In this blog post, we will look at how the introduction of the Special Act on Residents will affect medical workforce management, patient safety, and the training environment for residents.
On July 31, 2015, Kim Yong-ik, a member of the National Assembly’s Health and Welfare Committee, proposed a bill to improve the training environment and status of residents. This bill is better known as the Special Act on Residents, and it includes provisions to limit residents’ working hours to a maximum of 80 hours per week and to punish training hospitals that do not comply with this. The medical community is debating the bill, with various opinions being expressed. Currently, the medical community is at the center of a heated debate over the special law for residents.
The case that directly led to the Special Act on Residents in Medical Training was the case of Jung Jong-hyuk in 2010. Jung Jong-hyuk, who was being treated for leukemia, died after a resident in medical training, who was suffering from excessive workload and lack of sleep, mistakenly administered an anti-cancer drug that was supposed to be administered intravenously into his spinal canal.
A team led by Professor Kim Seung-seop of Korea University published a paper titled “Working Environment, Health, and Perceived Patient Safety of Korean Residents” in June. According to the paper, the average weekly working hours of residents, including interns and residents, is 93 hours, and 116 hours for interns. This is more than double the average weekly working hours of 41 hours for Korean workers. Compared to the average weekly working hours of 64 hours for residents in the US and Australia and 55 hours for residents in Australia, it can be seen that the working hours of Korean residents are very long.
Due to this working environment, 89.3% of interns and 68.6% of residents answered that they had “dozed off during working hours,” and 13.8% of interns and 8.7% of residents answered that they had “committed medical malpractice.”
Amid such controversy, the Ministry of Health and Welfare changed the Regulations on Training and Qualification Recognition of Specialists in July last year to allow them to work up to 88 hours per week. However, there is no means of sanctioning non-compliance with this, and many hospitals are using loopholes such as creating and submitting “fake timetables” due to labor shortages. Song Myeong-je, the chairman of the Korean Medical Residents Association, said, “There are many residents who create separate work schedules for their actual work and for reporting to their superiors,” and “Reducing the working hours of residents is not easy in reality without additional manpower.” Lim Eul-gi, the head of the Medical Resources Policy Division at the Ministry of Health and Welfare, said, “I agree with the overall direction of the bill,” but “It is necessary to consider whether a special law is desirable or whether it should be reflected in the existing medical law.”
The Special Act on Medical Residents is a bill with many practical barriers to implementation. The law is not effective and has more side effects than benefits. As mentioned earlier, the phenomenon of working outside of business hours and forcing employees to falsify their logs will become rampant. In addition, residents who have to do more work in a shorter amount of time will be under greater stress, which will greatly increase the risk of problems. There is also a possibility that the hospital will not be able to operate properly due to serious financial difficulties caused by a shortage of manpower.
There are many problems in terms of the health of patients. If the special law for residents is implemented, the quality of medical care will decline due to the shortage of medical personnel. This can be seen in the remarks made by Woo Go-un, the head of the Department of Surgery at the Korea University Anam Hospital, at the session of the Surgical Education Research Group at the 2013 Korean Association of Surgery Academic Conference held at COEX, “If you go to the hospital and there is an emergency due to a shortage of personnel, the lives of the patients will be in danger.” As medical care is a matter of life and death and health, the shortage of medical personnel must be prevented. If additional employment is taken to supplement the shortage of medical personnel, the financial burden will be too great, and it is also difficult to recruit qualified personnel in reality. It is unrealistic to push through a policy in such a situation without alternatives.
Next, there are problems in terms of the quality of training for residents. If the number of working hours per week is limited, there is concern that the quality of training will decline due to insufficient training time. In particular, in departments such as surgery, where a lot of practice is required in the operating room, the number of opportunities to learn will be greatly reduced as the working hours are limited to 80 hours.
The following are the opinions of those who are in favor of the implementation of the Special Act on Residents. First, there is an opinion that the presence of a small number of people in normal condition is more meaningful than a large number of people in abnormal condition. This opinion has some merit. If the Special Act on Residents in Training is implemented, there will be fewer people in the hospital than there are now, but there is a possibility that the condition of the workforce will generally improve due to sufficient sleep time. However, this opinion can be refuted as follows. The presence of an appropriate number of people is essential for the operation of a hospital. Some of the staff members are responsible for small tasks, and if the hospital is operated with a small number of staff, it will be difficult to take care of even these small tasks, making it difficult for the hospital to operate properly. In addition, if a cap is imposed on the number of staff members, the amount of work that each individual must bear to solve these operational difficulties will increase exponentially, making the cap meaningless.
Next, there is an opinion that the probability of medical accidents will increase, but there is no solution for this. Of course, poor physical condition due to excessive working hours can increase the probability of medical accidents. However, if a small number of people are overworked, the risk of medical accidents can also increase. If the level of accidents is similar in both cases, how quickly the accident is dealt with becomes a much more important issue. When an accident occurs, having enough personnel on hand to respond quickly and accurately can prevent further damage. Therefore, not implementing a cap is a more advantageous method from this perspective.
Finally, the biggest argument in favor of implementing a cap is the human rights of residents. However, when comparing the current situation, where the number of hours worked is limited but the number of hours worked per unit of time is increasing, which is more respectful of the human rights of residents? I believe that the former is more respectful. And even if a similar conclusion is reached when comparing the two, the reason why the upper limit should not be implemented is that it is much more reasonable not to implement the upper limit in terms of guaranteeing the human rights of patients.
Currently, the number of healthcare workers in Korea is much lower than the OECD average. According to a lecture given by Professor Jung Hyung-sun of Yonsei University to a healthcare organization, the number of active doctors per 1,000 people is 1.7, which is much lower than the OECD average of 3.1. Among the major OECD countries, only Turkey has a lower number of active doctors than Korea at 1.5. The number of annual doctor visits in South Korea is 11.8, which is significantly higher than the OECD average of 6.8, with only Japan at 13.6 and the Czech Republic at 12.6 having a higher rate. The number of annual consultations exceeds 7,200, nearly three times the OECD average of 2,515, and is the highest in the OECD. In other words, in Korea, the number of patients seen per doctor is very high due to the low doctor-patient ratio and high number of visits.
If the Special Act on Residents is implemented, the already insufficient medical workforce will be further depleted. This is an selfish attitude that only cares about the rights of residents while completely disregarding the human rights of patients who are in desperate need of help. A doctor is an important profession that directly deals with people’s lives and health. It is only natural that a lot of preparation and effort are required before becoming a specialist. If the training process is relaxed, it will have a major impact on the medical community and threaten the health of the people. Therefore, it is not desirable to implement an 80-hour upper limit on the working hours of residents.
