Direct Support for Professors and Fellows Needed to Prevent Collapse of Essential Medical Services

South Korea's essential medical services are on the verge of collapse, no longer sustainable through mere declarations or slogans. A prolonged exodus of residents and a persistent lack of interest in crucial departments have shifted the burden of patient care and surgery onto professors and fellows in fields such as obstetrics, pediatrics, emergency medicine, cardiovascular and thoracic surgery, pediatric surgery, and transplant surgery. The medical 현장 (field) is barely holding on through the dedication and sacrifice of its staff, but this situation is unsustainable.

Statistics reveal the systemic breakdown has already begun. The recruitment rate for first-year residents in the first half of 2026 dropped to 73.4%, a significant decrease from 83.2% before the medical dispute in the first half of 2024. For the eight essential medical specialties, the recruitment rate, even after the second-half recruitment, stood at a mere 70.1%. The 2025 second-half recruitment saw dismal figures: 13.4% for pediatrics, 21.9% for thoracic surgery, 36.8% for general surgery, 42.1% for emergency medicine, and 48.2% for obstetrics. The number of applicants for the 2026 specialist qualification exam also plummeted, with only 14 for cardiovascular and thoracic surgery, and substantial decreases in pediatrics, general surgery, emergency medicine, and obstetrics. This creates a vicious cycle of dwindling trainee intake and future specialist shortages.

Interviews with professors and fellows in essential medical fields across the country reveal a consensus: the current compensation system makes it impossible to sustain these departments. Many pointed out that simply increasing medical fees won't solve the problem. In hospitals struggling with deficits, any fee increase is likely to be absorbed by operational costs, failing to reach the professors and fellows working tirelessly. Since the abolition of selective treatment fees, the government has promised to compensate for losses through fee increases and expanded medical quality support funds. However, these funds have been absorbed into general hospital finances, not directly benefiting the professors and fellows who cover outpatient, inpatient, ICU, emergency surgeries, and on-call duties due to the resident shortage.

The article advocates for a paradigm shift, proposing a direct compensation system, similar to the former selective treatment fees, for essential departments primarily run by professors and fellows due to the resident shortage. Japan and the UK offer precedents, with Japan providing various allowances and subsidies for essential and underserved area physicians, and the UK offering separate compensation for high-difficulty fields and regional specialists. The funding could be a shared responsibility of the national and local governments and patients, strictly separated from hospital operating budgets. This compensation should be paid directly to medical personnel, not the hospitals, with a proposed distribution of 80% to professors and 20% to fellows, ensuring transparency and acknowledging the significant responsibilities and sacrifices of both groups.