Legal Responsibility and the Crisis in Essential Medical Care

Last year, the Essential Medical Policy Package was introduced in South Korea. While there is still debate over what constitutes essential medical care, there is a general consensus that it refers to specialties directly linked to saving lives and providing indispensable treatments. Examples include internal medicine, various surgical specialties within general surgery, obstetrics, and emergency medicine.

The government attempted to resolve the challenges in the healthcare system by increasing the medical school quota by 2,000 students, but at least from my perspective, this effort has proven to be a failure. However, the diagnosis of the problem was insightful. Physicians in essential medical fields are exposed to high risk, high intensity, and low career prospects, whereas those in non-essential fields enjoy low risk, low intensity, and higher earnings. This situation has led to significant challenges, particularly in essential medical fields.

A key issue that continues to deter physicians from entering critical specialties is the legal responsibility they bear in cases of medical incidents. Recent legal rulings regarding essential medical fields have raised renewed concerns about whether physicians are sufficiently protected from excessive legal liability. This article explores the impact of legal responsibility on essential medical services and the broader implications for Korea's healthcare system.

 

The Burden of Legal Responsibility in Essential Medical Fields

1. High-Risk, High-Intensity, Low-Reward: The Vicious Cycle of Essential Medical Care

Essential medical specialties—such as emergency medicine, pediatrics, and obstetrics—are often characterized by high medical risk, intense workloads, and limited career incentives. Physicians in these fields face greater exposure to medical lawsuits, contributing to burnout and workforce shortages. The Essential Medical Policy Package correctly identifies that the cycle of avoidance is fueled by these conditions, making it increasingly difficult to sustain the workforce in essential care areas.

2. Judicial Precedents Reinforce Physician Hesitancy

Recent court rulings highlight the persistent legal risks associated with practicing in essential medical fields. Physicians facing legal accountability for patient outcomes, even in emergency or high-risk scenarios, are increasingly discouraged from choosing careers in these vital specialties. For instance:

• A recent ruling held both a hospital and its medical staff liable alongside an assailant in a case where a victim of dating violence died after receiving emergency treatment. The case involved a woman who was severely injured by her partner and later died at the hospital. The court found that the medical team had not provided adequate emergency care, assigning partial responsibility to them despite the primary cause being the assault. This verdict has heightened concerns in the medical community about the increasing legal risks faced by doctors handling critical emergency cases. (Source)
• A case involving a patient with chest pain who visited the emergency room but later died from an undiagnosed aortic dissection has further fueled concerns. The attending emergency physician faced legal repercussions for failing to detect the rare but fatal condition in time. The ruling has sparked debates over whether physicians should be held accountable for missing difficult-to-diagnose cases in high-pressure environments. (Source)
• A case of intussusception surgery leading to patient death has also raised alarms about legal responsibility in essential medical care. A young patient underwent emergency surgery for intussusception, a condition requiring prompt intervention. However, complications arose post-surgery, leading to the child's death. The court ruled against the hospital, arguing that the medical team failed to adequately monitor the patient's post-operative condition. This case has intensified concerns about whether doctors performing life-saving procedures are being unfairly targeted for legal action. (Source)
• The Ewha Womans University Mokdong Hospital neonatal deaths case saw prolonged legal proceedings against medical professionals, despite eventual acquittals. The case significantly impacted the field of neonatology, leading to a sharp decline in pediatric and neonatal specialist applications.

These examples illustrate how legal precedents contribute to the reluctance of physicians to enter or remain in essential medical specialties.

The Impact on the Healthcare System

3. Deteriorating Workforce and Increasing Patient Risks

As legal risks mount, physicians are increasingly avoiding essential specialties, leading to a shrinking workforce and overloaded medical staff in critical departments. The consequences include:

• Emergency departments and trauma centers facing staff shortages, resulting in longer wait times and reduced patient care quality. In an attempt to resolve this issue, the government expanded the medical school quota by 2,000 students, but this approach has not proven to be a fundamental solution. Instead, it has accelerated the shift of existing essential medical professionals toward non-essential, high-revenue fields.
• An increasing concentration of patients in major tertiary hospitals in metropolitan areas, leading to higher travel costs and greater health risks for patients requiring urgent care. This shift has also accelerated the exodus of essential medical professionals from regional hospitals. While some criticize the difficulty of hiring doctors even with high salaries, from an individual physician's career perspective, it is natural to prefer working in an environment where multiple colleagues share responsibilities rather than facing high-risk situations alone.
• Medical professionals opting for non-essential, low-risk fields such as cosmetic surgery, further exacerbating the imbalance in healthcare services.

The government has introduced measures such as increasing the medical school quota by 2,000 students, but this policy alone has failed to address the root cause of physician shortages. Simply increasing physician numbers will not solve the problem without comprehensive reforms that address legal risks, improve working conditions, and provide fair compensation in high-risk medical fields.

A Call for Legal and Systemic Reform

To prevent further deterioration of essential medical services, Korea must implement structural changes, including:

• Reforming the legal framework to protect physicians in high-risk fields, such as introducing clearer guidelines on medical liability and expanding protections for emergency and essential care doctors.
• Enhancing compensation and incentives for essential medical practitioners, making these fields financially sustainable.
• Developing a sustainable workforce strategy, including better training, support systems, and career pathways for specialists in essential medical care.

The foundation of all these reforms is, above all, financial support. The next most crucial factor is the government's commitment to carrying out these reforms.

The heavy legal burden on physicians in essential medical specialties continues to deter new entrants, worsening workforce shortages and placing additional strain on Korea’s healthcare system. While policies like medical school expansions aim to increase physician numbers, they fail to address the fundamental issues of legal risk and inadequate incentives. Without substantial legal and systemic reforms, essential medical services will continue to struggle, ultimately affecting patient care and public health.

What are your thoughts on the current legal and systemic challenges facing essential medical care?