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INTRODUCTION
The number of defectors from Democratic People’s Republic of Korea (North Korea) to Republic of Korea (Korea) has increased year after year as economic decline continues in North Korea. According to a report by The Korea’s Ministry of Unification, the number of defectors living in Korea as of August 2011 was 21,165. Because healthcare workers are counted among this number, as the number of defectors increases, the number of requests for health license certificate approval in the receiving country will increase. Currently, North Korean defectors seeking certification approval to take the national health licensing examination must pass an oral exam presided over by three reviewers from the National Health Personnel Licensing Examination Board (NHPLEB).The purpose of this report is to describe the approval process of defectors’ certificates from North Korea and to track the numbers of defectors applying for the same. This report also discusses the ways in which this data may prove useful for constructing a better model to track the approval process for defectors seeking their certification to take the national health licensing examination.
METHODS
Relevant Korean medical law (medical service act) was reviewed to determine the approval process for North Koreans to gain their certification to take the medical licensing examination. The numbers of defectors who passed the process to complete their national health licensing examination were examined and their numbers cataloged by profession.
RESULTS
The approval process for North Korean defectors
In 1997, the Act for the Protection and Settlement Support of North Korean Defectors passed, which provided qualifications for licensed medical staff in North Korea to have their medical certifications carried over. Currently, NHPLEB evaluates each applicant defector and decides whether or not they qualify to take the national licensing exam in Korea.
In 2002, only defectors who already held licenses in North Korea were considered eligible to sit for the new examination. By February 2008, an addendum was added to the existing medical law that allowed defectors with no prior license to seek evaluation to take the medical licensing examination as well (Medical resources team-1638, 2008.02.28). Fig. 1 shows the approval procedure for North Korean defectors to qualify to take the licensing test.
North Korean defectors looking to become licensed in the Republic of Korea must first submit to a review of their academic background. These applications are solicited by the Ministry of Unification and passed along to be verified by the Ministry of Education, Science, and Technology. Once their academic background has been vetted, the Ministry of Unification sends the applicants’ requests for evaluation to the Ministry of Health and Welfare, who delegates the ultimate task of determining eligibility to the Credential Committee for International Graduate of the NHPLEB. This committee orally interviews the applicants and reports its judgments back to the Ministry of Health and Welfare who, in turn, notifies the Ministry of Unification. It is the Ministry of Unification that gives the results back to the North Korean defector applicants. Those who are found eligible after evaluation may then take the national licensing examination proctored by the NHPLEB.
Committee review for eligibility of North Korean defectors wishing to take the national licensing examination
The Credential Committee for International Graduate of the NHPLEB evaluates North Korean defectors for eligibility through oral examination and a review of their educational credentials, reporting the results to the Ministry of Health and Welfare. The Committee is composed of seven members, including the Chair and the Assistant Administrator, who are appointed by the NHPLEB president. The Chair and Assistant Administrator serve for three years and may be appointed to a second term. The Committee meets at the request of the director or when the majority of the Committee members call for a meeting. The meetings are conducted using consensus, with the chairman of the Committee acting as the facilitator.
The Credential Committee for International Graduate reviews each application, fact checking the applicant’s diploma, issuing data requests to government and university offices, and interviewing references. The Committee may also demand that the applicant provide supplementary documentation and can even request that an applicant appear in person to answer specific questions and provide needed information. If an applicant fails to submit the requisite documents or does not appear within 20 days of notification, the Committee may terminate their evaluation process. Such an incident would be reported to the director, and the applicants could still apply for reconsideration on administrative basis within twenty days of their case being closed, provided they produce the requested documents and provide reasonable cause for why they previously failed to comply.
Number of approved defectors and those passing the licensing examination
The number of applications submitted to the NHPLEB for evaluation has increased steadily since 2002, with a spike in 2007 (Table 1). Applicants are reviewed one by one. From 2002 until August 2011 a total of 41 North Korean defectors applied for certification, and of these 29 people (70.7%), were judged qualified. Out of 41 applicants, 33 defectors (80.49%) had graduated from medical college in North Korea or possessed a medical license to practice as an oriental medical doctor, dentist, nurse, or pharmacist.
DISCUSSION
During the reunification of Germany in 1990, the government of West Germany approved physicians from East Germany without any limitations. Though politically organized in distinct ways, the medical education system in East Germany was equal to that of West Germany. The situation is different in Korea. In North Korea, for example, there is not one system of medical licenses for physicians, but rather three. Physicians (uisa) are required to complete 7 years of education and may fully practice medicine. Associate physicians (bu-uisa) must have 4 years of education and may not participate in surgery or prescribe narcotics. Assistant physicians (jun-uisa) must complete 3 years of education and face the same limitations as associate physicians, and their role is typically limited to remote rural areas or medical staff in large companies.
Only physicians (uisa) can apply to qualify for a medical license in Korea. However, the North Korean authorities will not issue a license certificate to defectors, and it is unreasonable to expect Korean administrators to incorporate the qualifications of each of these distinct tiers into their national system. If we consider further that the economic gulf between the two countries includes a severe gap in health care service and that the education system for medical health personnel in North Korea is vastly different from that of Korea, it becomes more apparent why the Korean government requires defectors to show a minimum competency before taking a license examination, and why they may not rely on their possession of a North Korean license itself to sit for the exam.
It is possible that number of defectors who seek to take the national licensing examination may increase in proportion to the growing number of North Korean defectors. If so, more objective criteria should be prepared for a competency-based evaluation.
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