Trainee doctors at participating institutions have given failing grades to the government's "Emergency Patient Transfer System Innovation Pilot Program," which was launched in Gwangju, South Jeolla, and North Jeolla to address the so-called "emergency room merry-go-round" problem, as the program nears its conclusion. Critics point out that administration disconnected from the field—such as transferring patients regardless of emergency room capacity or patient severity—is increasing the burden of legal liability on medical staff.
The Young Doctors Policy Institute, under the Korean Intern Resident Association (KIRA), released these findings Tuesday in a policy brief capturing the realities and on-the-ground voices of the Honam region emergency patient transfer system pilot program.
To resolve the "emergency room merry-go-round" problem, in which ambulances circulate among multiple medical institutions due to bed shortages or lack of medical staff, the government finalized the "Emergency Patient Transfer System Innovation Pilot Program Plan" in February and launched the pilot in May, applying regional transfer guidelines in Gwangju, South Jeolla, and North Jeolla. The core of the program is that a regional emergency medical situation room decides which hospital receives severe patients, while the 119 emergency rescue service takes responsibility for transporting mild cases. Unlike the previous method, in which 119 rescuers called hospital emergency rooms to ask whether patients could be accepted, the new system selects receiving hospitals through a platform that shares medical resources in real time.
The survey was conducted last month targeting emergency medicine, internal medicine, and surgical trainee doctors working at emergency medical institutions in the Honam region, including Gwangju, South Jeolla, and North Jeolla. Of the 376 eligible participants, 44 (11.7%) responded.
According to the report released Tuesday, 71% of all respondents gave the pilot program's overall operational satisfaction a score of 3 or lower out of 10. The institute noted this amounts to a "failing grade," with 32% of respondents giving the lowest possible score of 1. The largest share of respondents, at 82%, cited "legal burden over medical accidents" as a problem with the pilot program. This was followed by "inadequate grasp of on-site capacity by the regional situation room" (59%) and "abolition of 119's prior notification obligation" (57%). Distrust of how the regional situation room operates was also high. Fully 78% of respondents said that the situation room's transfer support and priority acceptance orders fail to adequately reflect the actual status of hospitals' operating rooms, intensive care units, and backup medical personnel. An emergency medicine trainee at a tertiary general hospital in Gwangju said, "Patients are being transferred without any plan in a situation where treatment capacity is already saturated with mild patients who walk into the emergency room." Critics also pointed out a practice of calling emergency rooms in the name of "the patient wants it" even for mild cases, and dropping patients off in front of hospitals when refused. Because the focus is solely on transferring patients, overcrowding at tertiary general hospitals cannot be resolved, they argue.
Above all, dissatisfaction was high with a structure that places legal responsibility on medical staff when patients are accepted in situations exceeding treatment capacity. An emergency medicine trainee at another tertiary general hospital in Gwangju said, "In the end, difficult patients end up concentrated at a single regional emergency medical center. After actually accepting the patients, backup care is unavailable, and 'handle it yourself' is becoming the reality."
The institute proposed establishing a legal safety net—including exemption from criminal prosecution for medical accidents involving severe and emergency patients—as well as linking backup care and creating a real-time consultation system as prerequisites for resolving these issues. "Resolving the emergency room merry-go-round cannot be solved simply by designating ambulance destinations," the institute emphasized. "After the pilot program ends, the system must be reexamined based on the experiences and data of frontline medical staff."
The government plans to expand the program nationwide following an evaluation after the pilot ends. However, on-the-ground opposition has continued from before the program's launch, with critics calling it armchair theorizing. Immediately after the government's pilot program plan was made public, medical associations in the Honam region, including Gwangju, South Jeolla, and North Jeolla, issued a joint statement arguing, "This is a base attempt to sway public opinion by blaming doctors who refused to accept patients as the cause of the emergency room merry-go-round crisis, while ignoring the real cause of the problem." They added, "As long as investigative and judicial practices continue that hold doctors and hospitals accountable simply because outcomes were bad despite their best efforts, the emergency room merry-go-round problem cannot be solved."
