Rural doctors shed light on South Korea’s medical divide

Yeongyang County in North Gyeongsang Province, an area about 1.35 times the size of Seoul, has only one specialist physician. That doctor is Lee Sang-hyun, director of Yeongyang Hospital, who has staffed the hospital’s examination room for 20 years. Excluding dental clinics and traditional Korean medicine practices, the county has just three medical facilities in total: Yeongyang Hospital, one private clinic and a public health center. With access to doctors limited, the hospital’s waiting room, which can seat about 20 people, is almost always full. X-ray imaging is available only because a radiologic technologist approaching 80 delayed retirement, while the hospital stays open around the clock thanks to two public health doctors who rotate emergency room shifts.

Park Seung-min, director of a private internal medicine clinic in Jangsu County, North Jeolla Province, whom the reporter met recently, is another rural physician who has quietly sustained local medical care for two decades. He commutes six days a week, driving three hours round trip from his home in Jeonju. On weekdays, he treats an average of 70 to 80 patients a day. Still, he said he worries how much longer he can keep the clinic running as Jangsu’s population approaches the threshold of falling below 20,000.

While many doctors hope to work in Seoul or the surrounding metropolitan area, the question is why these two chose to practice in rural communities. One might expect them to cite a strong sense of professional duty or a lofty mission. Instead, their answers were unexpectedly simple.

“Like me, about half of rural doctors stay because of the positive memories they built with residents during their time as public health doctors,” Park said. “I completed my training in Seoul, came to this hospital as a public health doctor and ended up staying. My hometown, Pohang, is nearby,” Lee said.

The government is making a concerted effort to keep doctors from leaving regional areas. It plans to select all additional medical school students next year through a regional doctor system that would require 10 years of mandatory service outside the capital region, with a decision expected as early as next month. A proposed public medical academy, tentatively scheduled to open by 2030 as a graduate medical school, along with newly established regional medical schools, is also aimed at securing physicians for regional and essential medical services.

Both the medical community and the government acknowledge, however, that the regional doctor system and public medical schools are not fundamental solutions to physician shortages in medically underserved areas. With few incentives for doctors to remain in provincial regions voluntarily, the government is effectively relying on a system that exchanges public support for mandatory service in regional and essential care. President Lee Jae-myung underscored the point late last year during a Ministry of Health and Welfare briefing, saying that even if doctors are added under labels such as regional doctors or public doctors, they will eventually leave again, and that the underlying causes of the problem must be addressed.

The reasons these two physicians chose to stay may offer a clue to revitalizing local health care. One approach would be to strengthen exposure to regional medicine during medical education and training. In Japan, it is considered routine not only for residents but also for fellows and medical school professors to be dispatched to regional hospitals and clinics.

At present, medical education and residency training for interns and residents in South Korea are overwhelmingly concentrated in tertiary hospitals in the Seoul metropolitan area and major regional cities. Doctors earn medical licenses and specialist certifications after experiencing only one side of the health care system. This helps explain why even within the medical community there are self-critical voices lamenting that the system produces “medical technicians” rather than well-rounded physicians.

One possible reform would be to require residents to spend at least six months of their training in medically underserved regions. Residency lasts four years in most fields and three years in some specialties, including internal medicine and surgery. Such a change could also help offset the shrinking pool of public health doctors as more young men enter active-duty military service. If roughly 3,000 residents each year were to experience grassroots regional health care for even half a year, some could later grow into physicians committed to regional and public medicine.