Orthopedic specialists shift from tertiary hospitals to clinics, HIRA data show

The restructuring of tertiary general hospitals, combined with ongoing conflicts between the government and doctors over medical policies, is shifting the distribution of orthopedic specialists.

Statistics also confirm the exodus of orthopedic professors from university hospitals. Over the past three years, orthopedic specialists at tertiary general hospitals have clearly decreased, while their numbers at general hospitals and clinics have increased, making personnel movement between medical institutions more visible.

Korea Biomedical Review analyzed data from the Health Insurance Review and Assessment Service (HIRA) to reconstruct specialist numbers by institution type and specialty over the past three years. The analysis revealed a pronounced decline at tertiary general hospitals. Tertiary general hospitals held steady at 576 specialists in 2023 and 577 in 2024, but that number dropped to 528 in 2025. The number fell by 48, down 9.1 percent year on year.

In contrast, more specialists began working at general hospitals and clinics during the same period. General hospitals saw an increase of 32 specialists over three years: from 1,355 in 2023 to 1,364 in 2024, and to 1,387 in 2025. Clinics saw a significant increase of over 200 specialists, rising from 3,015 in 2023 to 3,149 in 2024 and 3,253 in 2025. The increase coincided with continuing medical policy conflicts.

The number of orthopedic clinics also grew. HIRA’s “Status of Medical Institutions by Specialty” data shows that orthopedic clinics rose from 2,570 in 2023 to 2,653 in 2024 and to 2,754 in 2025. That is a 6.7 percent increase, or 101 new clinics, over three years. Seoul (30 clinics) and Gyeonggi Province (32 clinics) had the largest absolute increases. However, the fastest growth rates were in Gwangju (15.8 percent) and South Jeolla Province (14.0 percent).

The exodus of orthopedic professors from university hospitals is evident in the statistics. Over the past three years, the number of orthopedic specialists at tertiary hospitals has decreased by 48. (Credit: Getty Images)

Professors say, ‘There is no hope’ as pride gives way to disillusionment

Within the field, these changes are interpreted as more than workforce shifts; they are seen as evidence that the restructuring of tertiary general hospitals is undermining the role and status of orthopedic departments. This restructuring, particularly the resulting reduction in orthopedic surgeries, has negatively impacted the professional pride that once supported positions in these hospitals.

“We requested that the government improve the severity classification system. But we only got responses saying it was difficult,” said a professor, identified as Professor A, from an orthopedic department at a tertiary hospital. “We asked to include elderly patients with complex conditions, but even this wasn't reflected. Pediatric orthopedic specialists are very rare, so only a small part of this request was accepted.”

Professor A added, “The government seems to believe secondary hospitals and specialized hospitals can adequately handle orthopedic patients. Consequently, most patients who come to tertiary hospitals are either infected regardless of severity or require complex, labor-intensive care. It feels like there's no medical referral system; we're just the cleanup crew.”

He continued, “They have stopped investing in orthopedic staff and equipment. Even when professors near retirement leave, there are no replacements. If this continues, professors who can perform high-complexity surgeries at tertiary hospitals will disappear. All we hear about are people leaving for other hospitals. There is no hope for improvement. Professors are resigned to the situation.”

Collapse of ‘professional pride’ accelerates specialists’ exodus

However, some argue that the current exodus and turmoil cannot be attributed solely to the restructuring of tertiary hospitals. In addition to policy changes, professors’ declining professional pride is also accelerating their departure, adding another driver alongside structural factors.

Another professor from the orthopedic department of another tertiary hospital, identified as Professor B, stated, “Many orthopedic professors have already left the hospital due to increasing disillusionment, which has been caused by persistent conflicts over medical policies. Although the restructuring project has made our role more difficult by requiring us to perform fewer surgeries on less severe cases, I believe that all these different factors combine to prompt professors to leave.”

Professor B continued, “We persevered for pride, not money. We trained students and served in regional areas. But that pride is gone. Society makes many demands of university hospital professors, but no one acknowledges their efforts. This disappointment also causes professors to quit.”

He added, “The strong appeal of private practice also encourages departures. Practices are actively recruiting dissatisfied surgical specialists with attractive terms.”

‘Structural transformation of tertiary general hospitals is inevitable’

However, some argue that structural transformation of tertiary hospitals is inevitable because treatment for all but the most complex orthopedic surgeries can be handled at regional or specialized hospitals. Although such restructuring requires sophisticated policy design to succeed, this was lacking during the system's implementation, contributing to its challenges.

Another orthopedic surgeon, Professor C, stated, "I believe the restructuring is a natural development. Many surgeries do not need to be done at university hospitals. Unless there is a specific issue, local hospitals can handle most procedures."

He added, “The government should have planned for a softer transition. Banning certain surgeries outright causes backlash and confusion at hospitals.”

Structural limitations in the medical referral system were also identified as a cause of ongoing issues. Professor A stated, “While the government aims to improve the referral system by sending mild cases to lower-level hospitals, comprehensive secondary hospitals have no obligation to transfer severe cases to tertiary hospitals.” He added, “Because fees for severe cases are high, comprehensive secondary hospitals choose to retain these patients instead of transferring them. This creates a barrier to the intended patient flow.”

Professor A continued, “Restructuring tertiary hospitals is pointless when the referral system itself is unstable. The policy was flawed from the beginning.”