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Obstet Gynecol Sci > Volume 64(5); 2021 > Article
Lee, Li, and Hwang: After 20 years of low fertility, where are the obstetrician-gynecologists?

Abstract

Korea has entered a stage of low fertility, with a total fertility rate of 1.178 in 2002 and 0.92 in 2019. The low birth rate has led to the closure of obstetric hospitals and clinics from 1,371 maternity health facilities in 2003 to 541 in 2019, which is 39.5% compared to 2003. Since 2011, the Ministry of Health and Welfare has been operating an “Obstetrically Underserved Areas Support Project,” however, a shortage of obstetrician-gynecologists (OB/GYNs) who can participate in labor and delivery is a major problem. In 2019, there were 5,800 OB/GYNs practicing. Of these, 4,225 (72.8%) were working in obstetrics-gynecology hospitals, each responsible for 2,855 fertile women. Their average age was 51.8 years. A total of 2,659 (45.9%) worked in clinics and 3,110 (73.6%) were working in metropolitan districts. Only 124 OB/GYNs (2.9%) worked in vulnerable rural areas. OB/GYNs working in obstetric hospitals were responsible for 113.8 newborns in 2019. Their average age was 50.1 years. Of them, 67.4% were working in hospitals, 74.1% in urban areas, and only 60 specialists (2.3%) were working in rural areas. To establish a safe childbirth environment during an era of low fertility, it is important to have obstetricians in charge of childbirth. The government should establish a comprehensive long-term plan to resolve the shortage of OB/GYNs.

Introduction

Korea has stated in the constitution its obligation to maternal safety, and the World Health Organization recommends that medical accessibility be established for prenatal management for the sake of maternal and child health [1].
Medical accessibility is influenced by physical, financial, and cultural obstacles. Physical obstacles include the geographic inequality of medical facilities, difficulties in travel, and financial loss due to long distances from facilities [2]. The best option for excellent maternity-related medical accessibility is to have an obstetric hospital nearby.
The persistence of a low birth rate in the last 20 years has led to difficulties in the management of obstetrics-gynecology (OBGYN) hospitals and clinics, causing many to close down. In the early stages of the low birth rate era, closures were mostly in vulnerable rural areas with few childbirths. However, with the apparent permanent low birth rate, closures are currently becoming more common throughout the nation, hampering medical accessibility for pregnant women [3].
The decrease in medical accessibility from closures of domestic obstetric hospitals and clinics has had a severe impact on maternal and child health, including maternal mortality. In 2011, the maternal mortality ratio (MMR) was 17.2 [3,4], which was 2.1 times higher than the Organization for Economic Co-operation and Development MMR average of 8.2, and 4.2 times higher than the MMR of 4.1 in Japan [5]. According to a report published in Korea in 2019, pregnant women residing in obstetrically underserved areas (OUAs) showed an abortion rate of 4.6% and an inadequate prenatal care of 7.2%, which were significantly higher than those in obstetrically sufficient areas [6,7].
In 2011, the Ministry of Health and Welfare started the “Obstetrically Underserved Areas Support Project.” To improve medical accessibility, 19 local governments opened obstetric hospitals and clinics in OUAs, supported facility, equipment, and operational expenses, and provided additional medical reimbursements for obstetric procedures. However, 65 of the 250 local governments still do not have obstetric hospitals or clinics [8].
Experts have provided various explanations as to why OUAs still exist, but the factors are complex. When the issue of OUAs first arose in 2010, the difficulty of operating obstetric hospitals and clinics was considered the most crucial factor. The government perceived that supporting facilities with equipment, rebuilding costs, and hospital operational expenses would resolve the problem of OUAs [9]. However, despite the government’s support project for OUAs in 2011, OUAs remained, showing the limitations of the government’s policies to resolve the issue.
Adequate equipment and staffing of obstetrician-gynecologists (OB/GYNs), particularly obstetricians, is crucial for the stable operation of obstetric hospitals. According to a 2014 report, the most important factor in the safety of childbirth in obstetric hospitals and clinics is the obstetric staff. In particular, the presence of an obstetrician is the most crucial factor for improving pregnancy outcomes in high-risk pregnant women [10]. However, various factors have led to difficulties in recruiting OB/GYNs for OUAs, impeding safe pregnancy and childbirth.
Becoming an OB/GYN requires 11 years of education in total; six years of medical college, 1 year of internship, and 4 years of residency. For a stable labor supply of OB/GYNs, supply and demand must be foreseen for long-term planning and comprehensive policy support.
As there have been insufficient studies on the supply and demand for OB/GYNs in Korea, it has unfortunately been difficult to establish countermeasures for OUAs and the management of high-risk pregnant women. To assist in establishing policies for supply and demand, this review article analyzes the status of OB/GYNs in charge of pregnancy and childbirth during this era of low fertility.

Status of OBGYN hospitals and clinics

According to the 2019 Health Insurance Review and Assessment Service (HIRA), there were 2,081 OBGYN hospitals and clinics in Korea. An analysis of 17 provinces showed that Seoul had the most number of OBGYN facilities (503), followed by Gyeonggi (403). The area with the least number of facilities was Sejong (8), followed by Jeju (29). Seoul, Gyeonggi, and Incheon, the capital area, had 999 OBGYN facilities, or 48% of the total in Korea [11].
It is important that OBGYN clinics, used mostly by women of childbearing age, operate adequately for medical accessibility. The national average of OBGYN hospitals and clinics per 10,000 women of childbearing age was 1.72, and each facility was responsible for 5,797.8 fertile women. Daegu had the highest OBGYN hospital and clinic count for fertile women in Korea at 2.3 per 10,000 women, and there were 4,329.2 of them per facility, the lowest in the country. Sejong had the lowest ratio for the number of OBGYN facilities in Korea to the number of women of childbearing age at 0.9 per 10,000 women, and there were 11,192.7 fertile women per facility (Table 1).
The capital area had the most number of OBGYN hospitals and clinics per 10,000 women of childbearing age at 1.55, which is lower than the national average. The number of women of childbearing age per facility was 6,469, with the ratio of OBGYN clinics to the number of fertile women also being higher than the national average.

Status of maternity health facilities

According to the 2019 National Health Insurance Service (NHIS) and HIRA, 741 maternity health facilities had labor and delivery rooms; 726 obstetric hospitals and clinics and 15 midwifery birth centers. In total, 541 maternity health facilities, 526 obstetric hospitals and clinics, and 15 midwifery birth centers had at least one childbirth in 2019 [12] (Table 1).
Classified by type, there were 260 obstetric clinics, 142 obstetric hospitals, 83 general hospitals, and 41 tertiary care hospitals. Interestingly, labor and delivery were managed in public health centers until 2013, but not after 2014 [13] (Table 2).
Based on an analysis of the 541 maternity health facilities that managed childbirth in 2019, Gyeonggi had the highest number of maternity health facilities with 122, followed by Seoul with 94. Sejong and Ulsan had the lowest at 4 and 9, respectively (Table 1). The capital area had 246 clinics, or 45.5% of all maternity health facilities. Many maternity health facilities are based in the capital area because 6,462,573 women of childbearing age, which represents 53.6% of the total in Korea, reside in the capital area.
Since pregnant women generally use maternity health facilities, an analysis of “maternity health facilities per pregnant woman” is a significant indicator of whether the facilities they actually use are operating properly. However, since there are no national statistics on the number of pregnant women in Korea, this can be indirectly confirmed by the number of childbirths and newborns. The statistics on childbirth are based on medical reimbursement payment requests from private maternity health facilities, and the statistics on newborns are based on birth registrations managed by Statistics Korea, a government organization; therefore, the figures are considered more accurate. Thus, the statistics of maternity health facilities per newborn have been used as an indirect indicator of maternity health facilities per pregnant woman in this study.
The number of maternity health facilities per 1,000 newborns was 1.79, with 559.5 newborns per facility. Jeonbuk had the most number of obstetric hospitals and clinics, with 3.23 per 1,000 newborns, and the least number of newborns, with 309.3 per obstetric hospital and clinic, showing the highest maternity health facilities to pregnant women ratio. Sejong had the least number of obstetric hospitals and clinics, with 1.05 per 1,000 newborns, and the highest level of newborns, with 954.6% per obstetric hospital and clinic. Sejong was the most underprivileged city for maternity services in Korea because it had a high total fertility rate of 1.47 and insufficient obstetric infrastructure due to the city being newly established. However, as Sejong is increasing its number of obstetric clinics, accessibility to obstetric medical services is likely to improve. Amongst established provincial areas, Gwangju had the least number of obstetric hospitals and clinics with 1.08 per 1,000 newborns, and the highest level of newborns with 929.3% per obstetric hospital and clinic, thereby lacking in obstetric hospitals and clinics for local pregnant women (Table 1).

Changes in maternity health facilities

As Korea entered a period of low fertility in the 2000s, many maternity health facilities with financial difficulties closed. From 1,371 in 2003, the number decreased by about 90 annually until 2009, and only 541 obstetric facilities remained in 2019, which accounted for a 60.5% reduction. In particular, 73.8% of the clinics closed, which was the highest percentage, 52.6% of general hospitals stopped providing obstetric care, and 40% of midwifery birth centers closed [12,13] (Table 2).
Most provincial areas showed a decrease in maternity health facilities; compared to 2003, the largest decrease was in Gwangju (77.5%), while the smallest was in Jeju (31.6%). In contrast, the number of obstetric hospitals and clinics in Sejong increased (Table 3).
In 2003, 2.77 maternity health facilities existed per 1,000 newborns, and 361.1 newborns were born per facility. Since then, the number of maternity health facilities per 1,000 newborns has been steadily decreasing, and the number of newborns per maternity health facility has been increasing. As a result, the maternity care environment was badly affected by 2015, with 1.41 maternity health facilities per 1,000 newborns and 707.1 newborns per facility. After 2015, the number of newborns decreased at a faster rate than the closure of obstetric hospitals and clinics, consistently reducing the number of newborns per maternity health facility; by 2019, 559.5 babies were born per facility (Table 1).

Status of OB/GYNs

Since the liberation and Korean War, pregnancy and child-birth dramatically increased during the baby boom era, leading to a rapid increase in demand for OB/GYNs, but various practical difficulties led to insufficient numbers. Therefore, in 1951, the government implemented a specialist system to increase the number of competent OB/GYNs. In 1957, the Korean Society of Obstetrics and Gynecology (KSOG) provided a unified nationwide training curriculum, and the current specialist system was implemented to allow one to become a specialist after 4 years of residency and an exam. Previously, an OB/GYN designation was granted based on a document review, not by an exam. Seven OB/GYNs were appointed under the new system for the first time in 1953. A specialist exam was finally implemented in 1960, and it produced 7,569 specialists in 2019 [14].
The supply of new specialists was 130 per year by the mid-1980s and over 200 in the 1990s. It peaked at 270 in 2001. However, low rates of fertility, excessive work demands, increasing medical disputes, lack of a compensatory system, and the government’s mistaken reduction of the residency training program led to a decrease in the number of specialists. By 2012, there were only 90 new specialists, the lowest since 1982 [15].
According to the NHIS, the number of practicing OB/GYNs in 2019 was 5,800. Most specialists worked in Seoul (1,544), followed by Gyeonggi (1,257). The new city of Sejong had the lowest number of specialists at 18, and Jeju had the lowest number among conventional provincial areas at 66.
The number of practicing OB/GYNs per 10,000 women of childbearing age was 4.81 nationwide, and each OB/ GYN was responsible for 2,080.2 of them. Seoul, having the most number of OB/GYNs, had 6.17 specialists per 10,000 women of childbearing age, and each OB/GYN oversaw 1,621.8 of them. Sejong had the least number of OB/GYNs, with 2.01 specialists per 10,000 women of childbearing age, and 4,974.6 per OB/GYN, the highest in Korea (Table 4). Although 5,800 specialists were currently practicing, only 4,225 were working in OBGYN hospitals and clinics, accounting for 72.8% of the total clinical specialists [16].
An analysis of OB/GYNs working in OBGYN hospitals and clinics according to area showed that Seoul had the most number of specialists (1,100), followed by Gyeonggi (951). The area with the least number of specialists was Sejong (14), followed by Jeju (49). The ratio of OB/GYNs working in OBGYN hospitals and clinics to the total number of practicing OB/GYNs was the highest in Daejeon (80.4%) and the lowest in Gyeongnam (48.6%) [17].
Of 2,505 OB/GYNs, 59.3% working in OBGYN hospital and clinics were male, and 1,720 were female. However, only Seoul had more female than male specialists (638 and 462, respectively). The area with the highest number of male specialists was Jeonnam, with 92 (87.6%) (Table 5).
Each OB/GYN working in an OBGYN hospital and clinic was responsible for an average of 2,855.7 women of childbearing age, and there were 3.5 specialists for every 10,000 fertile women. Although Seoul had the highest number of OB/GYNs working in OBGYN hospitals and clinics, the number of OB/GYNs per woman of childbearing age was the highest in Daegu at 4.55 for every 10,000; however, its ratio of fertile women to specialist was the lowest in Korea at 2,198.7 women. The area with the least number of OB/ GYNs per woman of childbearing age was Sejong, followed by Gyeongnam. Sejong had 1.56 OB/GYNs for every 10,000 women of childbearing age, with 6,395.9 women per specialist. In Gyeongnam, there were 2.5 OB/GYNs for every 10,000 women of childbearing age, with 3,987.5 women per specialist (Table 4).
The average age of OB/GYNs was 51.8 years; 55.5 years for males, and 46.5 years for females. Gyeongbuk had the highest average age in Korea, while Seoul had the lowest at 51.1 years. There was a discrepancy between male and female doctors. The average age of male OB/GYNs was the highest in Gyeongbuk at 60.2 years, while OB/GYNs in Jeju had the highest average age at 51.4 years. The city with the youngest male specialists was Sejong, with an average age of 53.1 years, while Incheon had the youngest female specialists, with an average age of 43.6 years.
Based on the type of medical facility, 1,941 (45.9%) of all OB/GYNs working in OBGYN hospitals and clinics were working in clinics, while 1,068 (25.3%) were working in hospitals (Table 6). Based on area, 3,110 OB/GYNs (73.6%) were working in metropolitan districts, with 991 being specialists (23.5% in cities), and 124 (2.9%) in vulnerable rural areas. In particular, 84% of female specialists worked in urban areas.

Status of OB/GYNs in obstetric hospitals and clinics

An obstetrician is a doctor who takes care of pregnant women and delivers babies. Unfortunately, there are no domestic or academic data for obstetricians. An indirect indicator is the number of specialists working in obstetric hospitals and clinics that report having a delivery room, but this has its limitations in that the count is higher than the number of actual obstetricians. According to NHIS statistics, the number of OB/ GYNs working in obstetric hospitals and clinics was 2,659 in 2019, with 45.9% practicing OB/GYNs, and 62.9% working in OBGYN hospitals and clinics participating in deliveries (Table 4).
Seoul had the most number of specialists (661), followed by Gyeonggi (639), while the area with the highest ratio of OB/GYNs working in obstetric hospitals and clinics was Incheon. Overall, 71.8% of OB/GYNs were working in obstetric hospitals and clinics. The area with the least number of OB/GYNs working in obstetric hospitals and clinics was Sejong (9). For conventional provincial areas, Jeju had the lowest ratio of OB/GYNs working in OBGYN hospitals and clinics with 48.9%, and 24 specialists.
To learn about accessibility for pregnant women, the main users of obstetric hospitals and clinics, the numbers of newborns and specialists in obstetric facilities were analyzed. The number of OB/GYNs working in obstetric hospitals and clinics nationwide for every 1,000 newborns was 8.78 and the average number of newborns for each OB/GYN working in obstetric facilities was 113.8.
Seoul had the highest ratio of OB/GYNs working in obstetric hospitals and clinics for every 1,000 newborns (12.3), which was the highest in Korea; however, the number of newborns for each specialist was 81.2, which was the lowest in the country. Sejong had the least number of specialists with 2.36 per 1,000 newborns, while each specialist oversaw 424 newborns (Table 4).
Among the OB/GYNs working in obstetric hospitals and clinics, there were 1,690 male specialists (63.6%) and 969 female specialists (36.4%). The area with the lowest ratio of male specialists was Seoul with 334 (50.5%), while the area with the highest ratio was Jeonnam with 58 (90.6%) (Table 5).
The average age of OB/GYNs working in obstetric hospitals and clinics was 50.1 years, with males at 53.7 years, and females at 43.9 years. Jeonnam had the highest average age in Korea at 56 years, while Sejong had the lowest at 47.4 years. Male specialists working in Jeonnam were the oldest at 56.1 years, while female specialists working in Daegu were the youngest at 40.4 years.
Based on the type of medical obstetric facility where OB/ GYNs were working, 873 specialists (32.8%) were working in hospitals, while 868 (32.6%) were working in clinics (Table 6). Based on the areas where OB/GYNs were working in obstetric hospitals and clinics, 1,969 specialists (74.1%), were working in metropolitan districts, 630 (23.7%) were working in cities, and only 60 (2.3%) were working in vulnerable rural areas.

Plans to procure obstetricians

In an era of low fertility, the decrease in the number of obstetric hospitals and clinics is not limited to vulnerable local areas, but is a nationwide phenomenon, and there is a lack of improvement in domestic mother and child health indexes. The government has attempted to establish a maternity infrastructure with projects for OUA support, but OUA areas still exist. The recruitment of OB/GYNs is crucial to rebuilding the damaged maternity infrastructure, and calculating the appropriate number of obstetricians is an important task.
In the past, Korean society did not provide adequate rest or appropriate compensation for obstetricians, and enforced personal sacrifice to operate obstetric hospitals with an inadequate number of obstetricians. More recently, the quality of personal life is being prioritized, and future OB/GYNs expect adequate compensation with an assurance of quality of life, as in developed countries.
For this reason, there should be a social consensus to recruit obstetricians on conditions such as salary, working hours, and breaks, as well as conditions for their quality of life as a doctor. However, there is still no social consensus on this matter, so it is difficult to predict how many specialists will be needed. Nevertheless, we can make predictions based on Korea’s neighboring country, Japan. Japan has established a work schedule of assigning 100 deliveries for each OB/GYN annually, one duty per week, and paid leave.
When considering Korea’s domestic situation, 302,676 babies were born in 2019, and when an obstetrician is assumed to be assigned 10 deliveries monthly or 120 deliveries annually, the required number of obstetricians is 2,522. When weekly duty and paid leave are provided, there should be 52 days of paid leave annually, so an additional 419 specialists are needed, making a total of 2,941, which is 282 more than the currently practicing 2,659 specialists.
Obstetricians have been complaining of various issues in clinical practice. The first is the high work intensity and deterioration of the quality of life. In the 2019 NIHS data, the average number of annual deliveries for a specialist working in an obstetric facility was 114. However, according to the 2019 KSOG survey, the average number of deliveries for an obstetrician was 16 per month or 192 per year, which differed from official statistical data from the government [18]. Therefore, it can be assumed that the actual number of obstetricians is low, their work intensity is high, and their quality of life is poor.
The second is the fear of medical disputes. In the 2019 KSOG survey, 55% of specialists who did not participate in deliveries reported that they did not perform deliveries due to “medical disputes and lawsuits.” Another serious issue is that only 43% of the residents who become specialists participate in deliveries. The biggest reason for not participating in deliveries is concerns about medical accidents and mental stress regarding deliveries [18].
The third is the closure of OBGYN hospitals and clinics due to financial difficulties in this era of low fertility and the resulting uncertainty about their status. The high labor intensity, impaired quality of life, high risk of medical malpractice litigation, and insecure positions have led to the low involvement of OB/GYNs in deliveries, with only 45.9% of OB/GYNs practicing in clinics and 62.9% participating in deliveries in obstetric hospitals and clinics [18].
The first task in rebuilding obstetric infrastructure is to recruit competent obstetricians. To do so, the long-term demand for OB/GYNs must be calculated, so that plans to obtain new OB/GYNs and recruit existing OB/GYNs can be implemented.
A new OB/GYN specialist requires 11 years of education, including medical college; therefore, long-term plans are needed to support programs, such as scholarships and the overseas training of medical students. In addition, support programs, such as training subsidies, foreign exchange, and public health and military doctor support policies are also necessary during residency. As the development of a new specialist takes time, another way to recruit obstetricians is to hire existing OB/GYNs. To do this, the government must create a support system to resolve the issues that concern OB/GYNs. First, a system to resolve medical disputes is necessary. To improve existing uncontrolled medical malpractice compensation, the government must create a full compensation budget for no-fault medical disputes, with an increase in compensation of up to 300 million won. Second, obstetricians who currently work at the hospital level or in higher level medical facilities may be employed doctors; 67.4% of OB/GYNs work in obstetric hospitals, and government support may not directly benefit them. Supportive regulations, such as night duty compensation for obstetricians and 24-hours rest after such duty, must be legislated as direct improvements [19]. Third, a policy to set an obstetric reimbursement fee from the national health insurance according to the number of newborns must be implemented so obstetric hospitals and clinics can continue to operate. In this era of low fertility, the number of newborns will continue to decline, and this will be a critical issue with regard to the operation of obstetric hospitals. To overcome these challenges, various new maternity-associated reimbursement fees must be added, and existing fees must be raised so that maternity hospitals may operate smoothly. Finally, a re-education system, such as a clinical medical personnel education center, could be provided to medical personnel with insufficient delivery experience.

Conclusions

When an era of low fertility began in Korea in the early 2000s, many obstetric hospitals and clinics in rural areas closed. Recently, obstetric hospitals in both rural and urban areas have been ceasing to operate. Only 541 maternity health facilities were opened in 2019, a decrease of 60.5% compared to 2003. Obstetric hospital and clinic closures has had a negative influence on maternal and child health, leading to increases in maternal mortality and the rate of miscarriages in OUAs.
Although the government has implemented various programs to resolve the problem of OUAs, they face many difficulties for various reasons. In particular, the recruitment of obstetricians is the biggest difficulty in solving the issues of underserved areas.
It is important to recruit obstetricians to be in charge of childbirth during an era of low fertility. However, the recruitment of obstetricians is difficult because of reasons such as high labor intensity, medical lawsuits, and low compensation. Thus, the government should create a long-term comprehensive supportive plan for obstetricians to work in obstetric hospitals, taking into consideration their quality of life. This will contribute to safe childbirth and overcome the current low fertility rates in Korea.

Notes

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Ethical approval

This study does not require approval of the Institutional Review Board because no patient data is contained in this article. The study was performed in accordance with the principles of the Declaration of Helsinki.

Patient consent

Written informed consent and the use of images from patients are not required for the publication.

Funding information

This work was supported by the Research Grant from Kangwon National University; Kangwon national university hospital.

Table 1
Status of obstetrics and gynecology hospital and clinics and maternity health facilities in 17 provinces (2019)
Province OBGYN hospitals & clinics Maternity healthcare facilities Newborns OBGYN hospitals & clinics per 10,000 women of childbearing age Women of childbearing age per OBGYN hospitals & clinics Maternity healthcare facilities per 1,000 newborns Newborns healthcare facilities
Obstetric hospitals & clinics Midwifery birth center Subtotal Women of childbearing age
Seoul 503 91 3 94 2,503,982 53,673 2.01 4,978.1 571.0 1.75
Busan 168 35 1 36 752,426 17,049 2.23 4,478.7 473.6 2.11
Daegu 129 23 0 23 558,471 13,233 2.31 4,329.2 575.3 1.74
Incheon 93 29 1 30 711,176 18,522 1.31 7,647.1 617.4 1.62
Gwangju 76 9 0 9 360,458 8,364 2.11 4,742.9 929.3 1.08
Daejeon 74 23 0 23 358,714 8,410 2.06 4,847.5 365.7 2.73
Ulsan 50 9 0 9 264,093 7,539 1.89 5,281.9 837.7 1.19
Sejong 8 4 0 4 89,542 3,819 0.89 11,192.8 954.8 1.05
Gyeonggi 403 116 6 122 3,247,415 83,198 1.24 8,058.1 682.0 1.47
Gangwon 59 23 0 23 309,384 8,283 1.91 5,243.8 360.1 2.78
Chungbuk 69 20 1 21 340,338 9,333 2.03 4,932.4 444.4 2.25
Chungnam 71 26 0 26 446,009 13,228 1.59 6,281.8 508.8 1.97
Jeonbuk 85 29 0 29 375,347 8,971 2.26 4,415.8 309.3 3.23
Jeonnam 59 14 0 14 353,505 10,832 1.67 5,991.6 773.7 1.29
Gyeongbuk 96 26 1 27 519,431 14,472 1.85 5,410.7 536.0 1.87
Gyeongnam 109 37 1 38 722,100 19,250 1.51 6,624.8 506.6 1.97
Jeju 29 12 1 13 152,814 4,500 1.90 5,269.4 346.2 2.89
Total 2,081 526 15 541 12,065,205 302,676 1.72 5,797.8 559.5 1.79

OBGYN, Obstetrics and Gynecology.

Table 2
Change of maternity health facilities based on type of maternity healthcare facility 2003-2019
Provinces 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Reduction rate (%)
Tertiary hospital 42 42 42 43 43 43 44 44 44 43 43 42 42 42 42 41 41 2.4
General hospital 175 156 151 138 133 125 112 108 100 97 91 90 85 89 85 86 83 52.6
Hospital 136 139 136 130 123 127 123 124 135 141 145 147 141 145 148 145 142 −4.4
Clinics 992 955 866 789 710 640 564 518 484 448 409 376 334 313 290 279 260 73.8
Midwifery birth center 25 18 18 18 17 18 16 14 13 13 17 20 18 18 17 16 15 40.0
Public health center 1 1 1 1 1 1 1 0 1 1 1 0 0 0 0 0 0 100.0
Total 1,371 1,311 1,214 1,119 1,027 954 860 808 777 743 706 675 620 607 582 567 541 60.5
Table 3
Change of maternity healthcare facilities in 17 provinces 2003-2019
Province 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Reduction rate (%)
Seoul 264 236 222 194 183 168 151 143 138 131 124 118 109 105 98 98 94 64.4
Busan 80 78 70 63 62 64 53 50 51 43 44 43 38 37 36 37 36 55.0
Daegu 43 46 39 35 35 29 29 30 28 41 35 38 26 27 25 24 23 46.5
Incheon 85 77 70 60 56 49 47 42 43 25 26 32 34 33 31 30 30 64.7
Gwangju 40 39 35 35 31 30 27 25 23 20 24 21 14 13 12 9 9 77.5
Daejeon 63 60 56 55 51 51 41 41 36 38 29 31 30 30 28 29 23 63.5
Ulsan 23 24 23 21 18 18 14 15 15 14 13 11 10 8 8 10 9 60.9
Sejong - - - - - - - - - - 2 2 2 2 2 4 4 -
Gyeonggi 312 296 272 250 230 200 185 173 167 172 165 155 142 137 135 129 122 60.9
Gangwon 56 56 54 52 46 44 38 34 31 32 31 27 24 23 24 23 23 58.9
Chungbuk 65 65 58 52 49 43 41 38 37 36 30 29 29 27 23 23 21 67.7
Chungnam 70 62 55 56 54 49 42 40 37 36 32 29 28 29 28 25 26 62.9
Jeonbuk 58 62 56 49 50 46 42 41 40 37 37 34 33 32 32 28 29 50.0
Jeonnam 49 46 39 38 29 32 28 22 21 17 14 16 17 15 13 16 14 71.4
Gyeongbuk 61 61 58 57 52 52 43 40 38 34 36 31 29 30 32 29 27 55.7
Gyeongnam 83 85 89 85 66 64 65 61 58 52 50 44 41 45 42 42 38 54.2
Jeju 19 18 18 17 15 15 14 13 14 15 14 14 14 14 13 13 13 31.6
Total 1,371 1,311 1,214 1,119 1,027 954 860 808 777 743 706 675 620 607 582 567 541 60.5
Table 4
Status of obstetrician and gynecologists in 17 provinces (2019)
Province Practicing OB/GYNs OB/GYNs working in OBGYN hospitals & clinics OB/GYNs working in obstetric hospitals & clinics Practicing OB/GYNs per 10,000 Women of childbearing age Women of childbearing age per Practicing OB/GYNs OB/GYNs working in OBGYN hospitals & clinics per 10,000 Women of child-bearing age Women of childbearing age per OB/ GYNs working in OBGYN hospitals & clinics OB/GYNs working in obstetric hospitals & clinics per 10,000 Women of child-bearing age Women of child-bearing age per OB/GYNs working in obstetric hospitals & clinics
Seoul 1,544 1,100 661 6.17 1,621.8 4.39 2,276.3 2.64 3,788.2
Busan 453 312 204 6.02 1,661.0 4.15 2,411.6 2.71 3,688.4
Daegu 318 254 138 5.69 1,756.2 4.55 2,198.7 2.47 4,046.9
Incheon 294 209 150 4.13 2,419.0 2.94 3,402.8 2.11 4,741.2
Gwangju 215 159 84 5.96 1,676.5 4.41 2,267.0 2.33 4,291.2
Daejeon 199 160 102 5.55 1,802.6 4.46 2,242.0 2.84 3,516.8
Ulsan 115 87 47 4.35 2,296.5 3.29 3,035.6 1.78 5,619.0
Sejong 18 14 9 2.01 4,974.6 1.56 6,395.9 1.01 9,949.1
Gyeonggi 1,257 951 639 3.87 2,583.5 2.93 3,414.7 1.97 5,082.0
Gangwon 143 105 68 4.62 2,163.5 3.39 2,946.5 2.20 4,549.8
Chungbuk 140 108 70 4.11 2,431.0 3.17 3,151.3 2.06 4,862.0
Chungnam 185 132 95 4.15 2,410.9 2.96 3,378.9 2.13 4,694.8
Jeonbuk 185 145 88 4.93 2,028.9 3.86 2,588.6 2.34 4,265.3
Jeonnam 158 105 64 4.47 2,237.4 2.97 3,366.7 1.81 5,523.5
Gyeongbuk 215 154 100 4.14 2,416.0 2.96 3,372.9 1.93 5,194.3
Gyeongnam 295 181 116 4.09 2,447.8 2.51 3,989.5 1.61 6,225.0
Jeju 66 49 24 4.32 2,315.4 3.21 3,118.7 1.57 6,367.3
Total 5,800 4,225 2,659 4.81 2,080.2 3.50 2,855.7 2.20 4,537.5

OB/GYN, Obstetrician and Gynecologist; OBGYN, Obstetrics and Gynecology.

Table 5
Sex ratio of OB/GYN in 17 provinces (2019)
Province OB/GYNs working in OBGYN hospitals & clinics OB/GYNs working in obstetric hospitals & clinics


Male Female Total Male Female Total
Seoul 462 638 1,100 334 327 661

Busan 179 133 312 117 87 204

Daegu 154 100 254 95 43 138

Incheon 144 65 209 102 48 150

Gwangju 77 82 159 47 37 84

Daejeon 111 49 160 75 27 102

Ulsan 58 29 87 32 15 47

Sejong 11 3 14 7 2 9

Gyeonggi 528 423 951 372 267 639

Gangwon 87 18 105 53 15 68

Chungbuk 87 21 108 56 14 70

Chungnam 104 28 132 75 20 95

Jeonbuk 106 39 145 71 17 88

Jeonnam 92 13 105 58 6 64

Gyeongbuk 134 20 154 89 11 100

Gyeongnam 133 48 181 86 30 116

Jeju 38 11 49 21 3 24

Total 2,505 1,720 4,225 1,690 969 2,659

OB/GYN, Obstetrician and Gynecologist; OBGYN, Obstetrics and Gynecology.

Table 6
Workplace of obstetrician and gynecologists based on the type of medical facility (2019)
OB/GYNs working in OBGYN clinics OB/GYNs working in obstetric clinics


Male Female Total Male Female Total
Tertiary hospital 229 139 368 (8.7) 229 139 368 (13.8)

General hospital 441 254 695 (16.4) 329 219 548 (20.6)

Hospital 654 414 1,068 (25.3) 523 350 873 (32.8)

Convalescent hospital 139 11 150 (3.6) 0 0 0

Clinics 1,040 901 1,941 (45.9) 609 261 870 (32.8)

Oriental medicine hospital 2 1 3 (0.1) 0 0 0

Public health center 0 0 0 0 0 0

Total 2,505 1,720 4,225 (100) 1,690 969 2,659 (100)

Values are presented as number (%).

OB/GYN, Obstetrician and Gynecologist; OBGYN, Obstetrics and Gynecology.

References

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