Medical school quota rise could shake up higher education

In a long-anticipated move, the South Korean government this month announced a major expansion in the national medical school admissions quota, unleashing new tensions between doctors, medical students and the government.

In terms of the new quota, the capacity of the country’s 40 medical schools – around 3,058 places since 2006 – will increase to 5,058 starting from the 2025 academic year. Higher numbers will be allocated to medical schools outside the Seoul region.

The aim is to increase the number of doctors to 10,000 by 2035 – more than tripling current figures.

But the changes could have an impact on the higher education sector generally, as the country’s top universities already lose many of their strongest STEM (science, technology, engineering and mathematics) students to medical programmes.

According to statistics from private tutor school Jongno Academy, released at the end of last year, the number of students accepted to the prestigious Seoul National University who did not ultimately register for admission was 228, or 10% of all accepted students (15% in the sciences). The figure was slightly higher than last year (194 students), according to Jongno Academy, which has been collating figures for several years.

“The reason for the increase in the number of unregistered students, particularly in the science field at Seoul National University, compared to last year, is that the number of top students choosing to leave the science major and register at other pre-med universities has increased,” Lim Seong-ho, CEO of Jongno Academy, told local media.

Other prestigious universities have been affected by the demand for medical degrees above other science qualifications.

Jongno Academy reported on 14 February that out of 3,345 applicants who passed the country’s university entrance exams and who were part of the regular university admissions process, 804 students — 483 from Yonsei University and 321 from Korea University — withdrew their applications, mainly to aim for medical schools instead.

The non-enrolment rate was 28.5% for Yonsei and 19.5% for Korea University.

Increasing the medical admissions quota is expected to exacerbate the flight to medicine. Lim said the preference for medical schools looked set to continue even after the admissions quota increased, pointing to a rise in those signing on for tutoring with the aim of attempting to get into medical school.

The quota expansion is also expected to trigger a trend among students to re-sit college entrance exams in the hope of improving their chances of being accepted into medical school.

Opposition from medical profession

Members of the medical profession oppose the government’s decision.

Kim Taek-woo, chairman of the Korean Medical Association’s (KMA) Emergency Response Committee against Medical School Quota Expansion, said: “Increasing medical school admissions by 2,000 at once, when the current capacity is 3,000, is equivalent to creating 24 new medical schools. The quality of education will also decline.”

This is the first increase in the medical school admissions quota for several decades. In December 2020, the government of then President Moon Jae-in was forced to back down in the face of mass protests by medical professionals during a critical period in the COVID pandemic over plans to increase medical school admissions by 400 students annually for 10 years, starting from the 2022 academic year. This would have meant a total of 4,000 extra places.

Doctors strongly opposed that move, arguing that expanding medical school admissions would not address gaps in essential healthcare provision.

Almost immediately after the latest announcement of quota changes on 6 February, the Ministry of Health and Welfare raised the health and medical alert level by two steps – to ‘caution’ level – as the KMA revealed its plan for collective action to protest the decision.

Members of the medical profession have already begun to fight back. On 15 February medical organisations in 11 regions across the country held protest rallies. The Seoul Medical Association gathered around 200 members in front of the presidential office at 7pm to express their opposition.

KMA’s emergency response committee chair Kim Taek-woo announced the committee’s first meeting to plan future actions.

Increased demand due to ageing

The backdrop to the latest decision by the government is the growing inadequacy of essential medical services, particularly critical specialties such as paediatrics, emergency medicine, obstetrics and gynaecology, and thoracic surgery.

Publicised instances of patients facing difficulties accessing timely medical care have raised concerns. They include the case of a 70-year-old man who died in an ambulance because he could not be admitted to a hospital.

Minister of Health and Welfare Cho Kyoo-hong stated in a briefing: “To secure medical professionals in underprivileged areas at the same level as the national average, we need about 5,000 doctors [a year]. Considering the rapidly increasing demand for healthcare due to ageing, experts predict a shortage of around 10,000 doctors by 2035.”

He added: “The government will regularly review and adjust the medical workforce situation, taking into account factors such as ageing trends, infectious disease situations, advancements in medical technology, and overall changes in healthcare environments. We will manage the supply rationally.”

A significant rationale for the medical school expansion are statistics that show South Korea has a lower number of doctors compared to other advanced countries of the Organisation for Economic Co-operation and Development (OECD).

According to the OECD Health Statistics 2023 report released by the Ministry of Health and Welfare on 25 July 2023, Korea has 2.5 doctors per 1,000 people — the second lowest after Mexico (2.4), and the lowest at 2.1 if traditional medicine is excluded.

Many OECD countries have significantly expanded medical school capacity in the last decade to cope with increased demand for healthcare due to ageing.

The government appears to have taken into account doctors’ reactions to the reforms, experts said. Minister Cho emphasised: “The government is pursuing policies with a sense of urgency, viewing the current situation as the last chance for healthcare reform. We hope the medical community will support and contribute to creating a new healthcare system.”

He also issued a warning: “We will respond firmly to collective actions that put the lives of the public at risk.”

Criticism of statistics

But Kim criticised the government's arguments that cite the OECD statistics. “Korea ranks top in the world for being a ‘country with good medical accessibility at a low cost’. If there's a shortage of doctors, accessibility to medical institutions should decrease … Saying [there is] a 'doctor shortage' is an unreasonable claim,” he said.

A survey by the KMA Health Policy Research Institute, conducted in November and involving 4,010 doctors, revealed that 81.7% opposed the plan to expand medical school admissions.

Among those against the expansion, 46.3% believed there was already sufficient manpower. Other reasons included concerns about a decrease in demand due to population decline (15.1%), worries about increased medical costs (13.9%), and concerns about a decrease in the quality of medical services (13.4%).

On the other hand, 18.3% of doctors supported the expansion, citing the need to address gaps in essential medical fields such as infectious diseases, trauma, and childbirth (49.0%), and the resolution of disparities in medical care between regions (24.4%).

Dr Lee Jun-hyung, a paediatric specialist, told University World News: “While it may seem like there is a shortage of doctors, the number of patients treated by Korean doctors per day is likely to be the highest globally.”

He said the workload is intense. “If the government wants to address essential healthcare gaps, focusing on medical system reforms such as increasing the number of essential medical services, rather than haphazardly expanding medical school admissions, would be wiser.

“Unplanned expansion will only exacerbate the confusion in medical education and training. Without sufficient infrastructure checks, abruptly increasing the number of students can lead to a decline in the quality of education,” he added.

Interns and junior doctors

Junior doctors, in particular, want improvements in working conditions to be given priority over an expansion in numbers.

In response to the plan to raise the medical admissions quota, trainee doctors at five major general hospitals in Seoul have said they will submit letters of resignation en masse. Medical students are pushing for a mass class boycott over the government’s plan, South Korean news agency Yonhap reported on 16 February.

Park Dan, president of the Korean Intern Resident Association, said on social media on 15 February he planned to submit his resignation on 20 February, describing the three years he worked in a hospital as “the most depressing and unhappy” of his life.

He pointed to rising depression, the fear of medical lawsuits, excessive working hours — up to 80 hours per week – and low wages, at the minimum wage level, as reasons.

Wonkwang University Hospital in Iksan, North Jeolla Province confirmed that seven out of 126 residents (junior doctors) submitted resignation letters, saying they would work only until 15 March.

Fourth-year medical students at Hallym University College of Medicine in Chuncheon, Gangwon Province, announced through their SNS page they had all decided on a “collective leave of absence”.

A medical school professor told University World News: “It seems that a ‘quiet struggle’ of young doctors has begun. In the field, specialists and residents work together, and the role of residents is significant. Resignation letters from residents will undoubtedly create pressure in the field.”

Deputy Minister of Health and Welfare Park Min-soo said on 15 February: “If specialists and others go on strike, causing problems in the functioning of hospitals, we will explore ways to make more use of existing personnel.”

Public opinion appears to be leaning towards support for the government. According to a survey released by the National Health and Medical Union on 17 December 2023, 89% of respondents among over 1,000 adults aged 18 and above supported the expansion of medical school admissions.

The percentage who believed shortages in essential medical departments needed to be relieved was also very high at 94%.