“In Korea female doctors have to have exceptional skills to be acknowledged”
We had a chance to interview only female surgeon at Anam Hospital in South Korea and she happens to be Mongolian national. She specializes in cardiac medical procedures and surgeries.
GAP BETWEEN MONGOLIAN AND KOREAN HEALTH SECTOR WAS SHOCKING
How did you end up here being only female cardiac surgeon? When did you come here? Was it your choice?
Back in 2009, I was working at cardiology department of 3rd state hospital in Mongolia. At that time my five-year-old daughter had injured herself in the head and she had major brain hemorrhage. After several treatments in Mongolia we came here for better treatment at Anam Hospital. It was a shock to experience huge gap between Mongolian and Korean medical sector.
At that time I was sure that Mongolian doctors were very skilled, but lacked a lot due to inefficient and outdated equipment. But that belief shattered after I came here and I wanted to study here and started looking for opportunities. I have expressed my interest in their Masters degree program, which followed with request to meet with Head of Cardiology Department. They said if I pass exams their doors are open. I passed exams and here I am studying and working at the Cardiology Department.
You are specializing in cardiac medical procedure that is not yet introduced in Mongolia and you are the only female cardiac surgeon at this hospital.
At our center we offer treatments related to coronary occlusion, cardiac defects and arrhythmia. Currently in Mongolia there is no laboratory or medical center that diagnoses arrhythmia or offers treatment for this cardiac anomaly. Specialists for this specific field are being prepared now, which includes me and Dr. Mungun-Ulzii at 3rd state hospital.
I GET DOWNGRADED A LOT JUST BY BEING ONLY FEMALE CARDIAC SURGEON
I suppose that you face some difficulties working in a foreign country, although conditions and pay is better?
As you could have noticed there are no other female surgeons in the operation room, except the nurses. Many visiting doctors get surprised to see me and always tend to ask what am I doing in that room. Most of the cardiac surgeries last for extended 8-9 hours. It is believed that this load is physically hard for female doctors to bear. Medical procedures to treat arrhythmia can last up to 8 hours and is considered one of the hard procedures.
You are the only female surgeon at this center?
Yes, there are no other female surgeons.
How about other surgical procedures? Are there many female surgeons?
If it is not obstetrics and gynecology ones, female surgeons are very rare.
There should be a lot of competition coming from your Korean peers.
Indeed. I have fierce competition from other peers who are also doctorate students here at this hospital. In Korea female doctors have to have exceptional skills to be acknowledged.
I WISH OUR HEALTH MINISTER WAS LIKE TEMUUJIN
What health reforms should take place in Mongolia in order to improve the whole sector? What policy differences have you noticed in Korea?
Here in South Korea Ministry of Health and Health Insurance Funds are separated. In other words, Health Insurance Funds are independent. While Ministry of Health develops policies Health Funds manage money in health sector. But in Mongolia Ministry of Health is operating everything starting from procurement of equipment and managing the health budget. This distinction enables hospitals to manage their budget.
Earlier I had a chance to meet Mongolian mother who is here at Anam with her daughter. She mentioned how she was frustrated with Minister S. Udval, when her answer that she was not the person at charge of what is happening in the medical sector. Her daughter got ill due to physician’s malpractice.
I personally could not answer in such arrogant way to anyone seeking medical help. I suppose it is personal issue. Frankly, I am not satisfied with our Health Minister. I wish she were like Minister Temuujin. He at least could turn new hospital building into an office. Health Minister could not even defend the hospital building. She could have at least claimed that building for establishment of Burn Treatment Center.
OUR MEDICAL SECTOR NEEDS SKILLED MANAGERS AND LAWYERS
I recall that our Health Minister was included in the process of appointing Head of Trauma Center. How this process is dealt here?
Here hospital doctors and staff appoint presidents for hospitals through ballot. Ministry cannot affect their decision. My personal opinion is we lack skilled health sector managers and lawyers specializing in health system.
Some Mongolian doctors working abroad are reluctant to come back and work in Mongolia citing to lower salary. How about yourself?
I have been studying and working non-stop for 16 years. It does seem unfair after so much dedication you are to get paid 600K. But I will go back and work in Mongolia. This is what I like to do.
IN KOREA DOCTORS’ PAY IS PERFORMANCE BASED AND IT TOTALS TO 13-15 MILLION WONS
Many criticize that Mongolian health system is corrupt. Every pregnant woman is convinced that she needs to pay more in order to have normal delivery. How is situation in Korea? Do doctors receive gifts from patients?
Situation here in Korea differs greatly. If pregnant woman has health insurance she pays 2.5 million won, this rate goes up to 5 million won in case one doesn’t have health insurance. Moreover, 10-20 percent of patient payment goes to doctor salary. In this regard, there is no need for doctors to seek extra income through bribe, while in Mongolia salary for doctors is based on a flat rate around MNT400-600K. It won’t change whether you have served 10 patients or 20 patients during a day. Some of Mongolians say that they had discounts on their treatment fees here. This simply implies that surgeon or professor had deducted his or her portion. In other words, doctor doesn’t get paid for services.
Does it mean that Korean health system pays doctors based on their performance?
Our professor serves 100 patients per day. If he is to service 30 patients, his income will drop dramatically. If he is to see 50 patients and to have 10 surgeries per day, he gets paid well. It is totally performance based. It is different from giving flat rate and then demanding to serve 100 patients per day.
What will be average salary for doctors in Korea?
Professors with PhDs get 13-14 million, residents get paid 3-4 million and nurses are paid 5 million won per month in average.
IN KOREA DOCTORS GET 5 DAYS FOR VACATION
How about the benefit packages?
It is not as great as one might imagine. Doctors here get only 5 days paid vacation. After 6 years of work they are entitled to 3-6 months of paid vacation. In Mongolia doctors have month worth of paid vacation.
Performance based salary triggers competitiveness, which in turn leads to quality. I think this is fair system.
In England health system runs same payment method and doctors pays are 100% funded by the health insurance funds. Funds’ job is to verify how many patients were served and how many of them experienced improvements in their health condition. If the evaluation results come out unsatisfactory doctors get paid less. Primary care physicians therefore offer quality medical services and therefore population health improves greatly. It is primary care physician’s job to explain on negative impacts of fatty foods or smoking. But in Mongolia doctors at hospitals take on those responsibilities, besides their load. It explains how our health system is chaotic.
HEALTH INSURANCE SYSTEM SHOULD BE INTRODUCED TO MAKE REFORMS IN THIS SECTOR
Could you give more insight into health insurance system adapted in Korea?
I heard one Canadian citizen saying that he might not be using his medical insurance, but his insurance fee money helps others who are in need and vice versa if he needs to seek medical help, money collected from others will help him and that is the reason why he never skips his medical insurance payments. I think we should start from this simple notion.
Next question is do we indeed receive quality medical help when we are in need? It is very unfair for the patients who were paying health insurance, but to be treated in a way we experience it currently. I hope policy makers are aware of the situation and should be already working on improvements.
Personally, I think improvements should be started with health insurance law. I have contributed my inputs into renewed law. Initiators are trying to copy Korean law. But there are limits when it comes to just plain copying. We need to work out ways that really go with Mongolia case.
How much Korean citizens pay for their health insurance on average?
Students like me pay 43000 won per month, others are to decide on their plan and pay according to it. Higher the monthly payment, patient receives good quality medical help. For instance, if a student undergoes surgery one pays 50% from pocket and 5-10% for prescription, the rest is paid by health insurance fund. In Mongolia we need improvements in Drugs Law and make it under insurance. This way we can cut many illegal medicaments.
There is list of prescription drugs that one can get with discount price, and difference is paid from health insurance fund.
I wonder who came up with that list of drugs. Main factor for healing process is use of quality drugs, besides doctor and hospital. There won’t be much help if patients still use low quality drugs. This causes the notion that particular physician is not good and patients start their hunt for other physician.
HERE EVERY ONE GOES TO THEIR PHYSICIAN EVERY 3-6 MONTHS
In Mongolia there are many factors that lead to improper poor control system.
That is very true. We have no monitoring for patients. This happens at both hospital and patient ends. Patients have no idea that one must be under physician’s control. Here every one goes to their physician every 3-6 months. In Mongolia when patients start feel better they will just forget to go back for regular check-ups.
For instance heart diseases cannot be healed within 10 days, it takes 2-5 years for a patient to heal. In Mongolia we recommend going to primary care physician for check-ups, but then are they capable of monitoring those patients?
This means that most of the time patients also have to be responsible for their health?
Close monitoring and regular check-ups can prevent fatalities, if not fully cure the disease. Improper monitoring can lead to complication after lets say two or three years.
PROBLEM LIES WITH BOTH PHYSICIANS AND PATIENTS
How does the attitude of doctors and patients differ here?
As summer vacation starts I usually go back to Mongolia and work during summer at hospitals. When I try to approach patients in a manner I would in Korea some patients start with “What do you know, you are too young”. While I am trying to provide professional medical help, it is sometimes disturbing and at that point the discord starts at both ends. Older patients are easier to work with. Problem lies with both physicians and patients.
Physicians in Mongolia refer to their load at work and try to conceal some of their rude behavior with that. How much load does physician has at Korean hospitals?
Load is more here. Next year I am planning to go back to Mongolia, I have worked here for five years. I have meetings at 7AM, then surgeries all day. We usually plan our day before and after lunch. If I had surgeries before lunch today, tomorrow I plan my surgeries after lunch. If there are no surgical procedures I have to monitor my patients and write my thesis.
How about patients’ attitude in Korea?
Patients treat physicians with respect.
WE NEED LAWS TO PROTECT BOTH PATIENTS AND PHYSICIANS
How are cases of physicians default treated in Korea? How policy makers arranged the legal environment in those situations?
I work in a very risky environment here. If I make mistake during surgical procedure, I am to face court examination in accordance with Korean laws. The law clearly states that it includes anyone doing medical practice, internship and medical students both domestic and foreign. At the beginning I was always worried and stressed about this one sentence. Since then I have worked for five years. In Mongolia there are no such laws, only decree approved by the Health Ministry.
In Korea they have laws on physician malpractice and they adhere to laws. Personally, I think that Mongolian physicians offered work here should be very aware of the laws here.
Your thoughts on legal environment in health sector in Mongolia.
I have researched on the legal environment and came up with only five laws covering hospitals, health, medications and drugs and medical equipment. Five is not enough to regulate. In Mongolia there is no law to protect patients from physician’s malpractice. Second, physicians also need to have their rights protected. Currently there are no such laws only decrees or orders from the Ministry of Health. The only applicable law for medical malpractice is Criminal Code. Medical practice should be dealt differently from criminal cases.
Before you have mentioned that medical malpractice can lead to loosing license. How long one can be prohibited from practicing?
Over 3-5 years.
I HAVE CRITICISED HEALTH MINISTER, PROBABLY SHE WON’T BE HAPPY
I had personal experience with unethical behavior of medical personnel. Emergency care physician came to my home intoxicated. This is absolutely unethical and needs regulations.
Mongolians can act careless. It was one example of it. I noticed how many in hospitals act unethically both physicians and patients. It is like mistranslation of one’s rights. What do you think?
Totally agree with you…
Nowadays, Mongolians have become very self-centered and only talk about me, me and me. When all those MEs meet discord starts.
You have openly criticized health system and policy makers. Do you have any fears that you might be outcast at your return home next year?
I have criticized Health Minister a lot, probably she won’t be happy. Working here is already very stressful and honestly saying I am really looking forward to coming back to Mongolia.
Thank you very much for interesting insight.
“In Korea female doctors have to have exceptional skills to be acknowledged”
We had a chance to interview only female surgeon at Anam Hospital in South Korea and she happens to be Mongolian national. She specializes in cardiac medical procedures and surgeries.
GAP BETWEEN MONGOLIAN AND KOREAN HEALTH SECTOR WAS SHOCKING
How did you end up here being only female cardiac surgeon? When did you come here? Was it your choice?
Back in 2009, I was working at cardiology department of 3rd state hospital in Mongolia. At that time my five-year-old daughter had injured herself in the head and she had major brain hemorrhage. After several treatments in Mongolia we came here for better treatment at Anam Hospital. It was a shock to experience huge gap between Mongolian and Korean medical sector.
At that time I was sure that Mongolian doctors were very skilled, but lacked a lot due to inefficient and outdated equipment. But that belief shattered after I came here and I wanted to study here and started looking for opportunities. I have expressed my interest in their Masters degree program, which followed with request to meet with Head of Cardiology Department. They said if I pass exams their doors are open. I passed exams and here I am studying and working at the Cardiology Department.
You are specializing in cardiac medical procedure that is not yet introduced in Mongolia and you are the only female cardiac surgeon at this hospital.
At our center we offer treatments related to coronary occlusion, cardiac defects and arrhythmia. Currently in Mongolia there is no laboratory or medical center that diagnoses arrhythmia or offers treatment for this cardiac anomaly. Specialists for this specific field are being prepared now, which includes me and Dr. Mungun-Ulzii at 3rd state hospital.
I GET DOWNGRADED A LOT JUST BY BEING ONLY FEMALE CARDIAC SURGEON
I suppose that you face some difficulties working in a foreign country, although conditions and pay is better?
As you could have noticed there are no other female surgeons in the operation room, except the nurses. Many visiting doctors get surprised to see me and always tend to ask what am I doing in that room. Most of the cardiac surgeries last for extended 8-9 hours. It is believed that this load is physically hard for female doctors to bear. Medical procedures to treat arrhythmia can last up to 8 hours and is considered one of the hard procedures.
You are the only female surgeon at this center?
Yes, there are no other female surgeons.
How about other surgical procedures? Are there many female surgeons?
If it is not obstetrics and gynecology ones, female surgeons are very rare.
There should be a lot of competition coming from your Korean peers.
Indeed. I have fierce competition from other peers who are also doctorate students here at this hospital. In Korea female doctors have to have exceptional skills to be acknowledged.
I WISH OUR HEALTH MINISTER WAS LIKE TEMUUJIN
What health reforms should take place in Mongolia in order to improve the whole sector? What policy differences have you noticed in Korea?
Here in South Korea Ministry of Health and Health Insurance Funds are separated. In other words, Health Insurance Funds are independent. While Ministry of Health develops policies Health Funds manage money in health sector. But in Mongolia Ministry of Health is operating everything starting from procurement of equipment and managing the health budget. This distinction enables hospitals to manage their budget.
Earlier I had a chance to meet Mongolian mother who is here at Anam with her daughter. She mentioned how she was frustrated with Minister S. Udval, when her answer that she was not the person at charge of what is happening in the medical sector. Her daughter got ill due to physician’s malpractice.
I personally could not answer in such arrogant way to anyone seeking medical help. I suppose it is personal issue. Frankly, I am not satisfied with our Health Minister. I wish she were like Minister Temuujin. He at least could turn new hospital building into an office. Health Minister could not even defend the hospital building. She could have at least claimed that building for establishment of Burn Treatment Center.
OUR MEDICAL SECTOR NEEDS SKILLED MANAGERS AND LAWYERS
I recall that our Health Minister was included in the process of appointing Head of Trauma Center. How this process is dealt here?
Here hospital doctors and staff appoint presidents for hospitals through ballot. Ministry cannot affect their decision. My personal opinion is we lack skilled health sector managers and lawyers specializing in health system.
Some Mongolian doctors working abroad are reluctant to come back and work in Mongolia citing to lower salary. How about yourself?
I have been studying and working non-stop for 16 years. It does seem unfair after so much dedication you are to get paid 600K. But I will go back and work in Mongolia. This is what I like to do.
IN KOREA DOCTORS’ PAY IS PERFORMANCE BASED AND IT TOTALS TO 13-15 MILLION WONS
Many criticize that Mongolian health system is corrupt. Every pregnant woman is convinced that she needs to pay more in order to have normal delivery. How is situation in Korea? Do doctors receive gifts from patients?
Situation here in Korea differs greatly. If pregnant woman has health insurance she pays 2.5 million won, this rate goes up to 5 million won in case one doesn’t have health insurance. Moreover, 10-20 percent of patient payment goes to doctor salary. In this regard, there is no need for doctors to seek extra income through bribe, while in Mongolia salary for doctors is based on a flat rate around MNT400-600K. It won’t change whether you have served 10 patients or 20 patients during a day. Some of Mongolians say that they had discounts on their treatment fees here. This simply implies that surgeon or professor had deducted his or her portion. In other words, doctor doesn’t get paid for services.
Does it mean that Korean health system pays doctors based on their performance?
Our professor serves 100 patients per day. If he is to service 30 patients, his income will drop dramatically. If he is to see 50 patients and to have 10 surgeries per day, he gets paid well. It is totally performance based. It is different from giving flat rate and then demanding to serve 100 patients per day.
What will be average salary for doctors in Korea?
Professors with PhDs get 13-14 million, residents get paid 3-4 million and nurses are paid 5 million won per month in average.
IN KOREA DOCTORS GET 5 DAYS FOR VACATION
How about the benefit packages?
It is not as great as one might imagine. Doctors here get only 5 days paid vacation. After 6 years of work they are entitled to 3-6 months of paid vacation. In Mongolia doctors have month worth of paid vacation.
Performance based salary triggers competitiveness, which in turn leads to quality. I think this is fair system.
In England health system runs same payment method and doctors pays are 100% funded by the health insurance funds. Funds’ job is to verify how many patients were served and how many of them experienced improvements in their health condition. If the evaluation results come out unsatisfactory doctors get paid less. Primary care physicians therefore offer quality medical services and therefore population health improves greatly. It is primary care physician’s job to explain on negative impacts of fatty foods or smoking. But in Mongolia doctors at hospitals take on those responsibilities, besides their load. It explains how our health system is chaotic.
HEALTH INSURANCE SYSTEM SHOULD BE INTRODUCED TO MAKE REFORMS IN THIS SECTOR
Could you give more insight into health insurance system adapted in Korea?
I heard one Canadian citizen saying that he might not be using his medical insurance, but his insurance fee money helps others who are in need and vice versa if he needs to seek medical help, money collected from others will help him and that is the reason why he never skips his medical insurance payments. I think we should start from this simple notion.
Next question is do we indeed receive quality medical help when we are in need? It is very unfair for the patients who were paying health insurance, but to be treated in a way we experience it currently. I hope policy makers are aware of the situation and should be already working on improvements.
Personally, I think improvements should be started with health insurance law. I have contributed my inputs into renewed law. Initiators are trying to copy Korean law. But there are limits when it comes to just plain copying. We need to work out ways that really go with Mongolia case.
How much Korean citizens pay for their health insurance on average?
Students like me pay 43000 won per month, others are to decide on their plan and pay according to it. Higher the monthly payment, patient receives good quality medical help. For instance, if a student undergoes surgery one pays 50% from pocket and 5-10% for prescription, the rest is paid by health insurance fund. In Mongolia we need improvements in Drugs Law and make it under insurance. This way we can cut many illegal medicaments.
There is list of prescription drugs that one can get with discount price, and difference is paid from health insurance fund.
I wonder who came up with that list of drugs. Main factor for healing process is use of quality drugs, besides doctor and hospital. There won’t be much help if patients still use low quality drugs. This causes the notion that particular physician is not good and patients start their hunt for other physician.
HERE EVERY ONE GOES TO THEIR PHYSICIAN EVERY 3-6 MONTHS
In Mongolia there are many factors that lead to improper poor control system.
That is very true. We have no monitoring for patients. This happens at both hospital and patient ends. Patients have no idea that one must be under physician’s control. Here every one goes to their physician every 3-6 months. In Mongolia when patients start feel better they will just forget to go back for regular check-ups.
For instance heart diseases cannot be healed within 10 days, it takes 2-5 years for a patient to heal. In Mongolia we recommend going to primary care physician for check-ups, but then are they capable of monitoring those patients?
This means that most of the time patients also have to be responsible for their health?
Close monitoring and regular check-ups can prevent fatalities, if not fully cure the disease. Improper monitoring can lead to complication after lets say two or three years.
PROBLEM LIES WITH BOTH PHYSICIANS AND PATIENTS
How does the attitude of doctors and patients differ here?
As summer vacation starts I usually go back to Mongolia and work during summer at hospitals. When I try to approach patients in a manner I would in Korea some patients start with “What do you know, you are too young”. While I am trying to provide professional medical help, it is sometimes disturbing and at that point the discord starts at both ends. Older patients are easier to work with. Problem lies with both physicians and patients.
Physicians in Mongolia refer to their load at work and try to conceal some of their rude behavior with that. How much load does physician has at Korean hospitals?
Load is more here. Next year I am planning to go back to Mongolia, I have worked here for five years. I have meetings at 7AM, then surgeries all day. We usually plan our day before and after lunch. If I had surgeries before lunch today, tomorrow I plan my surgeries after lunch. If there are no surgical procedures I have to monitor my patients and write my thesis.
How about patients’ attitude in Korea?
Patients treat physicians with respect.
WE NEED LAWS TO PROTECT BOTH PATIENTS AND PHYSICIANS
How are cases of physicians default treated in Korea? How policy makers arranged the legal environment in those situations?
I work in a very risky environment here. If I make mistake during surgical procedure, I am to face court examination in accordance with Korean laws. The law clearly states that it includes anyone doing medical practice, internship and medical students both domestic and foreign. At the beginning I was always worried and stressed about this one sentence. Since then I have worked for five years. In Mongolia there are no such laws, only decree approved by the Health Ministry.
In Korea they have laws on physician malpractice and they adhere to laws. Personally, I think that Mongolian physicians offered work here should be very aware of the laws here.
Your thoughts on legal environment in health sector in Mongolia.
I have researched on the legal environment and came up with only five laws covering hospitals, health, medications and drugs and medical equipment. Five is not enough to regulate. In Mongolia there is no law to protect patients from physician’s malpractice. Second, physicians also need to have their rights protected. Currently there are no such laws only decrees or orders from the Ministry of Health. The only applicable law for medical malpractice is Criminal Code. Medical practice should be dealt differently from criminal cases.
Before you have mentioned that medical malpractice can lead to loosing license. How long one can be prohibited from practicing?
Over 3-5 years.
I HAVE CRITICISED HEALTH MINISTER, PROBABLY SHE WON’T BE HAPPY
I had personal experience with unethical behavior of medical personnel. Emergency care physician came to my home intoxicated. This is absolutely unethical and needs regulations.
Mongolians can act careless. It was one example of it. I noticed how many in hospitals act unethically both physicians and patients. It is like mistranslation of one’s rights. What do you think?
Totally agree with you…
Nowadays, Mongolians have become very self-centered and only talk about me, me and me. When all those MEs meet discord starts.
You have openly criticized health system and policy makers. Do you have any fears that you might be outcast at your return home next year?
I have criticized Health Minister a lot, probably she won’t be happy. Working here is already very stressful and honestly saying I am really looking forward to coming back to Mongolia.
Thank you very much for interesting insight.