Analysis of Manpower Mismatch and Social Sunk Costs in Essential Medical Specialties: Implications for Medical School Quota Expansion Policy

BackgroundThis study argues that the crisis in South Korean essential medicine stems from "allocation failure" driven by economic and legal disincentives, rather than an absolute shortage. We evaluate the efficacy of the medical school quota expansion policy by analyzing workforce mismatch in the "Vital 5" specialties. (Internal Medicine, General Surgery, Obstetrics & Gynecology, Pediatrics, and Cardiothoracic Surgery). MethodsWe developed two quantitative models: (1) a Social Sunk Cost model to estimate the wasted resources when specialists work in fields unrelated to their training, and (2) an Expected Value (E(V)) model to analyze the decision-making process of physicians entering essential fields. The E(V) model incorporates variables such as Net Return (Rnet), Probability of Lawsuit (Psuit), and Cost of Risk (Crisk). Two real-life scenarios were coined to estimate the economic impact of workforce mismatch: (1) an Individual Sunk Cost model based on hypothetical profiles of a cardiothoracic surgeon and a pediatrician working in non-vital fields, calculating the loss of 11-year training investments; and (2) a National Sunk Cost model utilizing a "Shadow Price" valuation derived from the 2024 medical crisis data (3.4 trillion KRW government injection), to estimate the aggregate social replacement cost of mismatched specialists in essential fields. ResultsAnalysis of national data reveals a significant proportion of cardiothoracic surgeons working in non-major fields, indicating high social sunk costs. Simulations show that a rapid expansion of 2,000 medical students, without accompanying structural reforms, would dilute the net return (Rnet) for individual doctors and increase the probability of malpractice suits (Psuit) due to potential undertraining. Consequently, the expected value of entering essential medicine would drop to a negative value, exacerbating the avoidance of vital specialties. ConclusionExpanding quotas without addressing low compensation and high legal risks will likely accelerate the collapse of essential medicine--a phenomenon we term the "Paradox of Expansion." Policy must prioritize "Restoring Expected Value" through legal immunity and fee adjustments over mere headcount increases.