South Korea’s special doctor law aims to reduce medical errors and protect human rights by limiting the working hours of doctors. However, there is ongoing debate about the effectiveness of the law, as it may cause difficulties in hospital operations due to labor shortages and overloaded workloads.
In South Korea, on July 31, 2015, Kim Yong-ik, a member of the National Assembly’s Health and Welfare Committee, introduced a bill to improve the training environment and status of specialty doctors. This bill, more commonly known as the Specialty Physicians Act, would limit the working hours of specialty physicians to a maximum of 80 hours per week, with grounds to penalize training hospitals that fail to comply. The bill is controversial in the medical community, with varying opinions. Currently, the residency law is at the center of a heated debate in the medical community.
The case that directly led to the specialty law was the case of Jong-Hyuk Chung in 2010. A doctor who was suffering from excessive work and lack of sleep mistakenly administered an anti-cancer drug to the spinal cord cavity when it was supposed to be administered intravenously, resulting in the death of Jung Jong-hyuk, who was being treated for leukemia.
In June, a team led by Professor Seung-Sup Kim of Korea University published a paper titled “Working Environment, Health, and Perceived Patient Safety among Korean Medical Doctors. According to the paper, the average weekly work hours of medical doctors, including interns and residents, reached 93 hours, and 116 hours for interns. This is more than double the average workweek of Korean workers, which is 41 hours. Compared to the average weekly work hours of 64 hours and 55 hours for U.S. and Australian residents, respectively, Korean residents work very long hours.
As a result of these working conditions, 89.3% of interns and 68.6% of residents reported that they have fallen asleep on duty, and 13.8% of interns and 8.7% of residents reported that they have committed medical errors.
Amid the controversy, the Ministry of Health and Welfare changed the ‘Regulations on the Training and Qualification of Specialists’ in July last year, allowing doctors to work a maximum of 88 hours per week. However, there is no way to sanction non-compliance, and many hospitals have resorted to creating and submitting ‘fake timetables’ to claim labor shortages. “There are many doctors who create a separate timetable for their actual work and one for reporting to higher authorities,” said Song Myung-jae, chairman of the Korean Medical Association, adding, ”It is not easy to reduce the working hours of doctors without additional manpower.” Lim Eul-ki, head of the Medical Resource Policy Division at the Ministry of Health and Welfare, said, “I agree with the overall direction of the bill,” but added, “We need to consider whether a special law is desirable or whether it should be reflected in the existing medical law.”
The special law is a bill that faces many practical barriers to implementation. The effectiveness of the law is low and it has more side effects than benefits. As mentioned above, phenomena such as working overtime and being forced to fill out false logbooks will become widespread. In addition, doctors who are required to do more in a shorter time will be more stressed, which will greatly increase the risk of problems. In addition, there will be serious management difficulties due to lack of manpower, and hospitals may not be able to operate properly.
Patients’ health is also at risk. If the specialty law is enforced, the quality of medical care will decrease due to a shortage of medical personnel. “If you go to a hospital and there is an emergency due to a lack of manpower, the patients’ lives are at risk,” said Dr. Woo Go-woon, chief of surgery at KEPCO Hospital, at a session on surgical education and research at the 2013 Korean Medical Association conference in Coex. As healthcare is a matter of life and death, the shortage of medical personnel must be prevented. The financial burden of hiring additional healthcare workers to make up for the shortage is too high, and it’s difficult to find qualified workers. In this situation, it is unrealistic to push for such a policy when there is no alternative.
Secondly, the quality of resident training is also problematic. Limiting the number of working hours per week will lead to a decrease in the quality of training due to insufficient training time. Especially in fields that require a lot of hands-on practice in the operating room, such as surgery, the 80-hour work week will greatly reduce the opportunity to learn.
Those in favor of the specialty law make the following arguments. First, it is argued that it is more meaningful to have a small number of people with normal conditions than a large number of people with abnormal conditions. This argument has some merit. Although there will be fewer people in the hospital than there are now, it is possible that the condition of the workforce will be generally better due to the guarantee of sufficient sleep time. However, this argument can be refuted as follows. The presence of an adequate number of staff is essential for the operation of a hospital, some of whom are responsible for small tasks, and operating with a small number of staff will make it difficult to pay attention to these small tasks and make it difficult for the hospital to operate properly.
Next, there is an opinion that the probability of medical accidents will increase, and there is no solution to this. Of course, it’s true that overwork and poor physical condition can increase the likelihood of medical accidents. However, the risk of medical accidents can also be increased if the work is concentrated in the hands of a small number of people. If the incidence of accidents is similar in both cases, how quickly they are addressed becomes a much more important issue. When an accident does occur, having enough people on hand can help you respond quickly and accurately to prevent further damage. Therefore, not implementing a cap is more favorable in this regard.
Finally, the most common argument in favor of a cap is the human rights of doctors. However, which is more respectful of the human rights of doctors: limiting their working hours and increasing their workload per unit time or the current situation? In my opinion, it is difficult to say that the former is more respected. And even if the comparison between the two leads to a similar conclusion, the reason why we should not implement a cap is that it is much more reasonable to not implement a cap in terms of ensuring the human rights of patients.
Currently, South Korea’s healthcare workforce is far short compared to the OECD average. According to a lecture given by Yonsei University Professor Jung Hyung-sun at a healthcare organization, the number of active doctors per 1,000 people is 1.7, far below the OECD average of 3.1. Among the major OECD countries, only Turkey has fewer than 1.5. The number of doctor visits per year is 11.8 in South Korea, well above the OECD average of 6.8, with only Japan at 13.6 and the Czech Republic at 12.6 having higher rates. The number of medical consultations per year is also the highest in the OECD at over 7200, nearly tripling the OECD average of 2,515. In other words, Korea has a very high number of patients per doctor due to the small ratio of doctors and the high number of visits.
Implementing specialty laws will further strain the already scarce medical workforce. This is a selfish attitude that seeks to protect the human rights of doctors while completely ignoring the human rights of patients who desperately need help. Doctors are an important profession that directly deals with human life and health. It’s no wonder that a lot of preparation and hard work goes into becoming a doctor. If the training process is loosened, it will cause a huge ripple effect in the medical community and threaten the health of the public. Therefore, it is not advisable to cap the working hours of doctors at 80 hours.
