The recent series of strikes by physicians are different from those two decades ago in many ways.
First, the complexity of the issue is different. In 2000, the core issue was separating the drug prescribing from drug dispensing but setting details were complicated. Specific issues included whether to separate them institutionally or functionally, prescribing based on ingredients or brand names, categorizing drugs, preparing exceptional clauses, and setting the scope of alternative dispensing.
Even experts found it difficult to understand the details accurately, and the medical community’s internal voices were divided. Back then, stakeholders had things to negotiate while adjusting the details of the policy. (That is why the strike was rather prolonged, though.) But this time, the issue is very simple. It is about the government’s plan to increase the number of doctors by 4,000. That's all about the strike. There is not much to put on the negotiating table except for slowing the hike of admissions quotas at medical schools.
Second, there is a significant difference in the timing at which the effects of the policy change appear. The result of the separation of drug prescribing from drug dispensing was supposed to appear “immediately.” Whether it was an increase in costs or an increase in benefits, an increase in income, or side effects, the effects of banning pharmacists from drug prescribing and doctors from drug dispensing were to appear instantly. Naturally, established doctors reacted to the issue most sensitively, and trainee physicians and medical students did not know much about what was going on.
But this time, the effects of the policy change – increasing doctors – will appear at least 15 years later. The government is hurriedly pushing for the increase of doctors but physicians are scratching their heads. If the shortage of doctors in provincial areas is such an urgent problem, the government should have come up with an urgent solution. If it is a task that needs to be prepared in the long term, the government can take the time to persuade the medical community without pushing too much.
Third, for the reason above, the age groups of the physicians leading the strikes are different now. A surge of doctors 15 to 20 years later means it would rarely affect doctors currently aged 50 or more. In contrast, it would significantly affect medical students and trainee physicians in their 20s and 30s. In 2000, the doctors’ fight started from clinic owners and spread to medical school professors and salaried doctors. It took several months for junior doctors and medical school students, who were too busy to know the details of the policy change, to join the walkout, 20 years ago. But now, trainee doctors and medical school students were not forced to take to the street. They themselves decided to take collective action because the government’s plan did not sound logical. Established doctors are now even asking junior doctors to take it easy.
Fourth, the doctors’ strike today overlaps with the unprecedented Covid-19 crisis. Clinic owners and hospital operators suffer from severe financial losses. Salaried physicians are unhappy about pay reduction despite more work. Junior doctors and medical school students are having a hard time due to increased work and lowered quality of education. They felt grateful for the public campaign where people thanked medical workers’ efforts to fight Covid-19 on social media.
However, they were suspicious that the government might be paying just lip service when thanking doctors. In such a situation, the government dropped a bomb, instead of a gift. The government must have thought doctors would refrain from staging a strike because the nation is undergoing the Covid-19 crisis. What they missed was that doctors’ walkout could cause a greater impact because of the Covid-19 crisis.
Fifth, in 2000, pharmacists and civic groups were mediating the fight between doctors and the government, but now, the dispute is between doctors and the government only. The government has no third party that can encourage the fight or no civic group to stay neutral to mediate the two sides. If someone mediates, the government could budge a little and give some room for negotiation. However, if the fight is one on one, the government has almost no room for maneuver.
Sixth, in terms of the justification and rationality of the policy, the current situation is much worse than that of 2000. The discussion for the division of drug prescribing and dispensing took a very long time. There was no disagreement on the necessity of the separation. It was something doctors had to do one day, and there was enough consensus that it was abnormal that the separation was still not happening. Doctors only had to choose “how” to do it. They had enough to talk about the specific models and pros and cons of each option.
But this time, I do not understand how an increase in admission quotas by 400 could result in creating a supply of medical services in provincial areas and specialist doctors and medical scientists. The government plans to allocate 400 separate admissions from the university entrance stage. However, there will be a problem between normal medical school students and “regional doctor candidates” who were admitted on a special condition that they would “work in a provincial area for 10 years.”
Students who were admitted separately for regional doctors -- with lower grades than the brightest students admitted through normal admission procedures -- will have a “second-grade medical school student” complex, rather than a sublime sense of mission to take responsibility for regional medical care. Even if they work in a provincial area for 10 years, they will just count the days to leave for a big city rather than serving local patients with pleasure.
The government says they will increase doctors to secure manpower in special medical fields and medical scientists. Most special medical fields require the highest level of expertise and the longest training time. So, it is common that people choose such fields while attending medical school and receiving training. But the government expects that medical schools can select among high school graduates who will major in pediatric surgery, thoracic surgery, trauma surgery, or infectious medicine.
It sounds really weird. Needless to say, how funny it is to select “candidates for medical scientists” separately at medical school admissions. Does the government expect a Nobel Prize-winning researcher among them? In reality, medical graduates of major universities with top grades seek to become dermatologists or plastic surgeons because they think medical researchers have no future.
Seventh, doctors in 2000 and those in 2020 are not of the same generation. Back then, most physicians were not interested in other social issues and lacked knowledge, except for seeing patients. Doctors in the current age have a much deeper understanding of the political, economic, and social aspects of medical care. Established doctors were forcibly socialized through the medical turmoil in 2000, and younger generations who entered medical schools afterward were taught that doctors should not study with textbooks only.
Doctors now tend to think that a doctor is just one of many professions and that a doctor-patient relationship or a student/trainee doctor-professor relationship is just another relationship based on a contract. It is regrettably true that doctors in 2020 are relatively less concerned about what doctors in 2000 used to think – “If doctors do this, they might lose the trust of patients.”
Of course, there are similar emotions that doctors today and those in 2000 share. They think that the government’s policy design is not meticulous enough. They are also in a state of intense emotions where resentment, a sense of being betrayed, self-hate, and anger are all mixed up.
I fully agree that some medical fields suffer from a shortage of doctors and that there is a serious imbalance of the distribution of doctors between regions. However, simply increasing the number of doctors by 4,000 does not solve the problem. If the government had proposed measures that allow doctors to choose to work in provincial areas and do not worry about the future despite majoring in departments that doctors normally “avoid,” the medical community might have accepted the government’s plan without much resistance.
However, the government did not mention any other measure but announced the plan to increase doctors. They did not even explain how additional 400 doctors could turn to 300 regional doctors and 100 specialists and medical scientists. To make matters worse, the government is pushing another absurd policy to allow insurance benefits for traditional herbal medicines, which any doctor would oppose. The government is rather encouraging doctors to go on a strike.
Just like in 2000, government officials and politicians are not choosing words wisely but attacking them unnecessarily. Someone said he wrote the word patience three times before meeting doctors, and another said doctors’ medical services were for the public interest. Health and Welfare Minister said the government collected the medical community’s opinions sufficiently, and the leader of the ruling party said there was no compromise. President Moon Jae-in’s words that he would take governmental authorities’ stern measures made junior doctors furious. Lastly, both in 2000 and 2020, a relatively liberal government is in power and the medical community has no proper leader.
We already know the course and consequences of the doctors’ strike 20 years ago. I wonder which path the current strike will take us to. The government has the key. I hope they do not think that the doctors’ strike in 2000 and today’s strike are the same. Now is different from then in many ways.
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