Impact of the 2024 Korean medical workforce crisis on transfers in a pediatric emergency center: including comparative analyses with adults

Abstract

Background In February 2024, the South Korean government announced a substantial increase in medical school admissions, leading to the sudden departure of most junior doctors. This unprecedented workforce shortage significantly impacted emergency departments. Pediatric care, known to require specialized readiness, may have been disproportionately affected. Methods We conducted a retrospective study at an emergency institution with a specialized pediatric emergency center. The study period was divided into pre-policy (March 2023–January 2024) and post-policy (March 2024–January 2025) periods. All emergency visits were analyzed, and interhospital transfers were compared between periods. Interrupted time series (ITS) analysis, multivariable logistic regression and inverse probability of treatment weighting were performed to evaluate associations between the policy-driven workforce shortage and transfer occurrence. Subgroup analyses of transferred pediatric patients examined total length of stay, transfer reasons, and accompaniment by medical staff. Results Among 97,916 ED visits (46,165 pediatric; 51,751 adult), there were 48 and 89 pediatric transfers in the pre- and post-policy periods, respectively, and 130 and 83 adult transfers in the same periods. Notably, pediatric transfers nearly doubled (an 85% increase) despite an approximately 42% decline in pediatric ED visit volume (29,211–16,954 visits). ITS analysis showed a continuing upward trend in pediatric transfers, although this trend did not reach statistical significance. In multivariable regression, only pediatric transfers were significantly associated with the post-policy period (OR 2.49, 95% CI 1.74–3.61). Transfer reasons shifted toward the unavailability of specialized care and physician accompaniment during transfers increased significantly. Conclusions This study evaluated and identified the potential association between pediatric transfers and the government policy announcement, as well as the subsequent workforce departure, using statistical analyses and adjustment methods. Compared to adults, departure of the workforce following the policy announcement was more potentially associated with rises in pediatric transfers. Also, periodic changes in characteristics of pediatric interhospital transfers were observed. These findings reflect the vulnerability and complexity of pediatric emergency care and emphasize the necessity of ensuring medical readiness and specialized workforce capacity during times of healthcare disruption.