To be a good negotiator, remember "individualization.

 

To be a great negotiator, you need to know that  

1. every person is different 
2. Lazy people tend to perceive diverse people as one lump.
3. People who try to see much of the world through only one or two lenses are usually foolish, get into unnecessary arguments, and are easily manipulated. 

That's why it's important to recognize individual needs and desires. This way of thinking is called "individualization".

Let's look at the recent controversial negotiations to increase medical school enrollment through this lens.

If you thought, "How will the doctors react if the government increases the number of medical school seats by 2,000?" you're looking at the government as one monolithic entity, and the doctors as another monolithic entity. This is not helpful in most negotiations. Doctors are not a monolithic group of people with a common set of needs, so you need to separate them into different perspectives and identify their individual needs.

Let's categorize the doctors. For the sake of simplicity, here's a breakdown from youngest to oldest.

Medical students (6 years), specialists (1 year of internship & 4 years of residency), military doctors (or 3 years of public affairs), full-time doctors (1-2 years of fellowship), practicing doctors, and staff doctors (faculty doctors). 

Among them, faculty doctors are divided into primary hospital doctors (e.g., deputy director of an OO internal medicine clinic), secondary hospital doctors (e.g., head of the family medicine department of an OO hospital), and tertiary hospital doctors (university hospitals and large hospitals). 

Tertiary hospitals can be organized into major doctors, full-time doctors, professors by department, and department heads. 

Each of these groups of physicians has different experiences, interests, issues, and needs. 

In this article, we're going to focus on residency programs. 

After being at the top of their class throughout secondary school, students enter medical school and study for six years from the age of 20 (7.2 years on average, including paid work). Upon graduation, they take the medical license exam and become a "general practitioner". Although general practitioners are qualified, they are not highly specialized, so most general practitioners go to a training hospital (tertiary care center) for internship and residency. This lasts five years. 

Here's what they experience First, they work long hours. Well over 80 hours a week. They often don't get to leave the office and end up sleeping in the clinic. Emergency patients often arrive unexpectedly, disrupting their sleep patterns. 

The work atmosphere is tense. If you make a mistake, you're often reprimanded harshly because it could mean someone dies. In the early period of internship, you are ignored because you are less experienced than veteran nurses, in the first and second year of residency, you are busy running the clinic, and in the third year, you are busy running the residency society, and in the fourth year, you have a short time to stabilize and prepare for the specialty exam. 

The salary is about 4 million won. I work more than 320 hours a month and get paid about 4 million won, but I am often called in emergencies, sleep poorly, and get scolded when I make mistakes, so my confidence is low at this time. 

How do you get through these times? they stick to the hope that the hard work will pay off. After they go through internship and residency and qualify as a specialist, they can operate a specialty clinic center, rather than general medicine. Also, even if they want to work as a volunteer doctor, general practitioners are rarely hired, so it is important to qualify as a specialist. 

But how big is the fruit of their labor? Even though they were almost always at the top of their class throughout elementary, middle, and high school, it takes a lot of hard work to get into medical school, and they are often paid during their studies, so by the time they graduate from medical school (6), internship (1), residency (4), full-time physician (0-2), and military doctor (3), they are usually 36-40 years old. In a nutshell, you'll start your professional life 10 years later than your peers. However, the salary is very high. According to the Ministry of Health and Welfare in 2022, the average annual salary of a civil servant is 185 million won (not the starting salary, but the average annual salary), which is definitely higher than the average annual salary of Samsung Electronics employees in 2024. If you sacrifice cultural life and convenience to become a volunteer doctor at a local hospital, your salary will be even higher. 

To summarize, the reason why doctors go through the grueling five-year training period is that they are guaranteed a high salary later on, even if they start late. However, if we increase the number of medical students from the current level of 3,000 to 5,000, isn't it natural to have a sense of crisis that the utility of the current hard work may be reduced?

But here's a deeper question to ponder: why are there so few doctors who specialize in "essential specialties"? We use the word "essential specialties," but we might as well call them "avoidance specialties. Avoided specialties include emergency medicine, pediatrics, and obstetrics and gynecology. It's important to know why these are shunned departments. 

Emergency medicine is related to the saying "give an inch and you get a mile". When a patient comes in with an emergency, emergency medical technicians perform CPR, which carries a high risk of secondary injuries, such as broken ribs. Naturally, the mortality rate is also high. The problem is that even though the doctor saves the patient's life, the patient can sue the doctor for the reason of trauma. So who is responsible? No one, except the doctors themselves. 

What about pediatrics? In December 2017, a newborn baby died in the neonatal intensive care unit of Ewha Womans University Mokdong Hospital. Four doctors and three nurses were charged with professional negligence manslaughter. They suffered for five years, and although they were acquitted, many pediatricians were worried that "I too might one day stand in court as a murderer." 

What about obstetrics and gynecology? Many traditional obstetricians are now giving up delivering babies because of the high risk of lawsuits. The risk of lawsuits is high. In addition, the number of deliveries is set too low, and the declining birthrate has also had an impact. According to the Ministry of Health and Welfare, the number of medical centers available for deliveries is expected to drop from 517 in 2020 to 470 in 2022, a drop of about 10% in just two years. 

All general practitioners (medical school graduates) are aware of this situation.

But who are the specialists who apply and work in emergency medicine, pediatrics, or obstetrics and gynecology? Why did they make such an irrational choice? Perhaps it's a sense of pride, service, and mission.

In the early days of the healthcare crisis, the national consensus was that "doctors make too much money and are too greedy." By that logic, it beat down on residents who were willing to work in the poorest and most dangerous areas of medicine with a sense of mission and pride. "It breaks my heart to think that that's how you viewed us," cried one resident who worked in an essential care unit. 

Who would benefit most from more medical students? University presidents would be in favor, as it would increase the prestige of the university. Also, hospital directors of high-paying specialties (e.g., dermatology) who are already open and leading large hospitals and would like to have a large number of docs on the cheap come to mind. 

Can medical school professors control the strong resistance from residents? It may be possible if the system is revitalized and they go back, but it won't be easy now. Residents are already leaving school and exploring other avenues to become doctors abroad. Current medical students and residents are the highest achieving group in the country, so they have many opportunities to explore in life. What's more, many of them have wealthy parents; they're not in trouble, so it's unlikely they'll be coming back easily. 

The road ahead is long and difficult. Once people lose their sense of mission and pride, it's hard to get them back. After the massive restructuring during the IMF, the perception that "you shouldn't be loyal to the company" still dominates society. Even if professionals do come back, it won't be the same as before. The healthcare system will be greatly affected as a result, and the weak and sick will be the first to pay the price.

Simply put, viewing "doctors" as a monolithic entity solves nothing. When we view doctors as "bad guys who make a lot of money" without considering their various specialties - medical students, residents, fellows, professors, hospital directors, and practitioners - we pay the price. It's usually the underdog that pays the price. 

It is a basic truth, at least in the world of negotiation, that we need to stop trying to simplify everything and think in terms of individualization. This concept has been further developed in consulting with the term mutually exclusive comprehensiveness (MECE). Look up MECE for more information.