Letter to the Editor: Uneven Distribution of Physicians by Specialty in East Asia

To the Editor:

We read the recent article by Park with interest.1 In February 2024, the Korean government announced an increase in the number of enrollments in medical schools nationwide from 3,058 to 5,058 by 2025.2 As a result, thousands of trainee physicians have walked off the job to protest against the government’s plan, leading to conflict.3 This reform is reportedly due to the uneven distribution of doctors by region and the uneven distribution of specialties, such as the increase in cosmetic medicine physicians and a shortage of physicians in surgery, emergency medicine, and pediatrics.1,2 Considering the situation in Japan and China, which face similar challenges, increasing the number of medical school enrollments may not provide adequate respite.

East Asian countries do not have strict restrictions on the regions and departments in which young physicians are employed after graduation from medical school, giving them considerable freedom of choice. For example, Japan has had a shortage of physicians and an uneven regional distribution of doctors for a long time. Although the number of enrollments in medical schools have gradually increased from 7,793 in 2008 to 9,374 in 2022, from 2010 to 2020, the number of physicians in the surgical field as a whole has decreased, despite the increase in medical school enrollments, with only the number of young physicians in cosmetic surgery increasing noticeably.4 In China, the number of cosmetic surgeons has increased significantly over the past decade, as an increasing number of surgeons have switched to cosmetic surgery, which offers a better working environment and compensation, in response to burnout and other problems caused by harsh working conditions.5 Thus, although the maldistribution of medical specialties has become a problem in East Asia, there is a concentration of physicians in the field of cosmetic surgery, with Japan, China, and South Korea ranking third, fourth, and fifth, respectively, among the top countries with the highest number of plastic surgeons.6

In addition to increasing the number of enrollments in medical schools, these countries have taken other measures to address the uneven distribution of medical specialties, such as managing the number of specialty certification programs by region and facility according to medical demand. However, these measures have only had a limited effect. In Japan, young doctors who do not want to be bound by the capacity management of specialist programs are increasingly switching to cosmetic medicine, an area unrelated to community medicine; the Japanese Medical Science Federation raised this issue in December 2023.7 In these countries, effective measures are needed to improve the working environment of doctors engaged in surgery and other necessary medical care and to resolve the uneven distribution of physicians by specialty.