In this blog post, we examine how the introduction of the Special Act on Resident Physicians will affect healthcare workforce management, patient safety, and the training environment for resident physicians.
On July 31, 2015, in South Korea, Representative Kim Yong-ik of the New Politics Alliance for Democracy, a member of the National Assembly’s Health and Welfare Committee, proposed the “Bill to Improve the Training Environment and Enhance the Status of Resident Physicians.” Better known as the Special Act on Resident Physicians, this bill limits residents’ working hours to a maximum of 80 hours per week and provides a legal basis for penalizing training hospitals that fail to comply. The medical community continues to debate the bill, with a wide range of opinions being expressed. Currently, the medical community finds itself at the center of a heated debate over the Special Act on Resident Physicians.
The incident that directly led to the Special Act for Resident Physicians was the 2010 Jung Jong-hyuk case. In that incident, a resident physician suffering from excessive workload and sleep deprivation mistakenly administered an anticancer drug intended for intravenous use into the spinal canal, resulting in the death of Jung Jong-hyuk, who was undergoing treatment for leukemia.
A research team led by Professor Kim Seung-seop at Korea University published a paper last June titled “Working Conditions, Health, and Perceived Patient Safety Among Korean Residents.” According to the paper, the average weekly working hours for residents, including interns and residents, reach 93 hours, with interns working as many as 116 hours. This figure is well over double the average weekly working hours of 41 hours for Korean workers. Even when compared to the average weekly working hours of 64 hours for residents in the United States and 55 hours in Australia, it is clear that Korean residents’ working hours are exceptionally long.
Due to these working conditions, 89.3% of interns and 68.6% of residents reported that they had “fallen asleep while on duty,” while 13.8% of interns and 8.7% of residents stated that they had “committed medical malpractice.”
Amid this controversy, the Ministry of Health and Welfare amended the “Regulations on the Training and Certification of Medical Specialists” last July to limit weekly working hours to a maximum of 88 hours. However, there are no means to penalize non-compliance, and many hospitals are resorting to loopholes—such as creating and submitting “fake schedules”—citing staff shortages. Song Myeong-je, president of the Korean Resident Doctors’ Association, said, “Countless residents create separate work schedules—one for actual work and another for reporting to higher authorities,” adding, “Without additional staffing, reducing residents’ working hours is not realistic.” Lee Im-gi, Director of the Medical Resources Policy Division at the Ministry of Health and Welfare, said, “I agree with the overall direction of the bill,” but added, “We need to review whether a special act is desirable or if it would be better to incorporate these provisions into the existing Medical Service Act.”
As such, the Special Act on Resident Physicians faces significant practical barriers to implementation. The law’s effectiveness is low, and it carries more side effects than benefits. As mentioned earlier, phenomena such as working outside of scheduled hours and being forced to falsify logs will become widespread. Furthermore, residents who must do more work in a shorter time will face greater stress, and the risk of problems arising as a result will increase significantly. Additionally, severe financial difficulties due to staff shortages may occur, and there is a possibility that hospital operations will not function properly.
There are also many issues regarding patient health. If the Special Act on Resident Physicians is implemented, the quality of medical care will decline due to a shortage of medical personnel. This is evident from the remarks made by Dr. Woo Go-woon, Chief of Surgery at Hanjeon Hospital, during the Surgical Education Research Society session at the Korean Society of Surgery’s academic conference held at COEX in 2013: “If you go to a hospital and there is a shortage of staff, patients’ lives are at risk in an emergency situation.” Since healthcare is a critical matter involving people’s lives and health, the shortage of medical personnel must be addressed. However, hiring additional staff to fill the gap would impose an excessive financial burden, and realistically, it is difficult to recruit qualified personnel. Thus, pushing forward with this policy without viable alternatives is unrealistic.
Next, there are concerns regarding the quality of residency training. Limiting weekly working hours raises concerns that the quality of training will decline due to insufficient training time. In particular, for departments such as surgery that require extensive hands-on experience in the operating room, limiting working hours to 80 hours will significantly reduce learning opportunities.
Those in favor of implementing the Special Act on Resident Physicians present the following arguments. First, there is the view that having a small number of staff in good condition is more meaningful than having a large number of staff in poor condition. This argument has some merit. If the Special Act on Resident Physicians is implemented, there will be fewer staff members in hospitals than there are now, but the staff’s overall condition is likely to improve due to guaranteed sufficient sleep time. However, this argument can be countered as follows. An adequate number of staff is essential for hospital operations. Some of these staff members are responsible for minor tasks; if the hospital operates with a small staff, it will be difficult to attend to even these minor details, making proper hospital operations challenging. Furthermore, if the cap is implemented and the number of staff is reduced, the workload each individual must bear to resolve these operational difficulties will increase exponentially, rendering the implementation of the cap meaningless.
Next, there is the argument that the probability of medical accidents will increase, and that there is no solution to this. Of course, a decline in physical condition due to excessive working hours can increase the likelihood of medical accidents. However, the risk of medical accidents can also rise when work is excessively concentrated on a small number of staff members. If the likelihood of accidents is similar in both scenarios, the ability to respond swiftly to accidents becomes a far more critical issue. When an accident occurs, having sufficient staff allows for a rapid and accurate response, thereby preventing greater harm. Therefore, not implementing the cap system is the more advantageous approach in this regard.
Finally, the primary argument put forward by those in favor of implementing the cap system is the human rights of residents. However, when comparing the current situation to one where working hours are limited but the workload per unit of time increases, which scenario better respects the human rights of residents? I believe it is difficult to argue that the former respects them more. Furthermore, even if a similar conclusion emerges when comparing the two, the reason we should not implement the cap is that, from the perspective of safeguarding patients’ human rights, not implementing the cap is far more reasonable.
Currently, South Korea’s healthcare workforce is significantly below the OECD average. According to remarks made by Professor Jeong Hyung-sun of Yonsei University during a lecture at a healthcare organization, the number of active physicians per 1,000 people is 1.7, falling far short of the OECD average of 3.1. Among major OECD countries, only Turkey has a lower figure at 1.5. The annual number of doctor visits in South Korea is 11.8, far exceeding the OECD average of 6.8; only Japan (13.6) and the Czech Republic (12.6) have higher rates. The annual number of patient consultations exceeds 7,200, which is nearly three times the OECD average of 2,515 and represents the highest figure among OECD countries. In other words, due to the low doctor-to-population ratio and high number of visits, the number of patients seen per doctor in Korea is extremely high.
If the Special Act on Resident Physicians is enacted at this time, the already insufficient medical workforce will become even more scarce. This is a selfish attitude that prioritizes the human rights of resident physicians while completely disregarding the human rights of patients who desperately need help. Being a doctor is a critical profession that directly deals with human life and health. It is only natural, therefore, that becoming a specialist requires extensive preparation and effort. If the training process becomes lax, it will cause major repercussions throughout the medical community and threaten the public’s health. Therefore, implementing an 80-hour cap on resident working hours is not advisable.
