[Long Read] Why South Korean doctors have walked off the job

Although doctors appear to be protesting a government increase in medical school quotas, their concerns run deeper and reflect systemic problems in South Korea’s healthcare system, from undervalued essential care to poor working conditions. The government is offering some solutions, but deep mistrust between the two parties is preventing any significant progress.

Note: The doctor’s strike is a complex issue. My goal is to present the perspectives of both the striking doctors and the government as comprehensively as possible. Given the limited word count of published media articles, this post seeks to provide a more detailed exploration of the arguments on both sides. The statements and positions presented here are not necessarily factual truths; instead, they reflect the assertions and views expressed by each party.

What happened

On February 1, the South Korean government officially announced plans to reform the country’s healthcare system. This included increasing the number of medical school admissions every year by 2,000 to 5,058 — the first such hike in 19 years. Authorities stated that these measures were necessary to address shortages in essential medical fields and rural areas that are suffering from severe shortages, and to ultimately prevent the collapse of the healthcare system.

However, the plans were immediately met with opposition from the medical community. The Korean Medical Association (KMA), which represents some 130,000 physicians nationwide, argued that the decision to expand medical school admissions quota would not address underlying issues driving doctors away from essential medical care and could negatively impact the quality of medical education and ultimately patient care.

Junior doctors, who sometimes account for about 30–40% of the total doctors in major hospitals, have for long been against plans to increase medical school quotas, and have threatened to go on strike — reminiscent to a similar strike in 2020.

On February 20, thousands of them walked off the job (9,000 out of 13,000 nationwide several days later), leaving hospitals struggling to cope with the sudden staff shortage. They have been cancelling surgeries; outpatient services have been reduced; and patients in need of emergency treatment have been turned away. One person who struggled to find an emergency room after going into cardiac arrest died.

The government has attempted to counter the collective action by issuing back-to-work orders and threatening doctors with legal consequences. It has now started to process of suspending thousands of medical licences, but this seems to have done little to deter them who remain steadfast in their opposition.

Meanwhile, thousands of medical students are standing in solidarity with interns and residents by boycotting classes and taking leaves of absences.

Both sides remain at an impasse: the government insists on the necessity of the reforms while the doctors maintain that the government’s approach will not solve the healthcare system’s underlying problems.

Why doctors are angry

Doctors, in particular medical interns and trainees, strongly oppose increasing the medical school quota, arguing it will not effectively address the government’s stated goals of improving care access and quality.

A closer look at all the arguments being made suggests that their immediate opposition to the quota increase is just the tip of the iceberg, and their larger concern is deep dissatisfaction with the entire healthcare system they work within.

Several overarching themes emerge from their claims:

1. Systemic undervaluation of medical labour, especially in essential fields, driven by low reimbursement/compensation rates and cost-control policies that make certain specialities economically unsustainable.
2. Deteriorating working conditions and work-life balance for doctors in high-intensity specialities, with rising patient volumes, under-staffing, long hours, and limited support.
3. Punitive legal and regulatory environment that exposes doctors to harsh criminal penalties and license revocation for mistakes or disputes, creating a climate of fear and defensive medicine.
4. Perception that the government is pursuing misguided, simplistic solutions (like quota increases) for complex structural problems while ignoring root causes and potential negative consequences.
5. Lack of meaningful government investment or policy support for essential medical services, which is leading to worsening shortages and quality challenges as doctors flee to more sustainable fields like cosmetic surgery and dermatology.
6. Concerns about the quality of medical education: Doctors argue that rapidly increasing the number of medical students without ensuring adequate resources, faculty and clinical training opportunities could compromise the quality of medical education and produce less competent physicians.
7. There’s doubt hospitals have resources to adequately train additional students during residencies to produce competent specialists.
8. Misdirected focus on quantity over quality: Doctors believe that the government’s emphasis on increasing the number of physicians overlooks the importance of ensuring the quality and distribution of medical services, which are more critical factors in improving patient care and outcomes.
9. They argue that South Korea already provides very high levels of medical care and access by international standards, disputing physician shortage claims.
10. Fear that further eroding the economic stability and social status of the medical profession will deter top talent and compromise the quality of future physicians.
11. The medical community and government are experiencing a breakdown in trust and communication, with doctors feeling excluded from key policy decisions affecting their livelihoods and working conditions. They believe the government has imposed reforms without sufficient consultation, and doctors feel unheard and disrespected as key stakeholders.
12. Frustration with being demonised in the media and public opinion as a greedy, obstructionist interest group, when doctors see themselves as fighting for patient welfare and system sustainability.

Deep-rooted problems

The current crisis has been building for decades, with the government and senior medical professionals failing to address underlying issues.

The doctors argue that a long history of undervaluing medical labour and inadequate investment in essential healthcare services is what has led to the government’s current policies.

They say that, historically, the government has set reimbursement/compensation rates for medical services provided under the country’s health insurance system at levels significantly lower than the actual costs incurred by healthcare providers despite South Korea’s rapid economic growth and rising living standards.

They also highlight the regional disparity in healthcare access, especially with regard to Seoul’s concentration of medical resources. This imbalance is attributed to the public’s preference for receiving care at big, prestigious hospitals in the capital city and the absence of a functional referral system.

The result of this is that patients from all over the country flock to Seoul for medical treatment, even for conditions that could be easily be handled by provincial hospitals. This leaves hospitals and clinics in other regions underutilised and struggling to attract and retain qualified medical staff.

A case in point is the leader of the main opposition Democratic party, Lee Jae-myung, who was airlifted to Seoul after suffering a neck stab attack in Busan. There were accusations in the medical community that Lee could have gotten just as good care in Busan.

Medical professionals argue that policies like raising medical school quotas and “forcing” public service for doctors in rural are fundamentally ineffectual in addressing regional disparities. They contend that merely placing more doctors in these areas or making them work there does not deal with the underlying issues that initially make these jobs unappealing to medical professionals.

What the government is saying

In government documentation outlining the need the reform plan, it announces a “four-pronged healthcare reform package (4대 필수의료 정책패키지)” that provides: more healthcare professionals; stronger local healthcare; safety nets for medical malpractice; and fairer compensation framework. The rationale for the healthcare reform is as follows:

1. South Korea has an absolute shortage of doctors. The number of doctors per 1,000 population is 2.1 (or 2.6 when including practitioners of traditional Korean medicine), ranking near the bottom among OECD countries. The government estimates a current shortage of 5,000 doctors, which will grow to 10,000 by 2035 due to increasing medical demand from an ageing population.
2. Physician shortages are especially acute in essential medical fields like paediatrics, obstetrics, thoracic surgery, emergency medicine, etc. and in non-metropolitan regions. This has led to long wait times, lack of access, and overworked medical staff.
3. The shortage cannot be resolved without increasing doctor supply, as demand is projected to keep increasing even as overall population declines due to rapid ageing. The number of medical school graduates has been frozen for 19 years and needs to increase.
4. Major developed countries like the Germany, UK, France and Japan are proactively increasing their medical school quotas to prepare for increasing demand. South Korea needs to do the same.
5. Concerns about oversupply leading to unemployment of doctors in the future are unfounded based on demand projections. The government will establish a system to regularly re-evaluate and adjust quotas every 3–5 years as needed.
6. The government has sufficiently consulted with the medical community, contrary to claims otherwise. It collected data from all 40 medical schools on their capacity to educate more students while maintaining quality.
7. Increasing the number of doctors alone is not enough. It must be coupled with reforms in the medical delivery system, reimbursements for essential care fields, training environment for residents, and legal protections for medical accidents.

In announcing the reform plan, the government pledged to invest in expanding faculty recruitment, improving clinical training facilities, strengthening essential/regional medical training, and accrediting evaluation to ensure educational quality.

Specifically, the government lays out several initiatives under the “Regional Medical Care Reinforcement (지역의료 강화)” package to incentivise doctors to work in under-served regions and field by:

• Establishing a “contractual regional essential doctor system (계약형 지역필수의사제)” to provide generous scholarships, training expenses, and housing support to medical students who commit to working in under-served regions after graduation for a certain period of time.
• Greatly increasing the “regional talent admissions (지역인재전형)” quota in medical schools to admit more students from rural areas.
• Launching a “regional medical innovation pilot project (지역의료혁신 시범사업)” for stronger cooperation networks for essential services, providing support worth up to 50 billion won to selected regions over three years.
• Reviewing the formation of a “regional healthcare development fund (지역의료발전기금)” to increase investments in regional healthcare.
• Expanding healthcare service prices tailored to regional needs (맞춤형 지역수가 확대) to incentivise doctors to practice in under-served areas.

Under the “Fair Compensation (보상체계 공정성 제고)” package, the government pledges to:

• Invest 10+ trillion won by 2028 to raise reimbursement/compensation rates for essential fields like paediatrics, emergency care, etc.
• Introduce “alternative payment models (대안적 지불제도)” to compensate for deficits in essential medical services that cannot be adequately addressed through the fee-for-service system and to support network-based cooperative medical care.

It also seeks to build a “Safety Net for Medical Malpractice (의료사고 안전망 구축)” package by:

• Enacting a “Special Act on Medical Accidents (의료사고처리특례법)” that exempts medical professionals from criminal punishments in case of malpractice if they subscribe to relevant insurance or mutual aid plans. The law would allow medical professionals to focus on treating critical or emergency patients in a secure environment, while ensuring that patients receive rapid and sufficient compensation for malpractice.
• Strengthening state compensation for no-fault malpractice/medical accidents (무과실 국가보상 강화), such as those involving childbirth.

And finally, it seeks to set up a Presidential Committee on Healthcare Reform (대통령 직속 의료개혁특별위원회) to:

• Add momentum to the policy package and ensure the rapid establishment of an action roadmap for the initiative.
• Announce a comprehensive plan for the National Health Insurance (「제2차 건강보험 종합계획」) to support the implementation of the policy package.

Disagreements on both sides

Taking a closer look at the positions on both sides, there are many points on which they cannot see eye-to-eye. Here are just some:

1. Physician shortage denial: Some in the medical community argue that there is no actual shortage of physicians in South Korea. The government counters this by citing multiple studies projecting a shortage of around 10,000 physicians by 2035 if no action is taken.
2. Physician increase rate: Some argue that South Korea’s physician increase rate is already high. The government counters that while South Korea’s physician numbers have increased significantly in recent decades, it is starting from a very low base and still ranks at the bottom of the OECD.
3. Ageing population: Some argue that physician demand will decline as the overall population ages and declines. The government counters that the ageing population will actually increase demand for medical services, and that the physician workforce is also rapidly ageing.
4. Education quality: Many in the medical community, especially trainee doctors, argue that the sudden large increase in quota will undermine education quality. The government counters that the increase is within the range that medical schools said was feasible, and pledges investments to strengthen education quality.
5. Excessive quota increase: Some argue that 2,000 additional students per year is simply too many. The government counters that this number is necessary to meet the projected shortage, and that even with this increase physician numbers will remain well below the OECD average.
6. Reforms without increase: Some argue that reforms to the medical system and increased incentives for under-served regions and specialities can solve the problem without increasing physician numbers. The government counters that while such reforms are also needed, they are not sufficient without also addressing the overall physician shortage compared to other countries and the future needs of an ageing society.

Addressing grievances

The medical community appears to perceive the sudden large increase in medical school quotas as simplistic, rushed and avoiding the harder structural reforms they’ve been demanding. There is distrust that the complementary measures will be implemented properly.

However, the government has clearly acknowledged the systemic problems and published an ambitious reform package alongside the quota increase — increasing reimbursements for essential fields, improving training, legal protections, and regional supports. They claim to have consulted widely, grounded it in data, and left room for adjustments. The quota increase is positioned as a necessary but not sufficient condition for ensuring access in an ageing society.

So while the doctors’ scepticism and defensive mechanism is understandable given the history and buildup of frustrations, an objective look suggests the government is indeed, at least on paper, trying to tackle the root causes through the 4-part reform package, not just focusing on quotas. For instance:

1. Undervaluation of medical labour: The government acknowledges this issue and proposes a “Fair Compensation” package that promises to invest 10+ trillion won by 2028 to raise reimbursement rates for essential fields like paediatrics and emergency care.
2. Punitive legal environment: The government proposes a “Safety Net for Medical Malpractice” package that includes establishing a special law on medical disputes, expanding no-fault compensation, and limiting criminal charges for medical accidents.
3. Deteriorating working conditions: The government acknowledges the problem of overworked residents and proposes the “Medical Personnel Expansion” package that includes transitioning to a specialist-centred hospital system, improving the training environment, and limiting excessive consecutive work hours.
4. Lack of support for essential services: The government’s “Regional Medical Care Reinforcement” package includes measures to designate and support regional base hospitals, foster specialised essential medical care at secondary private and public hospitals, and introduce region-specific reimbursement rates.

Both the government and the doctors seem to have valid points and concerns. But ultimately, there seems to be a significant gap between the government’s view of what is necessary and feasible, and the doctors’ view of what should be done to address their concerns.

There has also been a complete breakdown of trust and communication. The government says it has engaged in extensive consultations with the medical community and expresses disappointment with the lack of constructive engagement from some doctor groups. Doctor groups say it’s the opposite: that they were not consulted enough. Trainees say they they were completely ignored. This lack of mutual understanding and trust is hampering progress.

Intentions and complications

The presidency of Yoon Suk Yeol has been far from popular since its inauguration two years ago, and he desperately needs policies to show that he can deliver tangible results. The Itaewon crowd crush disaster, the shambles of the World Scout Jamboree, and the latest designer handbag scandal involving his wife have left few things the government and President Yoon can be remembered for in a positive light. Since making the medical reform announcement, Yoon has enjoyed higher approval ratings.

The medical school issue can be interpreted as a populist move that is easy to score quick points with, especially considering the upcoming general election in April. Doctors assert that the reform package is a political manoeuvre ahead of the election. It’s worth noting that this policy of increasing the medical school quota is not new, as even the previous Moon Jae-in administration tried and failed to implement it due to opposition from doctor groups.

Doctors in South Korea are both admired and scorned by society. Traditionally, becoming a doctor is seen as one of the best career paths for a child, alongside being a lawyer. However, doctors are also often thought of as being primarily interested in making money and are easy targets for public criticism.

Frequent news reports about the dire situation in rural areas and long waiting lines to see paediatricians are sufficient to persuade people that there is a serious shortage of staff and that the issue requires immediate attention. The public appears to be in favour of the government’s move, and some opinions brand the junior doctors as selfish, only interested in keeping the doctor supply low to maintain their future potential high pay and prestige.

Conversely, the government has responded heavy-handedly to the walkout by doctors who have refused to return to work, which will do little to regain trust between both sides. On March 1, police raided the offices of the KMA and Seoul Medical Association, searching for evidence related to current and former KMA leaders accused of instigating the doctor walkouts. In some instances, overseas travel bans have been issued. The KMA has accused the government of suppressing rights and freedoms through the police searches.

The World Medical Association, of which the KMA is a member, has also expressed concerns:

Statement from Lujain Alqodmani, President, World Medical Association (WMA)

Dear colleagues, esteemed members of the global medical community, I am here today to address a critical situation affecting our colleagues in the Korean Medical Association. The World Medical Association stands firm, unwavering in support of the KMA amid a government- induced crisis.

The Korean government’s unilateral decision to drastically increase medical student admissions has caused unprecedented turmoil within the medical community.

Our colleagues, including medical students and young doctors, are peacefully exercising their rights within the boundaries of democratic law and constitution. The government’s attempts to prevent personal resignations and restrict conditions of school admissions are potential violations of human rights, setting a dangerous precedent in the country.

I strongly urge the Korean government to reconsider its actions and cease the forceful measures imposed on the medical community. The principles of justice, human rights, and ethical healthcare demand a collaborative approach. A resolution should respect the rights of physicians and ensure the well-being of both medical professionals and the patients they serve.

Let us stand together in solidarity with our colleagues in Korea and uphold the values that define our noble profession. Thank you.

It is clear that confrontation will lead nowhere, and that to move forward, there likely needs to be a more intensive, good-faith dialogue process where both sides work to truly understand each other’s perspectives, constraints, and priorities.

Ultimately, the government may need to do more to demonstrate it is genuinely listening to and incorporating doctors’ feedback, while the doctors may need to engage more constructively with the reform process and recognise the efforts being made to meet them somewhere in between.