[메디게이트 뉴스 하경대 기자] “The Physician Manpower Supply and Demand Estimation Committee has in fact been reduced to a ‘policy promotion justification’ in a short period of four months to reach the conclusion desired by the country.”
A day before the final meeting of the Health and Medical Policy Deliberation Committee on the 6th regarding the increase in the number of doctors, Lee Joo-young (Reform New Party), a former doctor and member of the National Assembly Health and Welfare Committee, criticized, “After going through the results of the estimation committee and revision review, the issue of increasing the number of medical schools has become another source of social distrust.”
Rep. Lee’s opinion is that as the estimation committee discussions are conducted in a structure that first presents the direction in which our country’s medical community should move forward and cannot allow for various discussions, such as future health insurance financial conditions, changes in population structure, and technological development, the discussion results are ultimately difficult to accept by the medical community, patient groups, and medical education sites.
Rep. Lee Joo-young criticized, “As there was a gap in the policy direction and discussion premise, the estimation committee only presented a rough range and the revision committee made the final decision on its own. This is no different from what was done under the Yoon Seok-yeol government.”
In particular, he believed that in a situation where the quality of medical education is seriously deteriorating due to the doubling of the 24th and 25th classes, the gap in education between Seoul and local medical schools could widen if the increase in medical schools is forced next year. As a result, there is a risk that substandard doctors will be produced, and as a result, trust in doctors will decrease, leading to the possibility that ‘medical shopping’ will become more prevalent.
Representative Lee emphasized, “With the current medical education curriculum, it is impossible to even set up (for education due to the increased number of students),” and added, “The World Federation of Medical Education certifies the evaluation of Korean medical school education every two years, and I am worried about whether we will be able to properly pass the certification.”
Regarding the final meeting of the revision review held on the 6th, he said, “I understand that discussions will be conducted using 680 people as the minimum score.”
The following is a Q&A from a Medigate News interview conducted with New Reform Party lawmaker Lee Joo-young on the 5th.
It is impossible to estimate the future number of doctors without considering policy changes and environmental conditions.
Q. How did you feel after watching the discussions between the Health and Medical Policy Deliberation Committee (Revision Review) and the Physician Manpower Supply and Demand Estimation Committee (Estimation Committee)?
Estimating means deciding in advance how much you will spend in the future based on the assumption that you earn 1 million won. However, how can we estimate the future number of doctors without considering policy changes or environmental conditions at all?
In particular, starting this year, about 4 trillion won in health insurance budget will be converted into a deficit. The current government has made estimates based on the time when we were eating well and living well. However, it is correct to calculate it assuming that expenses such as stock costs, eating out, and snack costs will increase in the future. In short, starting this year, we need to assume that households earn less money, start with the direction of health care policy, and then make scientific estimates based on that premise. If you make an estimate based on incorrect assumptions without doing anything, can it be called scientific?
Q. What is your overall evaluation of the Estimates Committee?
The government’s discussion on increasing the number of medical schools was flawed from the very first step, as it omitted the content of ‘on what premise the estimate will be made’. Because there was no premise, the estimation committee could not even form a structure to discuss future medical models. In the end, the estimation committee became obsessed with numbers, and talking about the system became outside of its authority. A situation was created where opinions on the system, which is the premise of the estimation, were not expressed or were ignored even if opinions were expressed.
In fact, the estimation committee was reduced to a ‘policy promotion justification’ in a short period of four months to reach the conclusion desired by the country.
The direction of the medical system is an area of social consensus. In that case, the estimation committee should have defined the system based on consensus and had a comprehensive discussion including changes in future population composition and medical technology development. As there was a gap in this area, the estimation committee only presented a rough range and the correction committee made the final decision on its own. This is no different from what was done during the Yoon Seok-yeol administration.
Q. What do you think about the situation in which the minutes of the 12th meeting of the Estimates Committee have not been made public?
On the surface, it is said that ‘we are not disclosing it because according to the regulations, it only has to be disclosed until the next meeting is held’, but it would probably be difficult to disclose it. This is because there is too much room for refutation and criticism. The estimation committee members would not have been able to provide a reasonable reason for including the models they most opposed.
In this situation, the medical community did its own thing, patients and civic groups did their own thing, and the education department all came to a result that they were not satisfied with. Through a process that no one understands, a result that no one understands has been reached. In the end, the process of the estimation committee and correction review meeting left another layer of social distrust.
Q. There is also a lot of controversy regarding the composition of the estimation committee. How do you think the estimation committee should be structured in the future?
It is a good democratic idea for the government to involve all stakeholders when creating a committee. However, when a family discusses issues of life and death, even the youngest member does not join in and decide together how to spend money on food. Ultimately, it is the parents who make the decision.
It should be a committee where people who have a cool-headed understanding of health insurance finances and who clearly know the limitations of health care and medicine can make decisions. If people go in expecting only possibilities, the conclusion will be mountainous. In particular, people who can calmly point out the limits of the policy and provide evidence should participate as committee members, and the government should transparently disclose the long-term pros and cons and side effects of the final decision.
Q. What are your predictions for the final meeting of Bojeongsim on the 6th?
I was told that 680 people would be discussed as the minimum standard (rather than the previously announced increase of 580 people per year) and that a decision could be made higher than that.
If the number of troops increases in 2027, proper medical education will not be possible, and there are concerns that it will create a distrustful society in which doctors are not trusted.
Q. Currently, problems in medical education, such as doubling of the 24th and 25th classes, are continuously being pointed out. If the number of students is increased in 2027, will medical education be possible at medical school sites?
The educational environments of all medical schools are not the same. Educational capabilities also vary depending on the school, hospital, and professor capabilities. Currently, certain schools in rural areas have no basic medical science professors at all. Take classes via Zoom. Practicums are conducted without vacations, but there is no way for anyone to check what quality these students are participating in in their practicums and whether they are truly receiving proper, close education among professors who are already leaving.
This time, the National University Hospital came under the jurisdiction of the Ministry of Health and Welfare. As a result, there is little chance that the medical education environment will improve. The government should seriously consider whether junior-level professors who stayed at universities because they found research and education interesting will remain there even after the transfer to the Ministry of Health and Welfare. I am also concerned about whether students can learn in a variety of ways in a medical care delivery system that is already broken.
Ultimately, students cannot receive proper basic medical education, and it is difficult to properly conduct not only anatomy practice but also various group classes. Even setting up (for education) is impossible with the current medical education curriculum.
Q. What are the side effects that occur as the overall quality of medical education declines?
Right now, the World Federation of Medical Education certifies Korea’s medical school education evaluation every two years, and I am worried about whether we will be able to properly pass the certification. I believe that the Institute of Medical Education Evaluation should dispassionately evaluate schools with immediate problems starting this year before their accreditation is revoked.
In addition, as people do not trust doctors due to poor education and distrust is increasing, social costs will rise as ‘doctor shopping’ and ‘hospital shopping’ increase. This may lead to an explosion in medical use and cause greater side effects.
Q. The government is showing its intention to place the increased number of medical school seats primarily at local mini medical schools. My opinion on this.
It’s impossible. Increasing the number of people by 10 in a place with 1 person is completely different from increasing the number of people by 10 in a place with 30 people. Rather, the gap with medical schools in the metropolitan area may widen as regional medical schools are unable to handle the greatly increased number of students. Medical licensing is a matter of certification that even those who passed last place have no problems with their abilities as doctors, and there has been trust in this until now. However, there is a high possibility that this trust will be broken (due to the excessive increase in medical schools).
