[의정갈등 해법, 해외서 길을 묻다]
〈3〉 The U.S. treats essential medical services exceptionally well
Compensation for specialists in essential medicine is double that of general internal medicine… Neuro-thoracic doctors have the first and second highest salaries.
Because the compensation is high, majors flock to essential departments.
Thoracic surgery recruitment rate 100%… Only 38% in Korea
“Have you ever had a stomachache or blood in your stool?”
Fresh Meadow Center in Queens, New York City, USA on the afternoon of the 3rd. When hemato-oncology specialist Kim Byeong-moon (40) asked, an African woman in her 70s expressed her gratitude and said, “There was no major problem.” This woman was introduced to Mr. Kim by her doctor in October last year when blood appeared in her stool. On this day, Mr. Kim was asked in detail for about 30 minutes about the progress since he underwent surgery for colon cancer and was declared fully cured.
This hospital is one of 64 centers owned by the network hospital ‘New York Blood & Cancer Specialists’ in New York City. Mr. Kim goes to work at two centers two or three days a week and works 50 hours a week. He said, “In the United States, compensation for chemotherapy is high, so unlike Korea, hematology and oncology, which is an essential specialty, is popular. They earn about 1.5 to 2 times as much as general internists (430 million won on average).”
● “High compensation attracts talented people”
Cleveland Clinic Endoscopy Center, Ohio, USA, on the morning of the 30th of last month. Jang Seong-wook, a 52-year-old professor of gastroenterology, said, “The gallstones are larger than the bile duct, so the gallstones must be broken. “It’s going to be difficult from here on, so I’ll do it myself,” he said, handing over biliary endoscopy equipment to the former doctor. The surgery on this day involved inserting a small endoscope with a diameter of 3.3 mm to check for gallstones and removing them with a laser.
Professor Jang, who has worked at Cleveland Clinic, one of the top four hospitals in the United States for over 20 years, is an expert in pancreatic biliary endoscopic procedures. They work 50 hours a day, 5 days a week, and perform an average of 36 procedures and 12 outpatient treatments each week. Compared to Korea, the workload is only about half. David Long (33), a full-time doctor, said, “In the United States, I believe that proper treatment can only be provided if sufficient recovery time is provided after work. “This is why excellent overseas talent gathers,” he explained.
Cleveland Clinic’s main hospital has eight gastroenterology specialists who focus on high-level endoscopic procedures. Additionally, the endoscopy center has six operating rooms measuring 61 m2 (approximately 18.5 pyeong). A team of up to six people, including a gastroenterologist, an anesthesiologist, two nurses, a full-time doctor, and an X-ray technician, perform the surgery in an operating room equipped with cutting-edge equipment such as an ultrasound endoscope. The size alone is two to three times that of Korea’s endoscopic operating room.
Cleveland Clinic is able to maintain excellent personnel and facilities because it receives high compensation for difficult surgeries. According to the U.S. public insurance system Medicare, when an upper digestive tract tumor is resected using an endoscope, you receive up to 1,093,000 won in Korean currency, which is more than five times the amount in Korea (194,000 won).
High fees lead to high salaries for specialists in essential medicine. According to Doximity, an online platform to which more than 80% of U.S. doctors subscribe, the first and second highest salaries for specialists this year were neurosurgery and thoracic surgery, with an average of 1.054 billion won and 995 million won in Korean money, respectively.
Based on the 2022 health and medical manpower survey, the average salary for neurosurgeons and thoracic surgeons in Korea is 370.6 million won and 488 million won, a difference of up to three times more.
Because the compensation is high and work-life balance can be maintained, there are many specialists in essential medicine who are moving from Korea to the United States.
● Unlike Korea, residents are concentrated in essential departments.
Since the more difficult procedures are performed in the serious field, the more compensation there is, so there are many residents (interns, residents) who want to pursue essential departments. Since the more severe the treatment, the higher the compensation, there is a high preference for essential departments that provide both surgery and treatment, such as thoracic surgery and neurosurgery in surgery, and gastroenterology, cardiology, and hematology-oncology in internal medicine.
In the United States, the recruitment rates for new cardiovascular and thoracic surgery and obstetrics and gynecology this year reached 100% and 99.6%, respectively. Among essential departments, the Department of Pediatrics and Adolescents, which has low competition, recorded a recruitment rate of 91.8%. On the other hand, in Korea, when applications were received for first-year residency at the end of last year, the application rate relative to the quota was 38.1% for cardiovascular and thoracic surgery and 63.4% for obstetrics and gynecology. The Department of Pediatrics accounted for only 26.2%. In addition, most of the residents in essential departments have left due to the current medical vacancy crisis.
The treatment of essential medical residents is also different. In the United States, the federal and state governments give approximately 83 to 97 million won each year to individual residents and pay separate training costs to hospitals. From the hospital’s perspective, residents are both workers and customers.
Professor James Stoller, Dean of Education at Cleveland Clinic, said, “We currently operate 124 training programs, and 75% of the costs are funded by government support.” Mr. Long also said, “When I was a resident, I developed my capabilities by doing surgeries one-on-one with professors according to the curriculum for 60 hours a week.”
On the other hand, in Korea, hospitals pay about 50 million won per year and make people do ‘work’ instead of ‘training’. The rate of overtime work of 80 hours per week on average for four weeks also reached 52%. Since there is no systematic education, you have to read books or listen to professors while seeing patients. Park Jin-wook (38), assistant professor of cardiology at the University of Louisville, Kentucky, who worked as a resident in both Korea and the United States, said, “In Korea, hospitals do not hire essential departments because they do not make money. As a result, there is no place to get a job even after completing training,” he said.
※ This project was supported by the Press Promotion Fund raised through government advertising fees.