What is the optimal number of physicians for a sustainable healthcare system?

Article information

Korean J Fam Med. 2025;46(1):1-3

Publication date (electronic) : 2025 January 20

doi : https://doi.org/10.4082/kjfm.46.1E

Seung-Won Oh^1,2,

¹Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea

²Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea

^*Corresponding Author: Seung-Won Oh Tel: +82-2-2112-5643, Fax: +82-2-2112-5635, E-mail: sw.oh@snu.ac.kr

In the present issue, Kim and Lee [1] reviewed the factors used for future projections that impact the supply and demand of physicians in primary care in Korea, Taiwan, Singapore, Japan, and the United States of America. This study evaluated 28 demand, 50 supply, and 26 additional variables. The results indicate that Korea uses less diverse demand and supply indicators, and highlight the need to implement the variables used in the other four countries to improve projection modeling.

On February 6, 2024, the Korean government announced its decision to increase medical school enrollment by 2,000 students. This decision was based on three studies that predicted a shortage of 10,000 physicians by 2035 [2-4]. To achieve this, starting in the 2025 academic year, medical school enrollment is projected to expand from the current 3,058 students to 5,058 students. As a result, an additional 2,000 medical graduates are expected to fill the shortage of physicians from 2031 to 2035, addressing the projected shortfall of 10,000 doctors. However, the final decision slightly reduced the scale of the increase to 1,509 students. Critics in the medical field argue that this policy lacks scientific evidence and cannot resolve systemic issues of the current healthcare system simply by increasing the number of physicians involved.

The main findings of the three studies referenced by the government are as follows: a key study by Shin et al. [2] explored various scenarios for 2035, projecting a potential physician shortage of 49,000 or, alternatively, a surplus of 17,000. These projections depend on workload assumptions, which range from 80% to 120% of the current standards. This study also analyzed scenarios considering changes in disease patterns, healthy aging, economic growth, healthcare payment reforms, climate change, and Korean unification. These comprehensive projections underscore the complexity of determining the optimal number of physicians, as they are influenced by a multitude of interconnected factors.

A study by Lee et al. [3] assumed that physicians gradually retire by the age of 50 and fully retire by the age of 90. Unlike other professions, such as judges or prosecutors, who typically retire around the age of 70, physicians tend to work longer owing to their self-employment status and the late start of their professional careers following extended training. This study estimated a physician shortage of 10,000 people by 2035, and 22,000 by 2050. Based on the current healthcare utilization levels by educational background, this study introduced a scenario reflecting future educational changes among the population, predicting a decreased demand for healthcare services. According to this scenario, no physician shortage will be observed until 2033, and by 2050, there will be a shortage of approximately 10,000 physicians.

Hong [4] investigated the impact of technological advancements on physician productivity, assuming an annual productivity increase of 0.5%. This study divided the scenarios into physician retirement ages of 75 and 80 years. For physicians aged 65 years and older, productivity was assumed to be 50% or 75% of that of younger physicians. This study estimated a shortage of 10,800 physicians by 2035, assuming a retirement age of 75 and 50% productivity for older physicians. By contrast, retirement ages of 80 and 75% productivity for older physicians resulted in a shortage of 7,200. The study also introduced a scenario in which 30% of the new physicians from 2030 onwards would serve as primary care doctors, reducing the physician shortage to approximately 3,000 by 2035.

Because the variables, assumptions, and scenarios applied in these studies vary, the projections within the same model can differ significantly. For example, a single model might predict a shortage of 10,000 physicians under one set of assumptions, but a surplus of 5,000 under another, highlighting the importance of these variables to the outcomes. It is also possible to selectively present specific outcomes, such as shortages of 10,000 or 20,000 physicians, which may lead to skewed interpretations. Therefore, all three authors emphasized that their results should not be collectively interpreted as justifications for increasing medical school enrollment by 2,000 students at a time. However, this cautionary note was not reflected in the policy decisions.

Another critical consideration in projecting the number of physicians is the rapid increase in healthcare expenditure relative to the gross domestic product (GDP) in Korea. Korea’s healthcare expenditure as a percentage of GDP is projected to surge from 9.7% in 2022 to 16% by 2033, marking the fastest growth rate among Organization for Economic Cooperation and Development countries [5]. Given the rapidly rising national healthcare expenditure, depleting insurance finances driven by an aging population, and the increasing demand for high-cost treatments, the current healthcare system is neither sustainable nor desirable. Without appropriate reforms to control healthcare consumption and reduce expenditures, the system faces the risk of collapse owing to skyrocketing expenses.

The three studies that form the basis of the government’s policy to increase the number of physicians operate under the assumption that the current trends in healthcare demand and workforce supply will persist in the future. However, it is unrealistic to project the number of physicians while assuming the continuation of a healthcare system on the brink of collapse. Hence, future studies on physician projections in Korea should address the following fundamental question: “what is the optimal number of physicians for a sustainable healthcare system in the future?”

When estimating the number of physicians, it is essential to incorporate scenarios that reflect the improved healthcare policies and their effects. For example, in a study by Hong [4], the introduction of a primary care physician system reduced the projected shortage from 10,000 to 3,000 physicians. As highlighted in the review by Kim and Lee [1], strengthening primary care is essential for sustainable healthcare systems. However, current government policies, including the increase in medical school enrollment, remain focused on addressing acute and severe illnesses, which is a limitation [1,6,7].

A recent study presented at a policy forum included various additional variables and scenarios, showing that the onset of physician shortages could be delayed to 2037–2040, more than a decade from now [8]. This finding suggests that the current rapid increase in medical school enrollment is unnecessary. Instead, Korea has sufficient time over the next 2–5 years to reach a consensus on appropriate enrollment levels through scientific projections and social discourses. Furthermore, this study suggests that if sustainable healthcare reforms are effectively implemented in the interim, increasing medical school enrollment may not be required.

The implications of these studies go beyond simply addressing physician shortages. They emphasize the importance of viewing the healthcare workforce as part of a broader ecosystem that includes technology integration, patient-centered care, and efficiency in service delivery. For example, leveraging telemedicine, digital health platforms, and artificial intelligence programs can alleviate the strain on physical healthcare facilities, particularly in underserved regions. Additionally, fostering interdisciplinary collaboration among healthcare professionals can improve patient outcomes and enhance systemwide efficiency.

As more studies are conducted, we can answer the above question with greater confidence. Various studies incorporating diverse scenarios will yield more objective results. If changes in healthcare delivery systems and utilization patterns become well established, research reflecting these new realities should be conducted regularly, as in advanced countries with periodic physician workforce projections. Such research will require collaboration between the government and the medical community.