A healthy, 31-year-old man died at work. The cause of death was “anatomically unclear.” He worked for 113 hours for the past week before he died. For the last four weeks, he worked 100 hours a week on average. The Labor Standards Act states that an employee should not work for more than 52 hours per week, but his workplace was “an exception.”

This is a story of Shin Hyeong-rok, the second-year trainee doctor at the Pediatrics Department of Gachon University Gil Medical Center, who was found dead at the hospital’s night duty room on Feb. 1. The incident occurred after the nation enforced the Medical Residents Act to limit their maximum working hours to 88 per week.

Lee Seung-woo, president of the Korean Intern Resident Association, speaks in an interview with Korea Biomedical Review on Monday.

Six months after Shin’s death, the Korea Workers’ Compensation and Welfare Service recognized the cause of his death as overwork. If the 12-week average weekly working hours exceed 60, the Ministry of Employment and Labor considers it as chronic overtime work.

Lee Seung-woo, president of the Korean Intern Resident Association (KIRA), has been speaking up for the recognition of Shin’s death as an industrial accident.

“His death shows the situation where all Korean medical residents are,” Lee said.

Even though the nation set up the law to improve the training environment for medical residents, there are still too many trainee physicians who suffer from overwork, he said.

“The resident was found dead while working at the hospital. But this incident was dwarfed by the deaths of other prominent doctors such as Yoon Han-deok, chief of the National Emergency Medical Center, and Lim Se-won, the psychiatrist at Kangbuk Samsung Hospital,” Lee noted. “The government remained silent about Shin’s death, too.”

Lee went on to say that some people had alleged that overwork was not the cause of Shin's death. He also heard that the hospital would take a “conservative” approach to Shin’s case because if the hospital admitted his overwork, it would incur significant repercussions.

“After the authorities decided that Shin’s death should be compensated as an industrial accident, I felt happy and relieved. Also, I felt angry because of the situation that made me worried, even though I didn’t have to be.”

After the enforcement of the Medical Residents Act, hospitals regard 80 hours of work per week does not fall into the category of overwork, he said.

“The criteria for chronic overwork are 60 hours per week for 12 weeks before the onset of the disease. If the working hours exceed 52 hours, and there are some factors that pressure work, the authorities judge it as chronic overwork,” he added.

He noted that allowing 36 consecutive working hours for medical residents was problematic. “It is harder to work 36 hours consecutively rather than 80 hours per week. The U.S. also limits weekly working hours for medical residents to 80, but they limit consecutive working hours to 16,” Lee said.

He went on to say that working at a hospital requires constant attention for medical residents. “The criteria for chronic overtime include difficulties in prediction and mental tensions,” he said.

To prevent trainee doctors from risking their lives because of overwork, hospitals should take practical measures such as adjusting work schedules.

Lee said the overtime working culture should not be regarded as a problem of an individual training hospital.

Even though the Medical Residents Act limited the working hours, there was no adjustment in the intensity of work, he noted. “There are so many other works, besides seeing patients. A survey found that 20 percent of the work of medical residents was chores. We need some work adjustment,” Lee said.

Lee claimed that the government should limit the number of patients that a medical resident sees during night duties. “A situation where a trainee doctor sees 50 to 100 patients could endanger patient safety,” Lee said.

To do so, the medical community needs hospitalists, he pointed out. “Hospitals have been running a pilot program for hospitalists for years. They should start the program in earnest as soon as possible,” he said.

However, Lee was negative about the Ministry of Health and Welfare’s plan to dispatch more medical residents to hospitals that participate in the pilot hospitalist program.

“The plan seems to be a tool for training hospitals to attract more hospitalists. It treats medical residents as a gift or a souvenir,” he said.

Shin’s death was an opportunity to look back on the issue of overwork of medical residents, but the discussion about how to provide better medical training is still lacking, he said.

As Lee is to complete his term this month, he hoped that his successor could continue pushing to raise the quality of education in training hospitals.

soo331@docdocdoc.co.kr

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