# Health system disruption and oncologic consequences: a retrospective observational study of South Korea’s 2024 medical walkout

## TL;DR

A sudden healthcare workforce crisis in South Korea in 2024 led to significant delays in colorectal cancer surgeries and worse patient outcomes.

## Contribution

This study quantifies the real-world impact of a healthcare workforce disruption on cancer care timing and outcomes.

## Key findings

- The proportion of patients undergoing upfront surgery dropped from 63.5% in 2023 to 39.5% in 2024.
- The median time to surgery increased from 30 to 52 days during the disruption.
- Postoperative complication rates doubled from 12.0% to 28.2% in 2024.

## Abstract

In February 2024, a sudden government policy to drastically increase medical school admissions triggered the mass resignations of medical trainees across South Korea, severely disrupting hospital operations. This study aimed to evaluate the impact of the resulting healthcare workforce disruptions on short-term clinical outcomes and the timing of colorectal cancer surgeries.

This retrospective comparative study analyzed patients with colorectal cancer treated at two national university hospitals in Daegu and Gwangju, South Korea. Patients who first visited the colorectal surgery department between March and August of 2023 and 2024 were included. Data from 2020 to 2022 were used for extended comparisons. The primary outcome was the interval from initial outpatient visit to surgery. Secondary outcomes included treatment modality distribution, tumor staging, and postoperative complications.

A total of 895 patients in 2023 and 853 in 2024 were included. In 2024, only 39.5% of patients (337/853) underwent upfront surgery compared to 63.5% (569/895) in 2023. The median time to surgery increased from 30 days (interquartile range [IQR], 22–44 days) to 52 days (IQR, 30–72 days) (p=0.001). Clinical T3–4 tumors increased from 49.9% to 59.3% (p=0.018), lymph node-positive cases increased from 25.9% to 51.3% (p=0.001), and postoperative complication rates increased from 12.0% to 28.2% (p=0.001).

The abrupt healthcare workforce crisis in early 2024 significantly delayed colorectal cancer surgeries and was associated with worse short-term oncologic outcomes. These findings highlight the critical importance of maintaining a stable healthcare workforce to protect access to timely cancer care.