MZ doctors rush to do rehabilitation medicine, but few specialize in ‘rehab from rare diseases’ < Hospital < Article

Millennials and Gen-Z doctors flock to "rehabilitation medicine," making it one of the top three popular departments. However, a closer look into it shows MZ doctors want to specialize in rehab for rare diseases, an essential care, are as "rare" as the diseases themselves.

Professor Kang Seong-woong, a leading expert in respiratory rehabilitation at Gangnam Severance Hospital, pointed out how serious the current shortage of doctors in the field of rehabilitation for rare and critical diseases in Korea is, stressing the need to take measures to improve the situation as soon as possible, in an interview with Korea Healthlog, a sister paper of Korea Biomedical Review.

"Rehabilitation is so popular now that they can't even apply for the department even at provincial university hospitals unless they're first in their class," Kang said. "However, it is hard to find applicants for rare disease rehabilitation, as there are few applicants for pediatrics and internal medicine departments."

Why are MZ doctors not interested in rehabilitation from rare diseases, a branch of rehabilitation medicine, despite the government's increased coverage for rare diseases? "Because it's hard," Professor Kang said.

What aspects of rare disease rehabilitation are challenging for MZ physicians?

"Most of the patients with rare diseases have disabilities, so it takes a lot of time to treat a patient, but the fees are not high," Kang said. "Also, there must be many patients to increase doctors’ performance, but the performance of rare diseases is low because there are not many patients."

A field with fewer patients, such as rare diseases, deals another blow to the university hospital professors who find research performances important.

"The more patients you have and the more data you collect, the more you can use, but that's not the case with rare diseases," he said, pointing out that rare disease rehabilitation research is underrepresented.

Rare disease rehab will be devastated without policy consideration

How do university hospitals treat physicians specializing in rehabilitation from rare diseases, a limited field often under-resourced compared to other serious diseases?

"When we ask the hospital to buy the rehabilitation equipment we need, they don't, and the faculty is always accused of being in the red," he said. "What will young doctors think when they see their superiors?"

Rare diseases often result in severe disability, where it's hard to treat a patient and find research items because there aren't enough cases. If young doctors can't feel proud of what they're doing and be treated like a "grub" in the hospital, why would they want to do it, not to mention of few practical interests?

What would happen if there were no doctors in rare disease rehabilitation for these and other reasons? It's little different from the absence of surgeons. For example, if there were no doctors to provide respiratory rehabilitation, patients with rare muscular diseases, such as amyotrophic lateral sclerosis and Lou Gehrig's disease, would be unable to breathe and could die.

"As things stand now, we could end up with patients dying like they did 20 years ago because there were no respiratory rehabilitation doctors," he said. "Without policy considerations, the field of rare disease rehabilitation will be devastated."

Up to 95 percent of rare diseases have no cure, making rehabilitation an essential part of treatment. Moreover, it is difficult for people with rare diseases to receive rehabilitation services specialized for rare diseases due to the low demand for rehabilitation infrastructure.

Most patients use private rehabilitation centers outside of hospitals because they have to wait months or years for treatment at university hospitals that offer specialized rehabilitation services for rare diseases. Even then, it isn't easy to get consistent access.

However, a "tomorrow" could come when specialized rehabilitation, such as respiratory rehabilitation, is no longer available due to a shortage of rare disease rehabilitation personnel. However, there is a way to tackle the problem.

"In Korea, everything is tied to ‘reimbursement,’" he said. "If we can improve the reality where university hospitals are losing money for providing appropriate rehabilitation, we can change the situation."

For example, Professor Kang cited the situation of the neonatal intensive care unit (NICU) situation. In the past, the low reimbursement of NICUs led to university hospitals neglecting loss-making NICUs, leaving premature newborns in Korea with nowhere to go, noting the changes to NICTs since the government significantly increased reimbursement for them.

"Just as hospitals have increased the number of NICU beds, hospitals will build rehabilitation centers voluntarily if the government raises reimbursement for them," Kang said. "This can also solve the problem of rare disease rehabilitation refugees."

He noted that the authorities allow additional fees for pediatrics because doctors must also meet patients’ mothers during outpatient treatments.

"Similarly, they must provide additional rehabilitation fees for the outpatient care of rare and severe patients, many of whom are incommunicative and difficult to get out of bed for treatments," Kang emphasized.

Control tower needed for rare disease rehab

Professor Kang also suggested a way forward for rehabilitating rare diseases in Korea.

Rather than a policy of decentralizing the rare disease rehabilitation treatment system, he said, the government should have a central place to serve as a control tower and let the rare disease rehabilitation treatment system spread out from there.

He said there are only a few rare diseases, and there are only one or two professors specializing in rare disease rehabilitation for some rare diseases, stressing that it's not a good idea to decentralize rare disease rehabilitation.

"Instead, we must universalize the rare disease rehabilitation service by centralizing the system, letting the control tower collect information, and making it accessible to patients." Professor Kang suggested.

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