South Korean hospitals are scrambling to keep their children’s units running, with the government declaring emergency measures Wednesday to keep the faltering pediatric health care system afloat.

In an emergency briefing, Minister of Health and Welfare Cho Kyoo-hong said his ministry would be adding more public pediatric intensive care centers, and implement a compensation system that will prompt larger hospitals to operate pediatric emergency rooms around the clock.

“Investments in the pediatric medical system are investments in the future of our country,” he said.

Earlier the same day, President Yoon Suk Yeol visited the Seoul National University Hospital’s pediatric ward and told staff that looking after the health of children was “the country’s top priority.”

“Nothing is more important than making sure our children are getting the health care services they need,” he said. “To do that we have to build a strong pediatric medical system, especially for children in intensive care, and compensate our medical workforce better.”

Overworked but underpaid

In December last year, the 1,500-bed Gachon University Gil Medical Center, the largest hospital in Incheon alongside the state-run Incheon Medical Center, announced it was halting admissions of pediatric patients.

The key reason behind what is meant to be a temporary closedown was a yearslong shortage of trainee doctors, known as residents, in pediatrics. The shortages forced existing pediatricians to be overworked.

At the same Gil Medical Center in 2019, a pediatrics resident died while on late shift. An investigation by the Korean Intern Resident Association at the time revealed he had been working 88 hours per week on average, sometimes working as long as 50 to 55 hours per shift.

The working conditions for residents are no better in other hospitals.

One of the largest hospitals in Seoul in 2019 came up with a policy to not to let a single shift last longer than 36 hours. But in “emergencies,” working up to 40 consecutive hours was permissible. The Intern Resident Association said in a statement December last year that at most hospitals, residents still worked a 36-hour shift at least two to three times a week.

Not only in Incheon but across the country, pediatricians’ offices are closing down and hospitals are limiting their pediatric services.

In 2021, about 120 pediatric clinics ran out of business, more than any other specialty. The Korean Pediatric Society’s survey from September last year showed that across the country, only 36 percent of hospitals large enough to train residents had 24-hour pediatric emergency units.

COVID-19 dealt a blow to pediatricians all over, but the root causes run deeper. Pediatricians say the crisis has been in the making for the past two decades.

“The fees for pediatric services have been nearly the same since the time when a million babies were born a year. Now less than 250,000 babies are being born a year,” Dr. Ma Sang-hyuk, who has worked as a pediatrician since 1995 at Fatima Hospital in Changwon, South Gyeongsang Province, said in a phone call with The Korea Herald.

“Simply calculated, this means pediatricians now can expect to make a quarter of what they would have made in the 1990s.”

Almost all pediatric care is covered by the National Health Insurance Service in Korea, which means that pediatricians are remunerated mostly through patient consultation fees. In other words, how much a pediatrician makes is dependent on how many patients they see.

According to the Health Ministry’s statistics for 2010-2020, pediatricians have consistently ranked the lowest in terms of average income among major specialists. In 2020, pediatricians made 134 million won ($102,700) a year on average, which is more than 100 million won less than the average yearly earnings of all doctors across specialties.

Ma, who helped formulate the pediatric health care policies while Yoon was president-elect, said that the health care crisis for children has been worsening amid the indifference of the administrations both left and right.

“Yes there was COVID-19. But this isn’t something that happened overnight,” he said.

The Health Ministry “got comfortable exploiting the cheap workforce of residents” and “didn’t look to fix what was wrong until it was too late,” he said. “Our government sustained the system by overworking residents at a cheaper price, to make up for the shortages in specialists.”

He called on Yoon to follow through with his pledge to build a health care system so that hospitals, especially ERs and ICUs, no longer have to rely on residents.

“Maybe it’s because children cannot vote. But children’s health care tends to be sidelined in our health care policies. The focus seems to be always on adult patients,” he said.

Dr. Lim Hyun-taek, another pediatrician, said that the state health insurance system has to catch up in a way that can increase compensation for specialties such as pediatrics that are struggling to retain doctors.

“On top of low birthrates, patient visits have dropped over COVID-19. More former pediatricians are going into aesthetic medicine, which is compensated far better (than pediatrics) because of how our system works,” he wrote in a series of Facebook posts. In the posts, Lim was referring to Korea’s fee-for-service system in which the fees for pediatric services are far lower than other “non-life-saving services.”

“Unless the system changes in a way that can compensate pediatricians better, fewer young doctors will want to pursue pediatrics, and I cannot blame them,” he said.