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Current orthopedic problems in Korea
J Orthop Sci (2002) 7:283–284
Editorial Current orthopedic problems in Korea Myung-Sang Moon Director, Spine Center, Sun General Hospital affiliated with Ulsan University, 10-7 Mok-Dong, Chung-Ku, Taejon 301-725, Korea
Key words Orthopedic problems · Korea · Current · Clinical and basic
Relevant topics of orthopedics in Korea are diverse. Four current orthopedic problems and challenges are presented and discussed by reason of their significance. First, the level of orthopedists’ clinical work and achievements in Korea has now reached international standards. The most noteworthy contributions are the instrumented correction of tuberculous kyphosis, thoracic pedicle screw fixation in other spine deformities, and replacement arthroplasties of hip and knee tuberculosis. Despite these accomplishments, and except for tuberculosis and leprosy, there is no nationwide, systematic survey system, such as a medical research council, for the screening of congenital and acquired diseases. As a result, basic research activities within Korea have remained at a substandard level compared with other countries. Among 48 Korean medical schools, fewer than 10 schools have research facilities within their respective Departments of Orthopedic Surgery. The few research facilities stem from a misunderstanding by the university authorities, by the governmental authorities, and by the potential researchers themselves concerning the importance of clinical and basic orthopedic research. Consequently, insufficient funds are available for basic research, and the need to attract grants to ensure the progress of orthopedic research is essential. Second, the main focus now within orthopedic research are the new, emerging treatments such as novel pharmacological products, gene therapy, tissue engineering, and biomaterial products. A few universities have began to set up research facilities to support clinical and research studies in molecular biology; therefore, recruitment of qualified clinician–scientists is also essential. Recently, junior staffs at the universities
are actively participating in molecular biology research to keep up with international research standards. However, there has been a trend among the junior staff to leave full-time academic positions for private practice. This loss of expertise has hindered orthopedic research activity because many of these researchers were well trained at foreign research institutes. To retain qualified staff, there is a need for the university authorities to address concerns of noncompetitive compensation, clinical overload, inadequate time allowance for research, and insufficient research funds. Third, the Korean medical insurance system was established in 1976 and expanded in 1988 to cover the entire population. At the beginning, it was expected that the system would bring better and brighter prospects within the medical community. However, the government increasingly instituted laws and regulations and inadequately funded the increasing medical insurance budget. As a result, the medical insurance system is continually hampered in its delivery of medical care to patients. Furthermore, the development of medicines is impeded by excessive government control and by the poorly informed demands of the public. The government has unilaterally determined the direction of the medical insurance scheme. Orthopedic surgeons and the remaining medical community have continually been denied an opportunity to participate in policy and decision making. Thereby, morale among surgeons has seriously deteriorated to the point where, in the year 2000, the medical community vocally and actively protested against medical insurance policies as dictated by the government. This outcry has resulted in a rift between the medical community and the government that has yet to be mended. Last, the number of malpractice suits against the Korean medical community has escalated to a crisis level throughout the country. The Korean government had set up a Coordinating Board to address this prob-
284
lem, but it has not functioned effectively or properly until most recently. In general, medical issues that result in malpractice claims can be classified as diagnostic, management, operative, and personal. Because of the increasing likelihood of professional liability claims, orthopedic practitioners tended to avoid taking on difficult clinical cases, and spent more time on the practice of orthopedic medicine; this was particularly true for cases where a considerable degree of surgical and technical skill was required and a high complication rate was expected to ensue. Furthermore, orthopedic surgeons were reluctant to use some effective, but difficult, treatment methods for fear of possible malpractice suits. Consequently, patients were neglected and did not receive optimal treatment while the surgical skills and knowledge of the practitioners were kept in abeyance. Clearly, orthopedists now face patient
M.-S. Moon: Current orthopedic problems in Korea
adversity and more complex social challenges that were not encountered in the past. Under these present social realities, the residency training curriculum needs to be revised to prepare surgeons to confront the new demands that may be encountered in practice and to insulate them from potential malpractice claims. From past experience, the Korean government authorities have not acted in good faith, for the medical community, with any meaningful and real tort reform. As yet, the Korean Medical Association, which administers malpractice insurance, has not been able to satisfy both physicians and claimants. In summary, Korean orthopedists face unique challenges on governmental, systematic, and academic fronts. I hope this overview has provided readers a rounded and better understanding of the state of orthopedics in Korean in the past, present, and future.
Editorial Current orthopedic problems in Korea Myung-Sang Moon Director, Spine Center, Sun General Hospital affiliated with Ulsan University, 10-7 Mok-Dong, Chung-Ku, Taejon 301-725, Korea
Key words Orthopedic problems · Korea · Current · Clinical and basic
Relevant topics of orthopedics in Korea are diverse. Four current orthopedic problems and challenges are presented and discussed by reason of their significance. First, the level of orthopedists’ clinical work and achievements in Korea has now reached international standards. The most noteworthy contributions are the instrumented correction of tuberculous kyphosis, thoracic pedicle screw fixation in other spine deformities, and replacement arthroplasties of hip and knee tuberculosis. Despite these accomplishments, and except for tuberculosis and leprosy, there is no nationwide, systematic survey system, such as a medical research council, for the screening of congenital and acquired diseases. As a result, basic research activities within Korea have remained at a substandard level compared with other countries. Among 48 Korean medical schools, fewer than 10 schools have research facilities within their respective Departments of Orthopedic Surgery. The few research facilities stem from a misunderstanding by the university authorities, by the governmental authorities, and by the potential researchers themselves concerning the importance of clinical and basic orthopedic research. Consequently, insufficient funds are available for basic research, and the need to attract grants to ensure the progress of orthopedic research is essential. Second, the main focus now within orthopedic research are the new, emerging treatments such as novel pharmacological products, gene therapy, tissue engineering, and biomaterial products. A few universities have began to set up research facilities to support clinical and research studies in molecular biology; therefore, recruitment of qualified clinician–scientists is also essential. Recently, junior staffs at the universities
are actively participating in molecular biology research to keep up with international research standards. However, there has been a trend among the junior staff to leave full-time academic positions for private practice. This loss of expertise has hindered orthopedic research activity because many of these researchers were well trained at foreign research institutes. To retain qualified staff, there is a need for the university authorities to address concerns of noncompetitive compensation, clinical overload, inadequate time allowance for research, and insufficient research funds. Third, the Korean medical insurance system was established in 1976 and expanded in 1988 to cover the entire population. At the beginning, it was expected that the system would bring better and brighter prospects within the medical community. However, the government increasingly instituted laws and regulations and inadequately funded the increasing medical insurance budget. As a result, the medical insurance system is continually hampered in its delivery of medical care to patients. Furthermore, the development of medicines is impeded by excessive government control and by the poorly informed demands of the public. The government has unilaterally determined the direction of the medical insurance scheme. Orthopedic surgeons and the remaining medical community have continually been denied an opportunity to participate in policy and decision making. Thereby, morale among surgeons has seriously deteriorated to the point where, in the year 2000, the medical community vocally and actively protested against medical insurance policies as dictated by the government. This outcry has resulted in a rift between the medical community and the government that has yet to be mended. Last, the number of malpractice suits against the Korean medical community has escalated to a crisis level throughout the country. The Korean government had set up a Coordinating Board to address this prob-
284
lem, but it has not functioned effectively or properly until most recently. In general, medical issues that result in malpractice claims can be classified as diagnostic, management, operative, and personal. Because of the increasing likelihood of professional liability claims, orthopedic practitioners tended to avoid taking on difficult clinical cases, and spent more time on the practice of orthopedic medicine; this was particularly true for cases where a considerable degree of surgical and technical skill was required and a high complication rate was expected to ensue. Furthermore, orthopedic surgeons were reluctant to use some effective, but difficult, treatment methods for fear of possible malpractice suits. Consequently, patients were neglected and did not receive optimal treatment while the surgical skills and knowledge of the practitioners were kept in abeyance. Clearly, orthopedists now face patient
M.-S. Moon: Current orthopedic problems in Korea
adversity and more complex social challenges that were not encountered in the past. Under these present social realities, the residency training curriculum needs to be revised to prepare surgeons to confront the new demands that may be encountered in practice and to insulate them from potential malpractice claims. From past experience, the Korean government authorities have not acted in good faith, for the medical community, with any meaningful and real tort reform. As yet, the Korean Medical Association, which administers malpractice insurance, has not been able to satisfy both physicians and claimants. In summary, Korean orthopedists face unique challenges on governmental, systematic, and academic fronts. I hope this overview has provided readers a rounded and better understanding of the state of orthopedics in Korean in the past, present, and future.