# **From Internist Dreams to Global Training: A Physician’s Experience Amidst South Korea’s Health Care Crisis**

### **A Career at a Crossroads**
In August 2020, while standing under the sweltering summer sun advocating for the future of South Korean health care, I was unaware that I would soon be faced with momentous decisions of my own. At that moment, I was a fifth-year medical student experiencing my initial nationwide doctor’s strike. The main issue? The government’s proposition to boost medical school admissions as a remedy for doctor shortages in rural regions and specific specialties. However, the medical community presented a different perspective—South Korea was not deficient in the number of physicians; rather, it struggled with untenable working conditions. Expanding the workforce without resolving these systemic challenges would likely worsen the situation.

That protest marked a pivotal moment in my career. It compelled me to reconsider whether my previously-clear ambition—becoming an internist—was still attainable in a progressively unstable system. I faced the stark reality of South Korea’s health care structure and had to reevaluate my future.

### **Navigating a Broken System**
The South Korean health care system functions under the National Health Insurance Service (NHIS), a single-payer model aimed at ensuring universal access. In theory, this should encourage equitable health care; however, in practice, the system has been financially challenged for years. Reimbursement rates for treatments often do not mirror the actual expenses incurred by hospitals or private practitioners. Certain specialties, such as cardiothoracic surgery and obstetrics, have been especially impacted, with many physicians departing these fields due to insufficient incomes and excessive workloads. Conversely, other specialties that depend on non-insured services managed to thrive beyond NHIS’s constraints.

Confronted with the threat of operating in a system seemingly crumbling under fiscal pressure, I explored alternative paths. I aimed for a specialty less intertwined with NHIS regulations, allowing me to practice medicine without the uncertainties tied to government reimbursement policies. This pursuit led me to aesthetic medicine—a sector fueled by private payment, offering financial security and a level of independence that conventional specialties could not provide.

For two years, I practiced as a generalist in dermatology clinics, honing my skills in aesthetic procedures. I envisioned establishing my own clinic by 2025, firmly believing I had discovered a way to harmonize my medical career while sidestepping the pitfalls of the NHIS framework.

### **A New Crisis, A Tougher Decision**
Just as I began to feel assured in my decision, 2024 brought another shock—a fresh wave of sweeping reforms and another nationwide doctor’s strike. This time, the government unveiled a contentious policy: prohibiting the simultaneous use of insured and non-insured treatments. The intention was to curb perceived overuse of health care, but the unintended fallout was severe. Patients faced either diminished access to essential treatments or markedly increased costs for services that were previously partially covered.

Even though I had already transitioned to a non-insurance sector, this policy had indirect ramifications for my field. If NHIS-affiliated doctors, disillusioned by the collapsing reimbursement system, opted to migrate into aesthetic medicine in large numbers, competition would soar. More critically, the reform represented yet another detrimental blow to the overall sustainability of South Korea’s health care landscape—it was evident that the fissures, long overlooked, were widening.

### **The Exodus of Young Doctors**
A marked difference between the 2020 and 2024 strikes was the response of younger physicians. In 2020, we championed change, hoping that reforms could enhance our working conditions. In 2024, however, instead of fighting, we turned our backs. Young doctors, once at the forefront of protest, began abandoning residency programs entirely. It was no longer a matter of reforming the system—the system itself appeared beyond repair. For the first time in history, doctors of all levels, from junior trainees to seasoned specialists, were seeking opportunities abroad.

I find myself included in this trend. I have come to terms with the fact that Korea’s health care instability is not merely a temporary crisis—it is a recurring phenomenon. As Paulo Coelho wisely states in *The Alchemist*, *“Everything that happens once can never happen again. But everything that happens twice will surely happen a third time.”* I refuse to wait for the next disaster. Instead, I have opted to take charge of my future by preparing for training overseas.

### **Final Thoughts: Choosing Survival Over Tradition**
In just a few short years, I have transformed from an aspiring internist to an aesthetic physician and now, a doctor readying for an international career. Every step in my journey has been dictated not just by professional goals, but by the imperative to adapt and thrive in an unpredictable environment.

South Korea’s medical crisis is far from resolved, and the future for those who