The physician strike in South Korea was associated with higher mortality

1. The recent South Korean trainee physician strike was associated with significantly higher mortality and reductions in inpatient and outpatient use 

Evidence Rating Level: 2 (Good)

From February 2024 to August 2025, South Korean trainee physicians initiated a walkout in protest of proposed reforms. Although previous studies from different countries have shown that physician strikes rarely increase short-term mortality but reduce health care use, the South Korean strike was unique in its prolonged duration and scale, with more than 90% of trainee physicians being ultimately involved. This retrospective cohort study explored the association between the strike and hospital-level mortality, health care use, and spending patterns across 200 teaching hospitals. The analysis included 7 719 828 patients with inpatient admissions (3 520 242 [45.6%] aged ≥ 65 years; 3 883 073 [50.3%] female) and 41 891 392 with outpatient visits (17 552 493 [41.9%] aged ≥ 65 years; 21 992 981 [52.5%] female). 3 727 632 inpatient and  20 400 814 outpatient encounters were from the walkout window, and 3 992 196 inpatient and 21 490 578 outpatient encounters were from a control cohort drawn from the same calendar window 1 year earlier. There were no significant differences in patient composition or demographics. The walkout group was associated with a 0.008 percentage-point increase in weekly mortality among hospital users (95% CI, 0.000 to 0.015 pp) and a 0.39 percentage-point increase in 30-day mortality after hospitalization (95% CI, 0.24 to 0.54 pp). These associations were largest early in the strike and reduced over time. There were significantly fewer hospitalizations (decrease of 19.2 hospitalizations per 10 million people; 95% CI, −24.1 to −14.3 per 10 million people [−17.3%]) and outpatient visits (decrease of 158 outpatient visits per 10 million people; 95% CI, −198 to −118 visits [−8.6%]) in the walkout group compared to the control group.

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