South Korea's government has threatened to arrest thousands of striking junior doctors and revoke their medical licences if they do not return to work on Thursday.
Around three quarters of the country's junior doctors have walked out of their jobs over the past week, causing disruption and delays to surgeries at major teaching hospitals. The trainee doctors are protesting government plans to admit drastically more medical students to university each year, to increase the number of doctors in the system.
South Korea has one of the lowest doctor-to-patient ratios among developed countries, and with a rapidly aging population, the government is warning there will be an acute shortage within a decade.
The empty corridors of St Mary's Hospital in Seoul this week gave a glimpse of what that future might look like. There was barely a doctor or patient to be seen in the triage area outside the emergency room, with patients warned to stay away.
Ryu Ok Hada, a 25-year-old doctor, and his colleagues have not been to work at the hospital for over a week.
“It feels weird not getting up at 4 a.m.,” Ryu joked. The junior doctor told the BBC he was used to working more than 100 hours a week, often for 40 hours without sleep. “It's insane how much we work for such little pay”.
Although doctors' salaries in South Korea are relatively high, Ryu argues that given their hours, he and other junior doctors can end up earning less than the minimum wage. More doctors will not fix the structural issues within the healthcare system, that leave them overworked and underpaid, he says.
Healthcare in South Korea is largely privatised but affordable. The prices of emergency, life-saving surgeries and specialist care have been set too low, the doctors say, while less essential treatments, like cosmetic surgeries, pay too much. This means doctors are increasingly opting to work in more lucrative fields in the big cities, leaving rural areas understaffed and emergency rooms overstretched.
Ryu, who has been working for a year, says trainee and junior doctors are being exploited by the university hospitals for their cheap labour. In some of the larger hospitals, they make up more than 40% of the staff, providing a critical role in keeping them running.
As a result, surgery capacity at some hospitals has halved over the past week. The disruption has been mostly limited to planned procedures, which have been postponed, with only a few isolated instances of critical care being affected. Last Friday, an elderly woman suffering a cardiac arrest died in an ambulance after seven hospitals reportedly refused to treat her.
‘There are no doctors'
Patience with the doctors is running out from both the public and the healthcare workers needing to pick up the extra work. Nurses have warned they are being forced to carry out procedures in operating theatres that would normally fall to their doctor colleagues.
Ms Choi, a nurse at a hospital in Seoul, told the BBC her shifts had been extended by an hour and a half each day and she was now doing the work of two people.
“The patients are anxious, and I am frustrated that this is continuing without an end in sight,” she said, urging the doctors to come back to work and find another way to demonstrate their grievances.
Under the government's proposals, the number of medical students admitted to university next year would rise from 3,000 to 5,000. The striking doctors argue that training more physicians would dilute the quality of care, because it would mean giving medical licenses to less competent practitioners.
But the doctors are struggling to convince the public that more doctors would be a bad thing and have garnered little sympathy. At Seoul's Severance Hospital on Tuesday, 74-year-old Mrs Lee was receiving treatment for colon cancer, having travelled for over an hour to get there.
“Outside the city, where we live, there are no doctors,” she said.
“This problem has been kicked down the road for too long and needs to be fixed,” said Lee's husband Soon-dong. “The doctors are being too selfish. They're taking us patients hostage”.
The couple was worried about more doctors joining the strike, and said they would be happy to pay more for their care, if it meant the dispute would be resolved.
But President Yoon Suk Yeol's approval rating has improved since the walkout began, meaning the government has little incentive to start overhauling the system and making procedures more expensive, just ahead of elections in April.
Both sides are now locked in an intense standoff. The health ministry has refused to accept the doctors' resignations and is instead threatening to have them arrested for breaking medical law if they do not return to the hospitals by the end of the day. The vice-health minister Park Min-soo has said those who miss the deadline will also have their licences suspended for a minimum of three months.
Though some of those who have walked out believe the government's heavy-handed approach could swing public opinion. On Sunday, the Korean Medical Association will vote on whether senior doctors should join the trainee physicians. If swathes of their junior colleagues have been arrested, they will be more likely to take action.
Ryu said he was prepared to be arrested and lose his medical licence, and that if the government would not compromise or listen to their grievances, he would walk away from the profession.
“The medical system is broken and if things continue like this it has no future, it will collapse,” he said. “I've done some farming before, so perhaps I could go back to that”.
— CutC by bbc.com
