Why the doctor association is unlikely to win this time

The professors at Seoul National University’s medical school and hospitals decided to stop their indefinite strike just five days after it began on Monday, and the Korea Medical Association’s publicly announced plan to go on a strike indefinitely from Thursday is likely to fall through due to internal opposition. The number of local clinics that participated in the one-day strike on Tuesday organized by the association was only half of the strike that took place four years ago. This is a stark contrast to the association's past successes, such as thwarting the government's plans in 2004 and 2020 with all-out fights. Some members of the association are saying that it’s hard to continue the fight. Why is the doctors’ association, which has a history of successful resistance, struggling this time?

In his book The Art of War, Sun Tzu said five factors determine a win or loss: the Way, seasons, terrain, leadership, and management.

The most important factor, ‘the Way,’ means the just cause of a war. While there can be some diverging opinions about raising the number of medical students by 2,000, the South Korean government’s justification for increasing the number of doctors in the country for the first time in 27 years was evident, as other major countries have also done so in response to aging populations. However, the doctors’ association only demanded a review from the starting point and did not reach an internal agreement on whether to accept the increase or not. It also failed to provide convincing reasons for each side.

Next, ‘seasons’ mean changes in the external environment. In 2020, when COVID-19 was spreading, the government tried to increase the number of medical students by 400. People asked the government why it should introduce a policy opposed by doctors in a time of a health care crisis. However, as the shortage of doctors in emergency rooms and pediatric clinics has become a daily experience, people palpably feel the need to increase the number of doctors.

‘Terrain’ means understanding their strengths and weaknesses and utilizing terrain features. The power of doctors comes from their monopoly over licenses that handle people’s lives. As a result, the only people who can address the medical vacuum created by a strike are the doctors, resulting in the government backing down when doctors hold. This time, the government devised alternative plans, such as deploying physician assistants, based on its past failures and pulled students and their parents on its side by announcing rolling admissions for medical schools at the end of May. The time when doctors could have taken advantage of their strengths the most was right before the April general elections, and the last time to do so was right before the announcement of the rolling admissions at the end of May.

‘Leadership’ refers to a general’s wisdom, faith, virtue, brevity, and sternness. The chair of the Korea Medical Association, Lim Hyun-taek, became the chair with non-compromising surprise guerilla tactics. However, he failed to showcase leadership in uniting 140,000 doctors. He had conflicts with the leader representing interns and residents, which meant the government didn’t have to deal with the association as its goal was to have interns and residents return to hospitals. It’s hard to say that the leader of interns and residents who remained lying down after leaving his hospital and a medical school professor who left his hospital by saying that providing patient care when other interns and residents who are like family to him left the hospital is like breaking morals have leadership.

Lastly, ‘management’ means the ability to manage an organization and maintain a supply network. However, the last four months of the doctors’ association after interns and residents left hospitals in February were literally in pieces with division, mistrust, self-righteousness, and slander in repetition.

After reading this article, some doctors may think it’s not over yet, or they can still win if they hold on longer. However, they don’t have an advantage over any of the five factors determining a war's win and loss. I am not the only one who thinks the situation won’t change even if the fight continues.