Abstract:Background Ensuring fair and sustainable working conditions for medical trainees is a critical component of building a resilient health workforce. In Korea, academic hospitals face the dual challenge of upholding labor law while addressing workload disparities among residents. At Seoul National University Hospital, a fixed extended work allowance had been paid uniformly to all residents regardless of actual overtime performed. While legally complaint, this system created significant inequities across departments, especially those with high-intensity clinical workloads, impacting morale and retention. Objectives This study aimed to reform the resident compensation structure to better reflect actual labor input, align with legal standards following the December 2024 Supreme Court ruling on “ordinary wages,” and support equitable workforce practices within the hospital. Methods A multidisciplinary task force reviewed department-specific duty hour records, legal implications, and financial impacts. The reform prioritized departments with consistently high workloads such as surgery, thoracic surgery, and obstetrics & gynecology. Key measures included: (1) replacing flat-rate allowances with workload-based payments. (2) redefining stipend categories in accordance with legal rulings. (3) Introducing additional allowances funded by department-specific government reimbursement incentives to reflect workload and ensure fair, lawful compensation. Expected Outcomes / Significance The revised compensation framework helped correct internal pay imbalances, enhanced transparency, and ensured appropriate remuneration across both high- and low-burden departments. By incorporating legal guidance into payroll policy particularly the December 2024 Supreme Court ruling the hospital reduced future litigation risks while staying within fiscal limits. Resident feedback indicated greater perceived fairness and trust in the institution, which contributed to improved morale and retention. This case demonstrates how legally grounded, workload-sensitive compensation reform can serve as a practical tool to strengthen workforce policy in training hospitals. The hospital’s model offers practical guidance for similar institutions aiming to manage trainee labor more fairly and sustainably. Status of Study Ongoing (data collection in progress).
Keywords: Global Health Workforce, Workforce Policy, Medical Trainees, Health System Management, Work Hours, Compensation Reform
