics and gynecology.
Out of a total of 5,221 obstetricians and gynecologists, 2,881 were doctors working in the metropolitan area, or 55.2% of the total.
54.2% of the total 17,510 doctors in the internal medicine department were located in the metropolitan area, and even in the metropolitan area, internal medicine was the only one where more than half of the doctors were concentrated in Seoul.
Among the four subjects, I will focus a little more on obstetrics and gynecology.
If you calculate the number of obstetricians and gynecologists per 100,000 people in Korea, you get 10.1.
Out of 250 cities, counties and districts nationwide, there are as many as 186 areas where the national average number of obstetricians and gynecologists is less than 10.1.
To examine the variation in more detail, we calculated the number of obstetricians and gynecologists with a population of 100,000 by city, county, and district nationwide.
If you look at the picture below, you can see how much there is a shortage of obstetricians and gynecologists in other regions compared to the metropolitan area and metropolitan cities.
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The gap between areas with good access to obstetrics and gynecology is so large that you have to scroll for a while to come down.
Daegu's Jung-gu had the highest number of obstetricians and gynecologists per 100,000 people.
The number of obstetricians and gynecologists in Jung-gu, Daegu is 4.7 per 100,000 people.
There were only four regions in the country where the number of obstetricians and gynecologists per 100,000 people exceeded 4, and all of them were in Seoul, except for Jung-gu, Daegu.
Gangnam-gu, Seoul came second with 4.6 people, followed by Jung-gu and Jongno-gu.
There are 23 places without gynecologists at all.
It was mostly fat.
Only one area was included in the metropolitan area, and that was Ongjin-gun, Incheon.
Including Ongjin-gun, there is no gynecologist in 1 Chungbuk, 3 Jeonbuk, Gangwon, Gyeongnam, 4 Jeonnam, and 6 Gyeongbuk.
What should I do if I want to have a child but there is no obstetrics and gynecology, and even if there is an obstetrics and gynecology, there is no delivery room?
Even the government provides support such as emergency transportation and outpatient treatment for mothers in these areas.
Although it is said to provide support such as emergency medical transportation, it is actually quite dangerous.
The data also reveals the risk. Let's look at the maternal mortality ratio data, which represents the number of maternal deaths per 100,000 live births.
The maternal mortality ratio in Korea in 2019 was 9.9.
By region, Seoul has the lowest number at 5.6.
On the other hand, the maternal mortality rate in Gangwon-do is 24.1.
As of 2019, among OECD countries, only Colombia, Latvia, and Mexico have higher maternal mortality rates than Gangwon-do.
There are no doctors in charge of not only obstetrics and gynecology, but also other essential medical subjects such as internal medicine and surgery.
To get surgery, you have to go on an expedition to a big city with doctors and facilities.
It is very important to shorten the time in an emergency situation that requires urgent surgery, but it is easy to miss the golden time in outpatient medical care.
In fact, there are cases where patients die during transport.
Readers, have you ever heard of a treatable mortality rate?
Curable mortality rate is a measure of the number of patients who are curable but die because of a lack of medical infrastructure.
As of 2015, if you look at the treatable mortality rate per 100,000 people, Gangnam-gu, Seoul, has 29.6 people, but Yeongyang-gun, North Gyeongsang Province, has a whopping 107.8 people, showing a gap of more than three times.
Q. What is the government-managed standard for childbirth vulnerable areas?
The Ministry of Health and Welfare is carrying out a medical support project by selecting areas vulnerable to childbirth for the health of mothers and newborns.
Areas vulnerable to childbirth are divided into grades A and B, and the criteria for dividing the grades are as follows.
① First, whether the utilization rate of childbirth within 60 minutes is less than 30%, ② Second, whether the percentage of the population who cannot access a medical institution capable of giving birth within 60 minutes is over 30%.
If you look at the criteria, you are trying to determine whether childbirth medical services are available to mothers and whether they can access such medical institutions within an hour.
If both criteria are met, it corresponds to a grade A of childbirth fragility.
As of the 2021 business standard, all 30 regions are grade A in our country.
Areas that meet only one of the two criteria are classified as grade B, which makes a total of 18 areas.
Physician Veterinary Issues vs Operations Management Issues
If there is no doctor applying for the major subjects that require medical treatment, and there is no doctor in the province...
Wouldn't the solution be to increase the number of doctors?
However, opinions are divided over the plan to increase the number of doctors.
Some people claim that there are few doctors in Korea, and others say that the number of doctors is not a problem.
I will introduce two data from now on, but I think it would be good for readers to judge for themselves.
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First is a statistic often cited by those who say there is a shortage of doctors in our country.
This is the number of doctors per 1,000 population among OECD countries.
According to OECD statistics, as of 2019, the number of doctors per 1,000 population in Korea is 2.4.
Korea ranks 34th out of 38 member countries, which is quite low.
After Korea, there are only Mexico, Poland, Colombia and Turkey.
The average of OECD member countries is 3.6, so it is true that the number of doctors in Korea is quite below the average.
The second data to look at is the number of doctors per country area.
It is important to use data on the number of doctors to compare medical services, but another thing that should not be overlooked is spatial accessibility.
This is because you can check whether the hospital is located within an appropriate travel time and is in a situation where you can receive medical treatment through spatial information.
This is the reason why space accessibility is included along with medical facilities in the criteria for vulnerable places for childbirth as discussed above.
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The territorial area of the countries referenced The World Factbook published annually by the US Central Intelligence Agency (CIA).
Based on this standard, if you look at the number of doctors per 10 km2, Korea comes out with 12.8.
The only OECD member countries with more doctors per unit area than Korea are the Netherlands (15.6) and Israel (13.4).
With the same number of doctors, some are saying that they are not enough and others are saying that they are enough.
Now the government is in the position that the number of doctors is insufficient.
So, we are focusing on increasing the number of doctors right now.
The current admission quota for medical schools is 3,058, and this quota has not changed for 18 years since 2006.
The government is considering a plan to increase the quota of medical schools to expand doctors in areas and subjects that are lacking.
Similar voices are also coming out from civil society organizations.
Gyeongshilyeon is urging that public medical schools should be newly built in medical vulnerable areas such as Incheon, Jeonnam, and Gyeongbuk.
In fact, this government is not specifically trying to fix the garden of medical schools.
The previous government also promoted a plan to train 4,000 additional doctors over 10 years at the time of 2020, but the discussion was stopped because doctors' groups opposed it.
As in 2020, medical associations are still opposed to increasing the number of doctors.
The Department of Pediatrics, which is one of the most understaffed subjects, is also opposing it.
The president of the Association of Pediatricians is holding a one-person protest.
The Medical Association insists that even if more medical students are recruited, people will go to popular departments and not to difficult ones.
Increasing the number of doctors alone without inducing policies for essential departments and local hospitals cannot solve the medical vacuum.
What do you think, readers?
The damage continues to pile up
When parallel lines continue to run between governments and doctors over health care, it is those of us who receive health care who suffer in the end.
We need to find a solution sooner than that.
Even if the government plans to increase the quota of medical schools right away, it usually takes 12 years to go through the curriculum and enter the market.
While waiting for 12 years, the medical vacuum and regional disparities we are experiencing now can grow.
Even in the additional recruitment after the first half of the recruitment, the average competition rate with children and adolescents fell further, reaching 0.12 to 1.
Gil Hospital, which temporarily suspended his inpatient treatment, eventually failed to secure additional staff.
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