(Bloomberg) -- South Korea has a contingency plan for a prolonged walkout by trainee doctors that has threatened the delivery of health care as they protest against a plan to increase medical school enrollment, according to the nation’s health minister.

The country is prepared for a worst-case scenario in which a large number of the trainee doctors in the walkout don’t return to work, Health and Welfare Minister Cho KyooHong said in an interview Tuesday, declining to elaborate on details of the plan. 

With doctors and the government at loggerheads, the walkout looks like it could take time to reach a resolution. As a way to fill gaps in the system so far, the government has opened up emergency rooms at military hospitals to the public, allowed telemedicine nationwide and encouraged people with minor illnesses to visit local clinics in their neighborhoods.

Cho said the government won’t back down from its plan to increase annual enrollment at medical schools by 2,000 from the current 3,058 to alleviate a doctor shortage that ranks among the most acute the developed world. 

“That is the core of our medical reforms and we do not at all consider holding out a cut as a bargaining chip,” Cho told Bloomberg News from his office in Seoul. The government contends that the number of slots at medical schools hasn’t increased for nearly three decades and poses enormous risks for the health-care system in the rapidly aging country.

About 7,000 of the country’s 13,000 trainee doctors have not returned to work and Cho demanded they end their labor action that has entered its third week.

“It’s not a matter between the government and doctors,” he said. “There’s demand from the public - doctors should change their mind. The door for dialogue is always open. We can talk about various problems in the medical system.” 

South Korea, Japan and other countries place quotas on medical school seats in a way to regulate the number of doctors. Japan, which faces a similar demographic challenge as its neighbor, has raised its quota in recent years while South Korea has not.

The doctors contend the enrollment plan won’t fix fundamental problems such as a shortage of physicians in fields seen as lower paying, a concentration of doctors in urban areas and a malpractice system they contend makes it difficult for them to do their jobs effectively. 

The trainee doctors, similar to medical residents, play key roles in emergency care. Their walkout has led hospitals to turn away patients and about a 50% reduction in surgeries, the government has said. 

“An increase in medical school enrollments won’t impact on us for a decade,” said Park In-sook, a member of the Korean Medical Association, a major lobby group for the profession. “This protest isn’t about money, it’s about the future of our country,” she told reporters.

President Yoon Suk Yeol’s administration has threatened to cancel licenses for doctors who organize what it says is an illegal labor action and suspend licenses for about three months for those taking part, which could hurt their career prospects. It has started legal proceedings that can lead to dispensing punishments. 

Universities, including those in remote areas seen as under-served by doctors, submitted plans to the health ministry Monday to increase nearly 3,400 enrollment spots at their medical schools. The government will allocate additional seats to campuses outside Seoul and increase investments in state-run medical schools, Yoon has said. 

South Korea ranks near the bottom in the developed world for its number of medical school graduates per capita, according to data from the Organisation for Economic Co-operation and Development. 

“It is an absolute fact that we lack doctors,” Cho said.

Polling indicates the public is siding with the government, seeing the reform as a way to cut waiting times for health care. South Korean doctors rank among the best paid among OECD members in comparison to average wages, which has led to criticism the labor action may be more about protecting the earning power of physicians rather than improving the health-care system. 

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Cho left the door open to a reduction in medical school slots to respond to population decreases. By 2050, the South Korean population is set to fall to 47 million from the current 51 million, according to government data.

Yoon’s approval rating climbed to 39% in a weekly tracking poll released Friday from Gallup Korea, the highest since July last year, indicating broad support among voters for his stance. This could help his conservative People Power Party in April elections as it tries to take control of parliament from the progressive Democratic Party. 

The last labor action by doctors was in 2020 when the previous government tried to raise the number of medical school seats by 400 people per year from 2022. The government buckled to pressure and dropped its plan after a one-month walkout as it was trying to contain Covid-19, and keep happy its base of support among organized labor groups.

This time will be different, Cho said, adding that withdrawing the plan would make doctors think that the government is bluffing in the future, hurting the credibility of any policies.

--With assistance from Shinhye Kang.

(Updates with comment from lobby group in paragraph 11.)

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