Medical school expansion ends but reform stalls

South Korea will increase medical school admissions by 490 students next year, and the government has completed the allocation of the additional seats across 32 medical schools. Given the bitter standoff between the government and the medical community that shook the country for more than a year, the quiet conclusion feels almost surreal. The turbulence of the dispute has largely settled. Yet the country’s distorted healthcare system continues along the same path, with little sign of a meaningful course correction.

When the government pushed to expand medical school admissions, it argued that the move was necessary to revive regional and essential medical services. Overcrowded emergency rooms had become a national concern, and local healthcare networks were faltering, producing what many called “maternity refugees” and long journeys in search of pediatric care. The medical community, though divided on the solution, broadly acknowledged the legitimacy of the problem. Yet simply increasing the number of medical students and assigning doctors to regional areas will not by itself restore essential medical services.

The chronic flaws in the healthcare system that surfaced during the conflict also remain unresolved. The collapse of regional and essential care stems in part from structural distortions such as reimbursement rates that fail to cover costs and a payment system that rewards diagnostic tests more generously than surgery. Physicians have increasingly relied on private indemnity insurance to offset income gaps, helping fuel the rapid expansion of a large market for noncovered medical services. Medical spending has risen sharply year after year while patient satisfaction has declined. Despite this, discussion of healthcare reform has largely faded since the expansion of medical school quotas, perhaps because both the government and the medical community emerged from the confrontation deeply bruised.

Another barrier to reform is the deep mistrust that accumulated among the government, doctors and patients during the dispute. Relations between the government and the medical community, once considered a key policy partner, appear so strained that even quiet communication has nearly disappeared. Patients have begun to question physicians’ professional ethics and often suspect unnecessary treatment when they visit hospitals. Doctors, for their part, have voiced strong frustration, saying they now feel uneasy facing patients and exhausted from trying to remain in operating rooms.

Amid this climate of frustration, a rare initiative has begun to take shape. Doctors, patients and civic groups have come together in an effort to repair the healthcare system. The effort began in 2024, at the height of the conflict, when physicians as healthcare providers and patients and civic organizations as healthcare consumers voluntarily formed a coalition known as Medical Solidarity Action. The group recently compiled its discussions in a book titled Korean Healthcare in Crisis: Reimagining It Together and launched a new organization called the Patient-Centered Medicine Society.

The society marks the first academic organization in the medical field jointly formed by doctors and patients. It is led by four professors at Seoul National University’s medical school and hospital who previously drew fierce criticism from within the medical community after saying that “the real victims are the patients who have been abandoned,” referring to residents and medical students who left hospitals and classrooms during the conflict. Most of the doctors who harshly criticized them at the time have since returned to their routines as if nothing had happened. The professors, however, chose to work with patients to address the structural problems that fueled the dispute and to build evidence for sound healthcare policy.

The launch of the Patient-Centered Medicine Society raises an uncomfortable question. What if medical residents had joined with patients to challenge the government instead of walking out of hospitals? When the government proposed expanding medical school admissions by 2,000 students, some doctors argued that patients would prefer treatment from physicians with top scores on the national college entrance exam. Patients expressed different priorities. Kim Sung-joo, head of the Association for Severe Disease Patients, who joined the society, has been battling esophageal cancer since his diagnosis in 2014. Speaking at the group’s launch ceremony on March 6, he said South Korea’s healthcare system excels at treating disease but often fails to care for the lives of patients. He described the pain patients experience when they are excluded from life-or-death decisions about their own treatment. If doctors and patients had acknowledged each other’s struggles and jointly demanded reform of a flawed system, the outcome might have looked very different.

The year-and-a-half-long conflict between the government and the medical community should not end as a meaningless struggle. A healthcare environment that allows patients to receive proper treatment is also one in which doctors can practice effectively. If the debate moves beyond narrow issues such as medical school quotas and reimbursement increases and returns to the principle of patient-centered care, the complex challenges facing the healthcare system may finally begin to unravel.