Arguments have been raised that the crisis in essential medical care cannot be overcome solely through the sense of duty and responsibility of the doctors who sustain severe emergency medical fields.

Because the dedication of medical staff can paradoxically end up masking structural problems, experts argue that rather than demanding a sense of sacrifice, institutional conditions must be established to help them maintain their intrinsic motivation.

Professor Kim Kang-moon, chair of the Department of Medical Education at Konkuk University, analyzed the motivation of severe emergency medical specialists to continue clinical practice in a research report recently published in the quarterly journal Medical Policy Forum by the Korean Medical Association Research Institute, raising the need for a paradigm shift in essential medical workforce policies.

This study is the result of in-depth interviews with 16 specialists in charge of severe emergency medicine at three university hospitals located in Seoul. The research focused not only on why medical staff leave the field, but also on why they continue practicing despite harsh environments.

Professor Kim paid close attention to the discourse surrounding “spillover doctors” that emerged during the medical-governmental crisis in 2024. He analyzed that the approach—assuming that expanding medical school enrollment quotas would channel workforce populations failing to enter popular departments or the capital area into essential and regional medicine—could undermine the professional values and career autonomy of young doctors.

He stressed that rather than viewing this simply as an issue of egoism or morality among young doctors, it should be examined as a process where intrinsic motivation weakens as professional values and the potential for achievement are frustrated.

However, this study did not directly survey doctors who left the field after the medical-governmental crisis. Instead, it analyzed the driving forces behind staying and the structural threats to them through the experiences of specialists remaining in the field.

Sense of Clinical Achievement, Responsibility, and Peer Bonding Serve as Retention Forces

The motivations for continuing clinical practice identified in the in-depth interviews consisted of complex factors that cannot be explained by a sense of duty alone.

A vital pillar was the clinical sense of achievement felt when stabilizing a patient in critical condition and saving a life through one’s own judgment and treatment. Some participants expressed this as “vital high.”

A sense of responsibility to stand by patients in critical moments, bonds with colleagues, and attachment to the department community were also reasons for continuing practice.

Despite recognizing poor clinical environments and the limits of sustainability, these doctors found meaning in patient treatment and their professional identity.

This demonstrates that intrinsic motivation is not a fixed personal trait, but something maintained by experiencing achievement and growth in the clinical process and verifying meaning through relationships with patients and colleagues.

Consequently, the study points out that essential medical policies should focus not merely on inducing doctors to choose these fields, but on creating an environment where medical staff remaining in the field can continue to practice sustainably.

Systems Relying on Dedication Risk ‘Depleting’ Even Retention Motivations

The study also highlighted that the retention of specialists does not imply unconditional dedication. Participants understood the positions of juniors and colleagues avoiding essential medical care and recognized that current working conditions are unsustainable.

If the departure of colleagues causes workloads to reach unmanageable levels, professional expertise fails to be respected, and individual sacrifice is taken for granted, it becomes difficult to continue guarding the field.

Doctors with a strong sense of responsibility tend to fill gaps in manpower and systems on their own, but such dedication can obscure structural problems and delay improvements. This implies that intrinsic motivation is not a resource that can be endlessly consumed.

Accordingly, criticisms point out that simply expanding medical school quotas or channeling the workforce into specific departments or regions cannot solve the essential medical crisis.

Experts argue that institutional foundations must be established to improve clinical conditions so specialists can exercise their capabilities and experience clinical achievements, while maintaining a sustainable cooperative system with colleagues.

Professor Kim stated, “Essential medical policies should not start by forcing a sense of duty and demanding new motivations from frontline medical staff, but by protecting and preserving the precious motivations they already harbor.” He added, “We must identify the structural factors causing doctors to lose their motivation and rapidly build realistic safety nets to defend against them.”

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