As the number of new public health doctors in medicine fell sharply to 98 this year due to fallout such as gaps in resident training, rural health care systems have entered an emergency. As early as this year, eight out of ten township-level health subcenters nationwide will lose their on-site physician. The government plans to prioritize assigning public health doctors to medically underserved areas and, for subcenters without a physician, to fill gaps by having nurses (public health practitioner civil servants) provide care, by having physicians at health centers make regular rotating rounds, and by using telemedicine.

The Ministry of Health and Welfare announced on the 13th that, in light of the steep drop in the public health doctor workforce, it considers the situation a regional health care crisis and will establish and implement emergency measures to minimize service gaps. According to the Ministry of Health and Welfare, the total number of medical public health doctors in service this year is 593, down 37.2% from 945 last year. Compared with 2,116 in 2017, the figure has fallen to about one quarter in roughly ten years. Only 98 are newly entering service this year; against 450 whose service ends, the replenishment rate is just 22%.

Public health doctor numbers have been steadily declining as structural factors intersect, including the service term gap with active-duty enlisted soldiers (18 months for enlisted versus 36 months for public health doctors) and a rising share of female medical students. Added to this, more medical students are taking military leaves of absence amid government-physician conflict, and shortages of public health doctors are projected to continue until 2031. New intake is expected to remain under 100 through 2027, and to stay in the 100s from 2028 to 2031. A recovery of the total in-service headcount to a customary level of 1,000 or more is not expected until after 2032. This increases the likelihood that rural health care gaps will become entrenched as a structural problem over the next six to seven years.

The share of township-level health subcenters without an assigned public health doctor rose from 59.5% last year to 82.1% this year. In particular, among 532 subcenters in primary-care-underserved areas that also lack private medical institutions, 393 (73.9%) must operate without a physician. Only 139 (26.1%) locations, such as islands and remote areas, will receive public health doctors on a priority basis. A health subcenter is a lower-tier facility established one per township under a city, county, or district health center; although it handles only 4.3 patient visits per day on average, it is effectively the only medical access point for residents where there are no nearby hospitals or clinics.

In response, the Ministry of Health and Welfare has presented targeted placement and functional reconfiguration. Public health doctors will be assigned first to subcenters in primary-care-underserved areas with the poorest accessibility. Public health doctors stationed at health centers will make rotating rounds to their jurisdictional subcenters two to three times per week. Subcenters without public health doctors will be reorganized into four types based on local conditions. First, the 393 unstaffed subcenters in primary-care-underserved areas will be reconfigured into three types: an integrated model (151 sites) in which public health practitioner nurses provide ongoing medical care; a clinic-conversion model (42 sites) that converts the subcenter into a public health post; and a rotating-visit model (200 sites) under which public health doctors assigned to health centers visit regularly. The remaining model, applied in non-underserved areas with sufficient private providers, is a health-promotion model that strengthens community-centered health promotion functions.

Use of telemedicine and senior physicians, among other existing resources, will also be expanded. To assist rural seniors unfamiliar with digital devices, a Phase 1 model will first be introduced in which health center nurses and administrative staff guide and support telemedicine, followed by development of a separate model tailored to underserved areas. Expanding home receipt of medicines (delivery), currently limited to islands, remote areas, and some vulnerable groups, to all townships in primary-care-underserved areas is also under review. The Senior Physician Support Program, which helps health centers hire board-certified specialists aged 60 or older with extensive clinical experience, will continue.

Over the medium to long term, the entire local public health care system will be overhauled. From 2027 through 2029, the government will pursue hub formation by consolidating small subcenters and public health posts around regional hubs to create care hubs. In areas with large populations and land areas, a regional hub model will be introduced that concentrates physician staffing at hub subcenters to provide outpatient care centered on internal medicine and basic emergency treatment. Smaller areas will apply a health-center-focused model that concentrates personnel at the health center.

Talks will also be pursued to shorten the service term for public health doctors. Because a term that is double that of active-duty enlisted soldiers is cited as a key reason applicants shy away, the plan is to reduce it to encourage applications. As personnel admitted to the regional physician system in 2027 begin graduating in 2033, a medium- to long-term workforce base will also be built to link them to service at local public health care institutions.

Minister of Health and Welfare Jeong Eun-kyeong said that the sharp contraction in the public health doctor corps makes reform of the local public health care system an urgent task that cannot be delayed, and that the ministry will mobilize all possible resources to build a dense medical safety net so that residents in underserved areas can receive care with peace of mind wherever they are, while using this as an opportunity to drive innovation toward a sustainable local public health care system.