SEOUL – In March 2023, a 17-year-old girl who fell from a building in the South Korean city of Daegu died after her ambulance was turned away by three hospitals that lacked doctors to treat her.

She was among more than 3,750 patients who have died since 2017 after local hospitals refused to provide care, a report by Professor Cheong Yooseok from Dankook University in Cheonan city shows.

The startling statistic from one of Asia’s richest countries has become a major issue in the parliamentary elections taking place on April 10. While the country won acclaim for its low fatality rate during the Covid-19 pandemic, the focus now is on inefficiency, waste and skewed economic incentives in the healthcare system. 

Renowned medical centres in the capital Seoul are overwhelmed by patients, while the rest of the country struggles with a lack of physicians. A six-week-and-counting national walkout by nearly 13,000 residents and interns protesting against a plan to boost medical school enrolment has exacerbated the situation.

Mr Jung Seung-pyo, an esophageal cancer patient who lives on Jeju Island, flew to Seoul National University Bundang Hospital for surgery in June 2023. While he is supposed to have check-ups every four weeks, sometimes it takes several months to get an appointment.

“There’s no doctor at all on this island who can treat esophageal cancer,” Mr Jung said of his hometown, which has a population of almost 700,000 people. “Everything is so concentrated in Seoul.”

South Korea has among the fewest doctors per capita of all developed countries and has not increased the number of medical students in more than two decades, said Mr Gaetan Lafortune, a senior economist at the Organisation for Economic Cooperation and Development. Demographic factors like a rapidly ageing population will exacerbate the scarcity, he said.

South Korean President Yoon Suk-yeol has vowed to address the crisis. He proposed measures, like increasing the number of doctors, that have drawn complaints for being “populist moves” ahead of the election to select the 300-member National Assembly.  

While his conservative People Power Party is in power, he is trying to flip dozens of seats held by his progressive rivals, led by the Democratic Party, to take control of the national legislature. 

The healthcare system is “collapsing”, Mr Yoon said at a public hearing in February. “Now is the golden time to push reforms.” 

Yet the doctors themselves oppose efforts to expand physician supply, arguing that the government’s proposal to increase medical school enrolment by 2,000 spots a year from the current 3,058 does not address the root problem. 

This, they say, is that doctors’ pay in some critical fields covered by the country’s National Health Insurance system is far lower than that for outside specialists, especially those who do cosmetic and aesthetic procedures. The disparity in compensation and infrastructure between Seoul and rural areas also means a dearth of medical workers outside the capital.

“Doctors are disappearing at emergency centres, surgery rooms, delivery rooms and hospitals in smaller cities,” said Prof Cheong in a December report. “Many young doctors gave up becoming fellows at medical colleges and work in the beauty industry.” 

Cosmetic surgery has aggressively taken hold and medical tourism is booming in South Korea. More than eight million foreign patients arrived between 2009 and 2022, many for the beauty industry that offers ubiquitous access to plastic surgery, Botox for US$6 (S$8) per shot and laser skin tightening. 

Meanwhile, essential fields including paediatrics have been hard hit. Only 53 residents applied to fill 205 paediatric slots for 2024, and just eight were outside Seoul and its surroundings, according to the health ministry. For paediatric surgery, two trainee doctors applied for spots outside of the greater Seoul area. 

In June 2023, the Korean Paediatric Society held a conference, How To Exit Paediatrics, focused on learning about other disciplines including cosmetic surgery. The seminar was held at the behest of members who said the country’s ultra-low birth rate made it difficult to run paediatric clinics, officials said in a television interview with Channel A.

The situation is dire in most parts of the country.  

More than half of South Korea’s 114,000 doctors and dentists worked in Seoul or Gyeonggi province in 2022, according to the Health Insurance Review and Assessment Service. 

Hiring doctors outside the capital is tough, said Dr Cho Seung-yeon, president of Incheon Medical Centre. He could not find anyone to lead the dialysis division for two years. Another public hospital offered US$1 million for a cardiologist, he said. 

Salaried doctors at private clinics can earn in excess of US$300,000 annually, while those on their own make even more, he said. Dr Cho offers US$200,000 a year for physicians at his public hospital in Incheon, but he said few ultimately come.

Even in Seoul, medical care can be tenuous given the doctor shortage. Mr Kim Sung-ju, a 62-year-old who had surgery for esophageal cancer a decade ago, undergoes a battery of tests and waits hours for a brief visit with his doctor at Seoul St Mary’s Hospital in Gangnam, an upscale neighbourhood in the city’s south-east, every three months.

“I really don’t understand why I have to visit this big hospital every three months, because I only get to talk to my doctor for three minutes,” he said. “I had thought South Korea’s health insurance system, with private doctors and national health insurance, was the world’s best, but now it’s becoming the world’s worst.”

A more robust medical workforce is also essential to the country’s public health, according to the Korea Disease Control and Prevention Agency, which has just 20 doctors out of 500 employees. 

“We hope just two doctors will join us a year,” said director-general of the agency’s bureau of public health emergency preparedness Hong Jeong-ik. “They can do something meaningful for the public, even if that may not help them make a huge profit.” 

Amid the national debate, wait times for care have worsened since the doctors’ walkout to protest against Mr Yoon’s proposed reforms. The President says he will not back down on what he calls a “minimum requirement” for fixing the underlying issues. Nearly four in five Koreans support the expansion, polling ahead of the election shows.

“A nurse died in August 2022 at one of Korea’s best hospitals, where she worked, because there was no doctor to treat her,” Health and Welfare Minister Cho Kyoo-hong said in an interview. “This is not right.” BLOOMBERG