It has been 10 months since the government entered a pilot program to introduce hospitalist system, but the project is not in place yet because of the lack of applicants.

The project has received attention by emerging as an alternative, which helps to reduce working time of medical residents and improve their training environment, in that the system can ensure safe hospital environment and provide higher-quality healthcare. Residents who are primary beneficiaries of the system have turned their back on it, however, disrupting its smooth introduction. Hospitals, which had tried to make up for the void in treatments caused by a law that limits residents’ work time to 80 hours a week from the end of this year, also can’t help but revise their plans.

Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to hospital medicine.

The Ministry of Health and Welfare (MOHW)_{보건복지부} designated 30 hospitals as medical institutions to take part in the program last July and entered a pilot project in September. The ministry additionally selected six more institutions in this past February, but only 14 institutions, or 42 percent of the total 36 hospitals designated, are operating hospitalist wards as of April.

The reason for its slow implementation is the shortage of applicants. Most hospitals offer an annual salary of 150 million won ($130,000) or more, which has fallen short of attracting medical residents, however. Standing in the way to their applications are stumbling blocks, such as the insecure status resulting from the mandatory renewal of contracts every year or two, and their uncertainty about into what occupational group the job will fall.

“The labor intensity here is quite high as the limited workforce has to handle diverse jobs but compensations, including pay, aren’t satisfactory,” said a resident at Seoul National University Bundang Hospital_{분당서울대병원}. “The number of applicants will not increase in the future, either, unless there are sufficient rewards for the work, making it difficult to maintain the system itself.”

Another medical resident pointed to insecure job status. “Some hospitalists receive more money than clinical assistant professors. While hospitals guarantee the future of clinical assistants to a certain extent, however, hospitalists remain contract workers who have to renew contracts every year,” said a resident at Asan Medical Center_{서울아산병원}. “Accordingly, there are more residents than expected reluctant to apply to become hospitalists. I had hoped to work at a university hospital with good infrastructure, and am working in one of such hospitals but can hardly shake off concerns about job security.”

The Health-Welfare Ministry has been conducting a pilot project to introduce hospitalist system since last July, but medical institutions’ participation remains quite low.

Too many applicants in Seoul metropolitan area -- why?

Moreover, nine of 14 hospitals that are operating hospitalist wards are in Seoul, Incheon and Gyeonggi Province, resulting in the problem of excessive concentration.

When the government implements the “act for the improvement of training conditions and status of medical residents” and curtails working time of medical residents, hospitals will have to make up for the void of treatments with hospitalists. As doctors don’t want to work in provinces and provincial hospitals are already suffering from workforce shortage, they will have problems recruiting hospitals who are concerned about heavy workload in rural hospitals.

“It’s difficult to work in province hospitals if they don’t guarantee higher-than-average salaries or firm guarantee of status,” said a resident at Severance Hospital_{세브란스병원}.

A professor at a provincial university hospital also complained. “To operate a proper rotation, we should able to form a team of hospitalists, but can hardly dream of it as only a few residents apply to work at rural hospitals,” he said. “That delays the ward operation at provincial institutions, forcing even the current applicants to give up complaining of workforce shortage.

Another problem is the failure by government and hospitals to offer long-term visions. “Residents think working at large hospitals in the metropolitan area for one or two years can be a plus to their careers but do not feel about experiences in provinces,” the professor said. “The government and hospitals should be held accountable for this, by failing to show long-term visions about the system.”

Uncomfortable relationship between hospitalists and other doctors in hospitals is another reason for their reluctance.

“Nurses and patients find hospitalists entirely satisfactory, but the existing fellows don’t show such high satisfaction,” a specialist at Asan Medical Center. “The greater the number of hospitalists, the fewer the positions for fellows, and this causes the uncomfortable relationship between them.”

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