Young doctors at crossroads “전문의 중심으로 병원 구조 바꾸고 PA (Physician Assistant)간호사

[정승남세기영어교육연구회장]

(EDITORIAL from Korea Herald on Feb. 28)

Young doctors at crossroads

“전문의 중심으로 병원 구조 바꾸고 PA​(Physician Assistant) 간호사 활용”

尹대통령, 의료 대책도 발표

Kim Boram All News 07:03 February 28, 2024 The Korea Herald

Young doctors at crossroads
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Medical professors expected to mediate between their students, government
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Some 80.6 percent of the nation's trainee doctors have tendered their resignation, and 72.7 percent, or about 9,000, have left the hospitals in protest of the government's plan to increase the number of places at medical schools. The worsening shortage of interns and residents for over a week at emergency rooms and operating rooms has led to delays in surgeries and emergency treatments as well as severe fatigue of the remaining medical staff.
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The Ministry of Health and Welfare on Tuesday filed a complaint with the police against five former and incumbent members of the executive department of the Korea Medical Association for instigating and abetting collective action by interns and residents.
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The government has given trainee doctors until Thursday to return to work, warning that those who continue to refuse to treat patients will be subject to police investigations and indictments.
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From March, a suspension of the medical license for at least three months as well as probes and indictments will be "inevitable" for those who have not returned to work, Health and Welfare Minister Cho Kyoo-hong said.
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"(The government) will respond to illegal collective actions according to the law and principle," he said.
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"Trainee doctors who have left their workplaces are once again asked to return by Feb. 29. If they come back by Thursday, they won't be held responsible (for having walked out)."
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To woo doctors, the ministry said it would speed up legislation on special cases that exempts insured medical staff from prosecution for medical accidents.
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Through such legislation, similar examples of which cannot be found in other countries, the ministry expects that patients will be promptly and sufficiently compensated for damage, and medical staff can focus on treating patients, Cho said.
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As nurses have been filling in for the interns and residents that have left, a pilot program went into effect Tuesday to provide nurses legal protection by having the chiefs of medical institutions determine the scope of work that can be performed by nurses. There are, however, medical procedures that nurses cannot perform, as per judicial precedents.
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Nurses in operating rooms known as PA (Physician Assistant) nurses are currently doing many of the jobs of junior doctors, such as checking for infections or bleeding after surgeries. In hospitals outside the greater Seoul area, it has been a long time since specialties such as obstetrics and gynecology, pediatrics and urology had any residents at all, and the number of PA nurses has been rising nationwide.
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Medical college professors at Seoul National University have called on the government to hold regular talks with medical college professors on policies to alleviate the dearth of doctors in essential health care. To get the residents to return to work, persuasion is necessary, not threats or coercion, they said. University presidents who have overstated the number of medical students they need to admit, and those who reported those hopeful numbers to President Yoon Suk Yeol should be reprimanded, SNU professors said.
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The figures reported to the ministry in November, the total of which came to at least 2,151, mostly reflected the hopes of the universities, rather than the medical colleges. Deans of 40 medical colleges and schools have officially asked the Education Ministry to push back its March 4 deadline for the schools' quota increase applications. The ministry has stated, however, that the deadline cannot be altered.
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Professors and nurses in areas of essential health care are working 160 hours nonstop to make sure no patient in critical condition is left untreated. But they can't keep going like this for weeks. Interns and residents should be more open to talks with their professors, some of whom are expected to serve as mediators between the junior doctors and the government. It is widely known that South Korea's trainee doctors are overworked and underpaid compared to those in advanced countries.
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This can be their golden chance to improve their working conditions by talking with the government which has pledged to spend 10 trillion won over the next five years to resuscitate areas of essential health care such as pediatrics, emergency medicine, general surgery, cardiothoracic surgery and obstetrics. A prolonged strike would only cause their bargaining power to diminish.
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(END)

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“전문의 중심으로 병원 구조 바꾸고 PA 간호사 활용”

尹대통령, 의료 대책도 발표

오주비 기자 입력 2024.03.07. 04:05 조선일보

윤석열 대통령은 6일 “지금까지 대형 병원이 젊은 전공의들의 희생에 과도하게 의존해 왔다”며 “특히 필수 의료 과목은 이런 현상이 더 심해 필수 분야 인력난의 주요 원인이 되기도 한다”고 했다. 전국 상급종합병원 47곳의 전체 의사 중 전공의(인턴·레지던트)가 37.5%를 차지하는 것은 “매우 기형적 구조”라는 뜻이다. “전공의 근무시간이 주당 77.7시간으로 지나치게 길다”고도 했다.

윤 대통령은 “이런(전공의 의존이 높은) 병원 운영 구조를 반드시 바로잡고 개혁해야 한다”며 “전문의 중심 인력 구조로 바꿔나가는 한편, 숙련된 진료 지원(PA) 간호사를 적극 활용해 근본적인 의료 체계 개편도 추진하겠다”고 밝혔다. PA 간호사는 수술 보조 등 의사 업무 일부를 맡고 있지만 법적 근거가 모호한 상태다. 윤 대통령은 “(현재 시행 중인) PA 간호사 시범 사업을 통해 전공의 업무 공백을 메우고 법적으로 확실하게 보호받을 수 있도록 하겠다”고 했다.

그래픽=양인성

또 “응급·고난도 수술에 대한 전폭적인 수가(건강보험이 병원에 주는 돈) 인상과 함께 소아·분만 등에는 건강보험 재정 투입을 확대하겠다”고 했다. 중증 심장 질환 보상 강화, 고위험 산모·신생아 통합 치료센터 사후 보상, 지방의 신생아 중환자실 전담 전문의에 대한 공공 정책 수가 도입 등 구체적인 방안도 언급했다. 정부는 건보 재정 약 1200억원을 투입해 이달부터 바로 산모·신생아·중증질환 분야의 보상을 강화한다.

윤 대통령은 병원별로 중증·경증 환자를 구분해 진료하는 방안도 제시했다. “빅5(서울대·서울아산·세브란스·삼성서울·서울성모)는 중증·희소 환자 진료에 집중하도록 중증 진료에 대한 보상을 확대하고, 경증 환자에 대한 보상은 줄이겠다”는 것이다. 최중증 응급 환자를 수용하는 권역 응급의료센터는 구급대 이송 환자 중심으로 수용할 방침이다. 윤 대통령은 “대통령 직속 의료개혁특위를 조속한 시일 내 출범시켜 공론화가 필요한 과제를 논의하겠다”고 했다.

정부는 이날 국무회의에서 ‘의료 파행’ 장기화에 대비하기 위한 예비비 1285억원 지출을 의결했다. 전공의 공백을 메우기 위해 추가 근무하는 의료진 보상과 대체 인력 채용에 필요한 비용 등을 지원하겠다는 것이다.

대한간호협회는 이날 윤 대통령이 ‘PA 간호사를 활용해 의료 체계를 개편하겠다’고 한 것과 관련해 “적극 지지한다”고 밝혔다. 협회는 “의료진 등의 헌신에 감사한다는 대통령 말씀에 큰 위로와 힘을 얻었다”며 “정부의 의료 개혁 의지에 변함없는 지지를 보낸다”고 했다.

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