In this study, we found that family physicians working in hospitals had higher rates of chronic disease management and higher rates of elderly patients compared to those working in clinics. This discrepancy increased for doctors under 40 years of age.
There are several possible reasons for the differences in medical treatment patterns in hospitals and clinics. Family physicians in Korea have expanded their range of medical services to encompass not only disease treatment but also assistance in health check-up centers, health promotion, and new advanced medical technologies, all of which are classified as medical services not currently covered by national insurance (7). As the proportion of total medical expenses classified as noncovered procedures has increased steadily in Korea, this phenomenon has also extended to the practice patterns of family physicians (8,9). According to a report by the National Health Insurance Service (NHIS), noncovered medical expenses doubled between 2009 and 2014, and the proportion gradually increased from 13.4% in 2006 to 17.1% in 2014 (10). Moreover, the number of clinicians who practice only noncovered medical areas has doubled in the last five years, including general medicine, plastic surgery, dentistry, and other fields (9). An appearance-oriented culture that emphasizes measures like anti-obesity treatments was recognized as one of the factors contributing to the demand for various cosmetic procedures, including skin care, plastic surgery, and anti-aging treatments (11,12). In this survey, 44.8% of all family physicians stated that their primary reasons for selecting a noncovered medical area was economic, 20.1% mentioned personal interest, and 10.4% cited their desire to gain independence from government restrictions related to the right to medical treatment (Supplementary Table 1). A similar report regarding the operation of clinics for purely economic reasons and other considerations affecting the choice of treatment specialties was published in the Korean Medical Association’s annual report, thereby indicating that this phenomenon extends beyond family physicians to other specialists who operate clinics (4).
Another reason for the evolving medical practice patterns in young family doctors is the instability of the medical delivery system that has reduced the influence of primary medical institutions throughout the medical market (13). The concept of primary care serving as a gatekeeper has yet to be established, and many challenges must be addressed before the possibility of patients having their own primary physicians becomes a reality in the Korean medical system (14,15). The number of family physicians now entering the medical market has increased. Further, clinicians have historically been more vulnerable to deterioration of the medical delivery system and may have been more sensitive about facing economic hardship when choosing their primary care specialty. This is a more pressing issue for family physicians working in clinics than in hospitals (13). Therefore, we can assume that future trends regarding the types of medical treatment provided by young doctors will more likely reveal an emphasis on the provision of medical services related to the promotion of health and well-being rather than chronic disease management. There is a need for additional in-depth studies of the different tendencies of family doctors working in clinics compared to those in hospitals.
This study also found that the amount of day and night duty was significantly higher for doctors working in clinics than in hospitals. This may be related to the operating hours of clinics and hospitals as clinics generally open later and close later than hospitals. In addition, this factor is strongly affected by the medical treatment area and practice patterns in hospitals; for example, if a family medicine department in a hospital is oriented to outpatient medical care and routine health check-up facilities, there is no need for inpatient care and night duty. Conversely, if a hospital provides mainly hospice-palliative inpatient care, this requires work by family doctors on a nightly basis. A more detailed evaluation of working hours should be performed to provide a comprehensive assessment of doctors’ work environments.
The limitations of this study are as follows: First, the questionnaire survey was limited to subjective factors of the respondents, thereby leading to potential under- and over-reporting. Second, this study was conducted only with subjects who agreed to allow the use of their personal information, and there were update limitations of the group databases. Therefore, the representativeness of the sample was limited because our study was conducted with only half of the family physicians in Korea, and the actual number of respondents was insufficient. Third, the study was limited by the lack of information on population samples covering the entire range of family medicine specialists and the standardization of participants in terms of gender, age, and region. Therefore, it is possible that some results of this study may be biased because of the selection bias of family physicians who are more active in the Family Medicine Society compared to the general characteristics of the entire population of family medicine specialists in Korea. In order to overcome this limitation, large-scale studies will be necessary to conduct sophisticated research on more representative sample populations in the future. Nevertheless, to our knowledge, this study is the first to focus on family medicine specialists that helps identify the medical practices of family doctors and confirms the impact of the decisions they made during their formal training regarding the types of medical care they chose to provide.