Impact of the medico-political conflict in South Korea on specialty choice and professional identity among medical students: a cross-sectional study

Background

Maintaining a balanced distribution of the physician workforce at the national level is a critical means of meeting population health needs [1–3]. Accordingly, when imbalances appear or worsen, governments typically respond with policy measures designed to restore equilibrium [4–6], applying strategies related to selection, training, recruitment, and retention [7–10]. These measures are grounded in scientific evidence and in the consensus of the medical profession, with policy development processes incorporating expert opinions and research findings to support informed and effective workforce planning.

In South Korea, persistent specialty and geographic disparities, along with delays in emergency care access, have elicited public concerns [11–13]. In response, the government increased medical school quotas to address shortages in essential specialties, such as pediatrics, emergency medicine, and surgery, and to reduce regional disparities. However, this policy was implemented without adequate consensus-building with medical professionals. Despite strong opposition, the government proceeded with plans to increase admissions by 1,500 students starting in 2025. This coercive policy prompted large-scale and prolonged leave from medical school, and many resident physicians submitted resignations [14,15], culminating in an 18-month standoff that jeopardized the education and training of an entire cohort of future physicians.

Previous research indicates that medical students’ career and specialty choices are influenced by gender, personal interests, socioeconomic context, mentoring, work–life balance, anticipated income, and training length [16,17]. Crises such as the coronavirus disease 2019 pandemic have further disrupted career decision-making and professional identity formation by interrupting clinical education, limiting hands-on experiences, and shifting learning online. Such events may also prompt students to reflect on physicians’ societal responsibilities, thereby influencing their developing professional identities in both positive and negative ways [18,19]. However, little is known about crises in which politically driven, large-scale academic disruptions affect medical students’ career preferences and identity formation. South Korea provides a recent and salient example of such disruption, where politically charged events have affected medical education and students’ professional identity development.

From the standpoint of professionalism, the policy and the medical community’s resistance represent competing efforts to renegotiate the social contract between society and the profession [20], which is fluid and changes with evolving social conditions [21]. Although these efforts differ in the extent to which they are ethically justified [22], they significantly influence students’ emerging professional identities as future physicians. Students, whose professional identities are still forming, are particularly susceptible to changes triggered by major events or social transitions, more so than residents or practicing physicians [23].

Objectives

A cross-sectional survey was conducted to explore the lived experiences of South Korean medical students during the prolonged, student-led academic boycott that followed the abrupt expansion of medical school admissions in 2024. To our knowledge, no prior study has examined how prolonged academic disruption caused by medico-political conflict influences medical students’ career trajectories and identity formation. This study explores the effects of a disruption initiated unilaterally by government policy on students’ career paths and professional identities.

Ethics statement

This study was approved by the Institutional Review Board of Korea University (KUIRB-2025-0016-01), and informed consent was obtained from all participants.

Study design

It is an online survey-based cross-sectional study. It was described according to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement available at https://strobe-statement.org.

Setting

Participants were recruited through “To Be Doctor,” a nonprofit organization led by medical students and residents available at https://tobedoctor.net/. The survey announcement was posted on the organization’s website and social media, and snowball sampling was used to reach students nationwide. Participation was voluntary, and an anonymous online survey was administered in February 2025.

Participants

This study purposefully targeted 4th-, 5th-, and 6th-year students from Korea’s 40 medical schools, representing an overall population of approximately 9,174 students. The rationale for selecting this population was that clinical education in South Korean medical schools begins in the fourth year, and students at this stage were considered better positioned to reflect on professional identity formation and career planning.

A total of 356 students completed the survey. Among them, 51.4% were male and 46.6% female. Respondents included 4th-year (37.6%), 5th-year (28.1%), and 6th-year (34.3%) students from all major regions of South Korea (Table 1).

Table 1.

Demographic characteristics of 356 students who participated in the online survey

Variables

The primary outcome was career/specialty preference before and after the medico-political conflict, assessed by selecting up to two preferred specialties from a list of 25 options. Specialties were classified as essential vs non-essential based on the Ministry of Health and Welfare policy (eight essential specialties: internal medicine, surgery, obstetrics and gynecology, pediatrics, emergency medicine, cardiothoracic surgery, neurology, and neurosurgery); general practice was included as a separate option. For between-group analyses, participants were categorized into discontinued essential specialty preference (DES), main­tained essential specialty preference (MES), and never had an essential specialty preference (NES) based on changes in essential-specialty preference across the two time points. Secondary outcomes were Likert-scale scores for identity crisis, overseas clinical career intentions, military service intentions, and self-reflection (personal, professional, societal domains). Key participant characteristics considered in analyses were sex, year of study, school classification (national/public vs private), and region.

Data sources/measurement

In December 2024, in-depth individual interviews were conducted with four fifth-year medical students from the authors’ institution. Insights from the thematic analysis of these interviews informed the development of an online survey that consisted of closed-ended items (select-one or select-multiple responses; 5-point Likert scales) and one open-ended question. Participants were invited to reflect freely on how the prolonged academic leave caused by the crisis had affected them.

The survey included closed-ended items assessing 5 key domains: (1) career or specialty preference, (2) medical students’ identity crisis, (3) intentions for overseas clinical practice, (4) military service plans, and (5) reflections on personal, professional, and societal dimensions. Among these domains, career or specialty preference comprised 25 specialty options categorized as essential or non-essential fields according to the Ministry of Health and Welfare’s official policy [24]. Eight specialties were classified as essential: internal medicine, surgery, obstetrics and gynecology, pediatrics, emergency medicine, cardiothoracic surgery, neurology, and neurosurgery. We also included general practice, referring to physicians who engage in clinical practice without completing internship or residency training. In South Korea, physicians may practice independently after obtaining a medical license, as no formal training program exists for general practitioners.

Cronbach’s α coefficients for the Likert-scale items ranged from 0.601 to 0.799 across the 6 subdomains, which is generally considered acceptable for exploratory studies (Suppl. 1) [25,26].

Bias

Because participation was voluntary and recruitment used online announcements and snowball sampling, selection bias is possible and the sample may over-represent students with stronger views or experiences related to the conflict. Reporting of pre-conflict specialty preference may be affected by recall bias, and attitudinal items may be influenced by social desirability bias; the survey was therefore administered anonymously to reduce response pressure.

Study size

A priori sample size estimation was not conducted because this study was based on volunteer participation.

Statistical methods

First, descriptive analyses were conducted to identify trends in responses regarding postgraduate training plans and specialty choice. Changes in specialty choice proportions were presented as percentage point (p.p.) differences. Second, participants were categorized into 3 groups based on specialty choice tendencies (maintenance of intention to pursue essential specialties); differences in other quantitative variables were examined using one-way analysis of variance with Scheffé post hoc comparisons. Finally, free-text responses were analyzed using Braun and Clarke’s six-phase framework for thematic analysis, which includes familiarization, initial coding, theme generation, theme review, theme definition, and reporting [27].

All statistical analyses were performed using IBM SPSS ver. 26.0 (IBM Corp.), with statistical significance set at P<0.05.

Career and specialty preference shift

The majority of respondents (93.8%) preferred physician career paths, either exclusively or in combination with research, whereas only 6.2% chose non-clinical paths such as research-only or entrepreneurship (Suppl. 2). When asked whether their preferred clinical specialty had changed after the medico-political conflict, 63.8% (n=227) reported a shift, 29.2% (n=104) indicated no change, and 7.0% (n=25) reported that they had never previously considered a specific specialty. To compare the extent of preference shifts before and after the conflict, p.p. change was calculated from the 227 students who reported a shift. Notable declines occurred in essential specialties, particularly internal medicine (–31.3 p.p.), general surgery (–22.0 p.p.), emergency medicine (–12.8 p.p.), and pediatrics (–11.5 p.p.). In contrast, preference for general practice increased (+29.5 p.p.), followed by dermatology (+12.4 p.p.) and ophthalmology (+9.2 p.p.) (Table 2, Figure 1).

Table 2.

Changes in specialty preferences: before and after the conflict (n=227)^a)

Figure 1.

Changes in specialty preferences before and after the conflict (n=227). Changes in medical specialty preferences before and after the medico-political conflict among students who had considered at least one clinical specialty are shown. The horizontal bar graph displays the percentage point change for each specialty. Positive values (red bars) indicate increased preference, whereas negative values (blue bars) indicate decreased preference. Students were allowed to select 2 specialties both before and after the conflict. All changes are reported as percentage point differences from pre- to post-conflict. ENT, ear, nose, and throat.

Among 331 respondents—after excluding 25 who had never considered a specialty—76.7% (n=254) preferred essential specialties before the conflict, 23.0% (n=76) preferred non-essential specialties, and only 0.3% (n=1) selected general practice as a future career. After the conflict, however, only 29.0% (n=96) preferred essential specialties, while 64.4% (n=213) preferred non-essential specialties and 6.6% (n=22) chose general practice (Figure 2).

Figure 2.

Shifts in specialty preference: before and after the conflict (n=331). ^a)For this analysis, 331 of the 356 surveyed students were included. The 25 students who had never considered any specific specialty were excluded. ^b)Essential: Eight specialties designated as essential by the South Korean Ministry of Health and Welfare (MOHW): internal medicine, surgery, obstetrics and gynecology, pediatrics, emergency medicine, cardiothoracic surgery, neurology, and neurosurgery. ^c)Non-essential: All medical specialties other than the 8 essential fields defined by the MOHW. ^d)General practitioner: Physicians who engage in clinical practice without completing internship or residency training. In South Korea, no formal general practitioner training program exists; physicians may practice independently after passing the National Licensing Examination and obtaining a medical license. ^e)Maintained essential specialty preference (MES): continued to prefer at least one essential specialty after the crisis (28.4%). ^f)Discontinued essential specialty preference (DES): previously preferred at least one essential specialty but no longer does, including those who shifted to non-essential fields or general practice (48.3%=43.2%+5.1%). ^g)Never had an essential specialty preference (NES): never preferred an essential specialty (21.1%).

Identity crisis, career intentions, and self-reflection across groups defined by shifts in essential specialty preference

When students were categorized according to whether they maintained or shifted their preference for essential specialties before and after the medico-political conflict, 48.3% belonged to the DES group (previously preferred at least one essential specialty but no longer did so), 28.4% to the MES group (contin­ued to prefer at least one essential specialty), and 21.1% to the NES group (never considered an essential specialty).

The groups differed significantly in identity crisis (F=25.20, P<0.001), overseas clinical career intentions (F=9.10, P<0.001), and military service intentions (F=3.99, P<0.001). Post hoc tests indicated that the DES group scored higher on identity crisis and overseas clinical career intentions than the MES and NES groups, whereas pairwise differences in military service intentions were not significant (Figure 3A). Furthermore, comparisons across domains of self-reflection—personal, professional, and societal—showed that the DES group scored higher on societal understanding (F=18.03, P<0.001) than the other groups. This societal-level subscale measured the extent to which students gained greater awareness of broader social and health policy issues and developed deeper reflection on their future career paths, including consideration of fields outside of medicine. By contrast, no significant group differences were observed for personal reflection (F=1.94, P=0.146) or professional reflection (F=0.97, P=0.382), which encompassed self-management, self-understanding, personal growth, interpersonal relationships, and awareness of physicians’ autonomy, responsibility, and communication with society (Figure 3B).

Figure 3.

(A) Identity crisis, career intentions, and (B) self-reflection across groups defined by shifts in essential specialty preference. ^a)Maintained essential specialty preference (MES): continued to prefer at least one essential specialty after the crisis. ^b)Never had an essential specialty preference (NES): never preferred an essential specialty. ^c)Discontinued essential specialty preference (DES): previously preferred at least one essential specialty but no longer does, including those who shifted to non-essential fields or general practice.

Perceived impact from free-text write-ups

A total of 221 students (60.5%) provided at least one free-text response regarding the perceived impact of their prolonged academic leave during the 2024 medico-political conflict. Thematic analysis identified 2 themes and 3 subthemes: (1) signals of erosion in professional identity and (2) reflection on the social dimension of professionalism (Table 3).

Table 3.

Perceived impact from free-text write-ups: representative quotes by theme

Key results

This study examined how a politically imposed disruption in medical education reshaped students’ specialty preferences and professional identities. Our findings show that such externally driven instability led to a sharp decline in interest in essential specialties and prompted students to reflect more critically on their roles within both the profession and society. Essential clinical specialties, which form the foundation of the nation’s healthcare delivery system, were notably the most adversely affected. Among the 3 trajectory groups, students who were DESs exhibited exhibited the greatest identity disruption and the most pronounced shifts in their perceptions of social expectations. These findings highlight that political interference in medical education can alter not only career choices but also the moral and motivational underpinnings of professional identity formation.

Interpretation/comparison with previous studies

Although most students continued to express a preference for clinical careers, with only about 6% opting for non-clinical paths, the disruption nonetheless reshaped how they conceptualized their professional futures. This persistence in clinical intent suggests that the conflict did not fundamentally erode the intrinsic motivation to become a physician. However, because our sample consisted primarily of senior students, their accumulated investment in medical education may have buffered them against withdrawal from clinical pathways, whereas earlier-year students might have responded differently, as indicated in previous studies [17,28]. A further concern was the sharp increase in students expressing intentions to pursue residency training abroad. While few are actively preparing, worsening domestic training conditions (push factors) and active overseas recruitment (pull factors) [29], suggest that outward migration could accelerate if trust and working conditions remain unresolved.

The distinct patterns of career preference shifts revealed 3 meaningful groups—DES, MES, and NES—that differed not only in specialty choices but also in how they navigated professional meaning under instability. Roughly half of the respondents belonged to the DES group, about one-quarter to the MES group, and one-fifth to the NES group. Compared with peers whose preferences were more stable, DES students maintained broader sets of options and were more responsive to policy-driven changes in the clinical environment and stakeholder incentives [30], functioning in a manner similar to swing voters. Understanding why this group abandoned essential specialties offers valuable insights for developing educational and policy strategies aimed at stabilizing the essential care workforce.

Compared with their MES and NES peers, DES students showed stronger signs of professional identity erosion, including larger declines in pride in being medical students or future physicians. Pride is closely tied to identification and belonging, which are central to professional identity formation [31,32]. These students also reported concealing their medical student identity in social settings because of concerns about stigmatization or interpersonal strain. Such concealment behaviors are often observed in professionalism dilemmas [33] and may be linked to identity dissonance, which can impede the development of professionalism [34]. Furthermore, DES students more frequently expressed intentions to pursue careers abroad. Even though only a few are taking concrete steps, their rationales—often framed in terms such as “fulfillment,” “remuneration,” “respect,” and “opportunity”—align with evidence linking migration to economic factors, career prospects, and working conditions [35].

Another key finding was that DES students reported significantly higher levels of societal understanding and deeper engagement in career reflection than MES and NES peers. This suggests that DES students’ disengagement from essential specialties reflects a form of identity work and sensemaking about their social role rather than a simple reaction to policy shifts. Their free-text responses support this interpretation, frequently referencing negative public sentiment toward physicians, its political amplification, and policies perceived as limiting professional autonomy. These findings correspond with prior research indicating that the narrative behind a policy may be more influential than its final content [36]. The students’ shifts, therefore, may reflect reactions not only to the government’s position but to the policy-making process itself. In particular, the strategic use of public sentiment to justify policy appeared to foster growing mistrust toward both the government and the public, ultimately prompting withdrawal from essential specialties.

Policy implication

Our results carry several policy implications for understanding medical students’ career decisions and specialty selection. First, students vary substantially in their sensitivity to policy-related changes. Consistent with existing evidence, many students adjust their preferences in response to the broader policy climate [37]. Second, the process and social meaning of policy formation may exert greater influence than the policy’s final wording. Our qualitative findings reinforce this point, as students were strongly affected by the unilateral implementation of the policy and the perceived political instrumentalization of the profession. Many respondents, especially in the DES group, viewed the policy as a breach of the social contract, interpreting it as a situation in which their sacrifice was taken for granted rather than respected. This breach emerged as a primary reason for abandoning essential specialties. These insights underscore the need to segment the target audience and craft tailored strategies for the groups most responsive to policy signals. Finally, this study demonstrates that students’ specialty choices are shaped by trust in the government and society, not merely by individual or curricular factors. For society to cultivate the physicians it needs, trust between the medical community and the public must be restored [38,39]. In the long term, rebuilding trust with students, who represent the future of the medical profession, will be crucial.

Limitations

First, because it relied on a cross-sectional survey conducted approximately one year after the conflict began, recall bias may have influenced retrospective responses. Second, we categorized students based on 8 essential specialties defined by government policy; however, no universally accepted definition of “essential specialties” exists, which may have introduced classification bias. Third, as noted earlier, participants were senior students rather than a full representation of all academic years. Finally, our findings reflect students’ current intentions rather than their eventual career decisions; actual specialization, including overseas training, will depend on numerous factors and requires longitudinal follow-up.

Conclusion

The 2024 medico-political conflict substantially shaped Korean medical students’ specialty preferences and professional identities, resulting in a marked decline in interest in essential specialties. Importantly, this shift was driven by a re-evaluation of the medical landscape as students gained greater awareness of societal realities and recognized the legal and social vulnerabilities of essential specialists, prompting them to pursue non-essential specialties to ensure professional security. Beyond its immediate effects on the workforce, the event exposed the fragility of professional identity formation amid political instability and threatened the sustainability of the essential care pipeline. Future research should examine the long-term consequences of such disruptions for students’ career trajectories and professional development.