Korea's rural healthcare system faces a crisis as the number of public health doctors, who have long sustained medical services in farming and fishing villages, is plunging sharply. Local governments plan to prioritize deployment to vulnerable areas and expand mobile and telemedicine services, but critics say these measures fall short of filling the healthcare void.
According to the Ministry of Health and Welfare and local governments on Tuesday, 450 medical public health doctors will complete their alternative military service at the end of April, while only 98 new recruits will join. The overall replacement rate stands at just 21.7%. As a result, the nationwide number of medical public health doctors is expected to drop 37.2% from 945 last year to 593 this year.
The number of public health doctors has steadily declined from a peak of 2,116 in 2017 to 1,960 in 2019, 1,432 in 2023, and 1,209 in 2024. A major cause is the aversion to the lengthy service period. Public health doctors must serve 36 months excluding military training, twice as long as the 18-month term for regular enlisted soldiers. In a survey by the Korean Association of Public Health Doctors, 97.9% of 1,553 medical student respondents cited the long service period as a reason for not wanting to serve as military doctors or public health doctors.
The disruption of resident training and medical school education in 2024-2025 due to the conflict between the government and the medical community has also had an impact. The number of medical students entering active military service jumped about 19-fold from just 150 in 2020 to 2,895 last year. South Gyeongsang Province will see its numbers drop from 116 to 69, South Chungcheong from 86 to 45, North Chungcheong from 57 to 33, North Jeolla from 100 to 64, North Gyeongsang from 153 to 97, and South Jeolla from 179 to 129.
The decline in public health doctors directly translates into reduced access to medical care in rural areas. In farming and fishing villages where private medical facilities are scarce, public health doctors effectively handle primary care, making reduced clinic days and expanded mobile services unavoidable when staffing gaps emerge. Emergency response could also be compromised, potentially delaying initial treatment and decisions on transfers to higher-level hospitals.
The government is pursuing a "tweezer policy" to concentrate limited personnel where they are most needed to minimize the healthcare void. After analyzing medical accessibility in 547 eup and myeon districts nationwide, authorities have prioritized deploying public health doctors to 139 public health subcenters on islands and in remote areas where no private medical facilities exist within or near their jurisdictions. For subcenters without public health doctors, authorities plan to expand the scope of duties for community health practitioners.
The government also plans to expand the "senior doctor" program, which utilizes specialists aged 60 and over, to 180 physicians, and to increase "regional essential doctors," who sign long-term contracts with local medical institutions, to 268.
Local governments are also implementing various measures, including mobile clinics, subsidies for hiring senior doctors, remote consultations in underserved areas, telemedicine, and reassignment of public health doctors. Some regions have begun recruiting daily-wage or contract physicians, but the situation remains difficult. While work at public health centers is not particularly demanding and involves relatively few emergency calls, poor infrastructure continues to deter doctors from working outside the Seoul metropolitan area. Hapcheon County in South Gyeongsang Province, for instance, managed to secure a physician only after posting three recruitment notices this year, eventually offering 1 million won per day.
Disruptions are inevitable at rural public health centers and subcenters that rely heavily on public health doctors. In some regions, public health doctors are already rotating among multiple areas, and residents are expected to face inconveniences such as reduced clinic days and longer wait times. Local governments say they will efficiently deploy limited personnel to minimize healthcare gaps, but fundamental solutions appear elusive.
"With changes in medical school quotas and diversification of service options, the number of public health doctor applicants is declining every year, and the low new recruitment rate means existing gaps are repeatedly going unfilled," a local government official said. "Structural improvements across the regional healthcare system, including the establishment of public medical schools, are urgently needed."
