After graduating from medical school, my first job was a doctor at a health care center in Ulleung County, an island located in the East Sea. The health care center was the only medical institution in the county with a population of 10,000 at the time. The locals had to depend on public health doctors for medical service. The health care center had features of general hospitals, having departments of internal medicine, general surgery, pediatrics, obstetrics, orthopedics, radiology, anesthesiology, ophthalmology, dentistry, emergency rooms, and wards with 20 sickbeds.

My daily life there was quiet and calm. Treating internal medicine patients was quite busy, but other departments did not much have to do. It was quite rare when more than five beds were occupied in the hospitalization room. Three nurse practitioners worked in the ward in two shifts and one in the operating room. I remember that senior nurses and nurse's aides were in charge of other departments.

Professor Kang Hyun-seok of the Department of Hematology and Oncology at the University of California San Francisco (UCSF) School of Medicine

I was one of three duty doctors in the emergency room. Although I worked 24 hours once every three days and engaged in health checkups during the daytime, the work intensity was very low. Also, there were no nurse practitioners in the emergency room, so the ward nurse came down to help whenever something came up.

All of the other public health doctors, except for the three on duty in the emergency room, had completed their specialist training and were very dedicated and excellent people. Our residence was located right next to the health care center. We could call the specialists to the center whenever necessary. Formally, the center was an exemplary model of local health care where specialists reside nearby. Still, the real problem was in a different part of the hospital.

There were supposed to be two clinical pathologists and radiologists at the hospital, but there was only one each. That required unimaginable effort to perform a blood test or diagnostic imaging at night. Calling them for such work became so stressful that I later learned how to run the pathology instrument and take a chest radiograph. There were no pharmacists at the health care center, and the nurses complained about not having their quota filled. The operating room was also poor, and we could not operate when the only anesthesia machine went wrong. There no blood banks, so when a trauma patient needed a transfusion, we had to call a nearby military unit to summon soldiers with the same blood type and transfused.

We tried our best in such a poor environment, but the residents there distrusted the health care center. In many cases, they also questioned our capabilities. Although it was rewarding to save patients with complex trauma, including liver and spleen rupture and hemothorax, it was a daily routine to get involved in trivial things and suffer abuse and violence from the drunkards. I tried to find what was wrong by reading the images of outdated computed tomography made in the 1980s. Still, the residents considered me an unskilled doctor whenever I missed something.

Of course, Ulleung Country was a remote island, but it has the basis for living and its unique charm made some doctors settle down there. In fact, the only dentist residing in Ulleung once served as a public health doctor in the island about 10 years ago. I heard there had been a private clinic right before I went there. However, those who previously opened clinics could not last a few years and left the island. The situation was so difficult even to retain one practicing doctor there, which had a public health care center for less than 10,000 residents.

The problem of villages without a doctor cannot be solved by building a structure in a remote area and forcing a doctor into it. It could have been meaningful in the 1980s when the public health doctor system was first established. However, what meaning would the forceful assignment of doctors have in 2020 when it only takes half a day to reach Seoul from anywhere in the nation? Unlike in the 1960s, medical care in 2020 cannot be one-man-show of a doctor. Large hospitals emerge in places where healthcare markets can support the demand and an abundant labor pool. We should remember that even in the early 1990s, the government permitted the establishment of many small medical schools, saying it would help save local medical care. As far as I remember, only a few of those pledged to build university hospitals in the local provinces fulfilled the promise.

I believe that the problem of Korea's medical system in 2020 lies not in training the doctor but how to make the most of the educated workforce. What do the health authorities think is the reason that hard-trained medical professionals have given up their specialty and are engaged in uninsured treatment at their clinics? Suppose they were allowed to make use of their specialties under the attending system. In that case, the nation might not have to complain about the lack of medical workforce in some departments. If the government wants to revive healthcare in local communities, providing extensive support to public hospitals instead of demanding profitability under the guise of a self-supporting accounting system would be 100 times more effective than establishing a public medical school.

Kang Hyun-seok

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