“None of what I did was ever recorded. I joined the hospital and received a monthly salary. That is the only record on me.”

A, who has been working as a nurse for twelve years, worked as a physician assistant since he was a rookie nurse. When he was in the surgery department, he even made an incision in a patient’s stomach in place of the surgeon who was late for the surgery. He inserted the abdominal surgical drain himself. He was also in charge of performing an appendectomy, gallbladder removal and gastrectomy. But A’s name was nowhere to be found in various medical records, because what he did was plainly an illegal medical practice. Article 27 of the Medical Service Act stipulates, “even medical personnel shall not perform any medical practice other than those licensed.” A confessed, “I performed illegal medical practices that should have been handled by a medical fellow.”

On May 12, International Nurses Day, the Korean Health and Medical Workers’ Union organized a symposium and four nurses including A gave statements about the status of illegal medical practices in which nurses performed doctors’ tasks. They wrote prescriptions, conducted surgeries and treatments, and filled out medical charts. They wore animal masks and altered their voices to protect their identity.

The number of physician assistants nationwide is estimated at over 10,000. Hospitals suffer a chronic shortage of doctors and after the bill restricting the working hours of medical residents to 80 hours a week was enforced in 2016, the number of physician assistants continued to grow. Last year when residents went on strike to protest the government’s attempt to increase the number of medical school students and to establish a public medical school, the medical field was able to continue providing services because of these physician assistants. But the current law does not recognize the status of physician assistants. They exist, but they are people who are not supposed to exist.

Countless nurses including physician assistants are exposed to illegal medical practices. D, a nurse with 11 years of experience who currently works in the ICU said, “When rookie nurses come, we begin by teaching them how to write prescriptions with the doctor’s ID.” He also said, “Even when bedsores penetrate into the muscles, the nurse removes them with a blade and sterilizes the area.” D mentioned a case where a patient had to amputate his arm after a nurse mistakenly injured his nerves when holding his arterial line instead of the doctor and said, “It is the same as telling a child who cannot drive to drive.”

C, a physician assistant nurse in the cardiothoracic surgery department with 10 years’ experience said, “When assisting heart surgery, I also have to collect blood vessels from the limbs. When an unexpected situation occurred during surgery, I held the patient’s heart in my hand and massaged it to buy time while the surgeon inserted the ECMO.” C said, “I feel like the physician assistant is ultimately an easy-to-use substitute, who only provides the labor without receiving any protection from the law.”

It was no use raising an issue about the situation. B, an ICU nurse for seven years said, “(When the nurse raised the issue with the doctor) The doctor took retaliatory measures giving unnecessary orders only when that nurse was on duty preventing her from getting off work on time.” A also asked the manager of his department to clearly separate the tasks of doctors and nurses, only to receive the answer, “There are many people who can take your place. If you don’t want to work, leave.”

The nurses said actions at the government level were needed to allow nurses to work rightfully. The U.S. recognizes physician assistants and nurse practitioners, who receive licenses after undergoing a systematic training program. South Korea also has a nurse practitioner policy in thirteen areas including health, emergency medicine, anesthesiology, senior citizen care, family medicine, critical patient care, and psychiatry. But it is not clear as to how far the government allows these nurse practitioners to perform medical practices. In the medical circle, experts are talking about ways to legalize physician assistants by expanding the nurse practitioner policy and clearly defining the tasks of doctors and nurses with an amendment of the Medical Services Act.

Na Sun-ja, chairperson of the Korean Health and Medical Workers’ Union suggested a public debate to the Ministry of Health and Welfare, the Korean Hospital Association, the Korean Medical Association, the Korean Intern and Resident Association, and the Korean Nurses Association. If there is little progress by this coming September, the Union will go on a general strike.