One of the leading roles of “Hospital Playlist,” the popular TV miniseries aired from March to May, was a pediatric surgeon named Professor Ahn Jung-won.

The audience sympathized with Professor Ahn, who laughed and cried while treating pediatric surgical patients with various stories in the drama and showed a doctor's desirable image.

Professor Ahn was cool on the TV screen, but what will he look like in reality? Pediatric surgery is a subunit of the surgery department specializing in the operation of children and infants.

Kim Seong-chul, president of the Korean Association of Pediatric Surgeons President, explains the problem pediatric surgery field during a recent interview with Korea Biomedical Review.

Currently, Korea only has 35 pediatric surgeons. The number of surgeons has fallen after the first-generation doctors began to retire in 2010 since the introduction of pediatric surgery in 1984. The department is one of the fields, in which medical institutions hesitate to invest due to low profitability.

The government has recently announced a plan to expand the medical college admission quotas to increase the number of doctors in essential departments. However, pediatric surgeons who hold down the fort, such as Professor Ahn in the series, believe that only increasing the number of doctors would not improve the situation.

Korea only has 35 pediatric surgeons, department on brink of extinction

Kim Seong-chul, president of the Korean Association of Pediatric Surgeons (KAPS) and a professor of the Department of Pediatric Surgery at Asan Medical Center, warned that although surgeons find pediatric surgery as an attractive subspecialty, the department could face an existential crisis if the current situation continues, in a recent interview with Korea Biomedical Review.

According to Kim, the Pediatric Surgery Department was separated from the Surgery Department and formed an independent association in 1984. The first-generation pediatric surgeons who ran the association had led the field of pediatric surgery until the 2010s. There were about 70 pediatric surgeons in the nation at that time.

However, the number of pediatric surgeons sharply has declined since the first-generation doctors began to retire in the 2010s, and there are now about 35 left.

To become a pediatric surgeon, a medical student must win a qualification as a surgeon first and then obtain the certification for specialists in pediatric surgery. However, only four to five surgeons wish to become a pediatric surgeon annually, according to Kim.

It’s been okay so far, but there will be problems in the future. As the birthrate falls, pediatric patients are considered as unprofitable as hospitals see it, driving pediatric surgery to the brink.

Only 16 percent of pediatric patients get surgery from pediatric surgeons

Such being the case, general surgeons operate on pediatric patients at about 40 percent of all tertiary hospitals nationwide.

"According to the analysis on National Health Insurance Service's big data, only 16 percent of the pediatric patients' surgeries were performed by pediatric surgeons in Korea," Professor Kim said. "General surgeons are performing the rest of the operations."

A pediatric surgeon is necessary even in this situation because of neonatal surgery. According to statistics, pediatric surgeons perform 85 percent of operation in the case of neonatal surgery. Pediatric surgeons are essential for surgeries of newborns, he added.

The KAPS head noted that it is a pediatric surgeon who can help babies born with a blocked bowel and unable to eat live a healthy life for the rest of their lives with surgery.

"The second-generation pediatric surgeons are playing a key role in pediatric surgery, but they will also retire in about 10 years," Kim said. "If the birthrate and pediatric patient revenue continue to drop, and hospitals stop hiring pediatric surgeons, a severe problem could occur within a decade."

Kim said that four or five surgeons wish to study pediatric surgery every year. Pediatric surgery is considered an attractive specialty to surgeons, at least for now. If the situation does not improve after 10 years, pediatric surgery will lose its charm and get out of hand, he added.

Increasing medical college admission quotas cannot solve the problem

The ultimate goal of the government's policy to increase the number of doctors, which is facing a backlash from the medical community, is to send doctors to vulnerable areas and solve the shortage in essential departments.

Pediatric surgery is a necessary medical field for pediatric patients and neonatal surgery. It is essential medical care that should receive the most benefits from the government’s policy to expand the number of doctors. However, pediatric surgeons believe that just expanding the number of doctors cannot solve the problem of pediatric surgery.

Kim said that merely increasing the number of doctors and specialists will not improve the situation of pediatric surgery. Each hospital must create jobs for pediatric surgeons. Raising the medical charge is also significant, but the problem will remain even if the health insurance raises payments by tens or hundreds of percent, he emphasized. It will also be impossible to increase the medical charge by 1,000 percent considering the equity with other departments, Kim added.

"If so, the remaining option is to create jobs for pediatric surgeons in the field. I understand the policy's intention to increase the number of doctors and send them to various fields," Kim said. “However, there should be jobs opened for young doctors to choose and work in medical fields, such as pediatric surgery. The government cannot force doctors to specialize in specific fields unless there are jobs at hospitals.”

Trauma surgery could be model for pediatric surgery

Kim emphasized that the way to save pediatric surgery is to provide full support, modeled after the severe trauma center.

"Our association has had extensive discussions about the difficulties of pediatric surgery. There were opinions that raising medical charge is necessary because the falling birthrate is a matter that cannot be controlled, but alone will not solve the problem by itself," Kim said. "We need a system like the one the government supports trauma centers."

Currently, the government supports the labor costs of medical personnel at trauma centers and prevents them from treating people other than trauma patients. The government aims medical teams at trauma centers to be prepared and save as many trauma patients as possible without complications. The government should introduce similar policies in pediatric surgery for hospitals to hire pediatric surgeons.

Kim noted that general surgeons could also perform surgery on children, but there is a difference with pediatric surgery. These surgeons can operate appendicitis surgery for children about seven to eight years old but not on newborn babies. Also, it is not easy to move to another hospital because there were no pediatric surgeons to carry out surgery for infants.

"We call ourselves natural monuments, which means that we will naturally disappear with time," Kim said. "The government should protect these natural monuments from extinction."

kss@docdocdoc.co.kr

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