Academic articles with public health perspectives as a potential tool for Korean doctors in addressing health policy concerns
Article information
An increasing number of Korean medical doctors feel helpless and are leaving the field due to a healthcare policy-making process that often ignores critical issues they face daily. This frustration has intensified since the government announced the plan to expand medical student intake from 3,058 to 5,058 per year, aiming to improve access to specialists who handle high-risk, high-workload procedures but receive relatively low compensation. However, 82% of Korean medical doctors doubt the policy will be effective in addressing shortages in fields such as internal medicine, pediatrics, obstetrics, emergency medicine, and complex fields like general, neuro, and cardiothoracic surgery [1]. Rather, they believe the deficit will continue unless the low compensation and insufficient legal protections related to high-risk procedures are tackled [1].
In response, many medical students and junior doctors are planning to practice abroad, and more attendings are shifting to better-compensated practices. According to a March 2024 survey by To Be Doctor, 41.3% of medical students are seriously considering residency abroad, up from 2% before the announcement [2]. Additionally, the Korean Ministry of Health and Welfare reported a 35% increase in pediatricians changing specialties, from 491 to 662, between 2019 and 2022 [3].
The growing frustration among Korean doctors driven by government policies that overlook their concerns calls for a more proactive and structured approach to influencing health policy. Bold actions, such as the department closure declared by the Korean Pediatricians’ Association in March 2023, may draw immediate public and government attention. However, a more sustainable solution lies in incorporating public health perspectives. By focusing on comprehensive factors that determine population health, doctors can uncover overlooked health challenges and craft informed policy recommendations. Therefore, interpreting data through a public health lens and publishing policy-driven academic articles are a strategic and professional means of amplifying voices from the field and addressing this growing frustration.
Academic articles grounded in public health perspectives provide evidence that strengthens both issue framing and policy recommendations. Firstly, healthcare providers can identify overlooked circumstances or unexpected policy consequences, highlighting their threat to social values beyond doctor-patient concerns. This engagement helps steer public awareness toward pressing health challenges. Secondly, the evidence doctors gather can inform and shape more effective policy suggestions.
The three following published articles provide public health perspectives on the broader implications of healthcare issues. The first article, by Wadhera et al. [4], described the unintended consequences of the Hospital Readmissions Reduction Program driven by the Centers for Medicare and Medicaid Services (CMS) in the United States. In an effort to deliver higher-value care, CMS adopted 30-day readmission rates to assess hospital performance and enforce financial penalties. However, the authors, who were cardiologists, found that the sum of post-discharge emergency department visits and observation stays increased more rapidly than the decline in 30-day readmissions from 2012 to 2015. This national retrospective analysis suggests that quality metrics may hinder patient-centered care rather than promoting it.
The second article evaluated CMS value-based payment programs that led to financial disadvantages for quality care. A paper by Aggarwal et al. [5], who were all clinicians, discovered that hospitals with mostly Black patients received more penalties than other hospitals under CMS programs. The authors noted that, given that these hospitals were more likely to be under-resourced, such value-based initiatives may hinder the ability to improve care in hospitals requiring more aid and can exacerbate racial disparities.
The third article, a research letter by Figueroa et al. [6], examined COVID-19 cases in US nursing homes. They found that nurse staffing shortages were highly associated with the spread of COVID-19 cases compared to other quality measures adopted by the CMS. The authors, half of whom were medical doctors, concluded that straightforward support for staffing limits would be the most effective policy to contain a contagious disease, rather than other quality control domains.
These examples highlight how physicians, through firsthand observation in healthcare facilities, can draw attention to overlooked challenges and offer direct evidence for future policy by advocating for societal values and healthcare equity from public health perspectives. Furthermore, they underline the importance of understanding broader factors influencing health outcomes.
Public health perspectives emphasize the importance of social determinants of health, which encompass nonmedical factors ranging from healthcare access to education, housing, economic stability, and other aspects that comprehensively impact both health outcomes and disparities. By understanding the social determinants of health, Korean doctors can leverage field observations to advance public health efforts, transcending their traditional focus on clinical medicine and individual care. These efforts can ultimately contribute to shaping health policy, tackling the root causes of systemic health challenges, and advancing health equity.
Notes
Conflicts of interest
The author has no conflicts of interest to declare.
Funding
The author received no financial support for this study.
Data availability
Data sharing is not applicable as no new data were created or analyzed in this study.