Most Korean Doctors Back Patient Voice in Decisions, Yet Cite Time and Pay as Barriers

Shared decision-making, the practice in which physicians and patients jointly weigh treatment options against the patient’s values and preferences, has become a cornerstone of patient-centered care worldwide. Yet a new survey of 542 physicians across South Korea suggests that even where doctors strongly endorse the principle, routine implementation is far from universal, and the obstacles they identify are less about conviction and more about the architecture of the health system itself.

The study, published in Frontiers in Public Health by researchers at Hanyang University College of Medicine in Seoul, used a nationally distributed, web-based cross-sectional survey run from April 3 to August 31, 2025. Because no comprehensive national roster of physicians with current contact details was available, the team relied on non-probability volunteer recruitment through academic societies, professional associations, web postings, email distributions, and professional networks. Eligible participants self-reported holding a Korean medical license and at least one year of clinical experience. Of 709 screening entries, 542 complete, eligible, non-duplicate questionnaires made it into the final analysis, an 83.5 percent completion rate among eligible starters.

The respondents were a professionally diverse group. Their mean age was 40.6 years with an average of 11.9 years of clinical experience. Equal shares of 34.5 percent each worked in clinics or small hospitals and in general hospitals, while 24.4 percent practiced in tertiary referral hospitals. All 17 administrative districts of South Korea were represented, though 54.1 percent practiced in Seoul. Internal medicine was the largest specialty group at 31.7 percent, followed by surgical specialties at 17.0 percent.

The survey’s most striking pattern was one of simultaneous endorsement and hierarchy. Respondents rated both physicians’ views (mean 4.68 on a 5-point scale) and patients’ views (mean 4.64) as highly important in their own clinical decision-making, and physicians’ explanations received the highest rating of any predefined factor at 4.71. Patients’ views rated slightly higher (4.75) when physicians were asked what mattered to patients than when asked what mattered in their own practice, a small but statistically significant drop of 0.11 points. Information from television and internet sources, by contrast, received the lowest rating at 2.69, underscoring how strongly physicians prioritized their own explanatory role in the clinical encounter.

The study also documented a familiar psychological pattern: physicians rated their own patient-centered behaviors more favorably than those of physicians in general across all four measured items, including involving patients, considering values and preferences, providing detailed information, and checking understanding. The mean paired differences ranged from 0.22 to 0.27 points, all statistically significant but with small effect sizes (Cohen’s d of 0.25 to 0.29), a signature consistent with the better-than-average effect known from comparative self-evaluation research. The authors caution that these are self-reports, not observations of actual behavior, and should not be read as proof of self-deception or resistance to feedback.

When it came to shared decision-making as a named practice, familiarity and experience fell short of the enthusiasm. Overall, 67.5 percent of respondents had heard of the term SDM, 49.8 percent reported experience with it, and only 38.9 percent rated their understanding as high or very high. Because the SDM definition was presented alongside the awareness item, the researchers describe this as reported term awareness rather than verified prior knowledge. Interestingly, 41 respondents reported experience despite no awareness of the label, suggesting some physicians may practice the approach without knowing its formal name.

Statistical modeling using modified Poisson regression with robust variance estimation revealed that reported term awareness was strongly associated with self-reported experience (adjusted prevalence ratio 2.32, 95 percent confidence interval 1.74 to 3.08). Awareness was higher among female physicians (aPR 1.53), those in tertiary referral hospitals (aPR 1.23), and those in provinces relative to Seoul (aPR 1.15), and lower among diagnostic, support, and population-based specialties (aPR 0.67). Self-reported experience was likewise more common among women and physicians in larger hospital settings, hinting that institutional context shapes whether conceptual knowledge becomes lived practice.

The most policy-relevant finding emerged from the subgroup of 200 respondents, 36.9 percent of the sample, who rated the feasibility of implementing or expanding SDM as neutral or worse. Among them, 78.5 percent identified environmental or system-level factors as the highest-priority domain for improvement, dwarfing the 16.0 percent who prioritized professional-related factors. Within the environmental domain, short consultation times and insufficient reimbursement for explanation and counseling tied as the top concerns, each selected by 41.5 percent, followed by busy or inefficient clinical environments at 31.0 percent. In other words, even physicians skeptical about feasibility pointed not at their own skills but at the structural conditions of their workplaces.

This convergence with international implementation research is what makes the South Korean case broadly instructive. Prior studies in the Netherlands, Japan, Dubai, and the Philippines examined physician perceptions in different settings, and together they support a shared conclusion: conceptual endorsement of SDM does not automatically translate into routine clinical use. South Korea is a particularly informative setting because its high-volume system features brief consultations and competing service demands, pressures that resonate in health systems worldwide where consultation durations vary dramatically. The findings raise a question that transcends borders: can professional education alone produce routine shared decision-making when workflow, workload, and reimbursement do not support deliberative communication?

The authors are careful about the limits of their evidence. Volunteer sampling means selection bias is plausible, since physicians interested in communication may have been more likely to respond, so the figures should not be read as nationally representative prevalence estimates. All outcomes were self-reported at a single time point, the full questionnaire underwent no formal construct validation, and the cross-sectional design rules out causal claims about whether short visits or low pay actually reduce SDM use. The researchers frame the policy implications as hypothesis-generating, calling for probability-based surveys, validated instruments, observed consultations, and longitudinal or interventional studies. What the survey does establish is a clear agenda: physician education, consultation time, clinical workflow, reimbursement, and organizational support as candidate targets for making shared decision-making a daily reality rather than an aspiration.

Subject of Research: Physicians' perceptions and structural barriers to shared decision-making in South Korea

Article Title: Physicians’ perceptions, reported experience, and perceived structural barriers to shared decision-making in South Korea: a multispecialty survey

Article References: Yoo, S.-H., & Kim, M. J. (2026). Physicians’ perceptions, reported experience, and perceived structural barriers to shared decision-making in South Korea: a multispecialty survey. Frontiers in Public Health, 14, Article 1938324. https://doi.org/10.3389/fpubh.2026.1938324

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1938324

Keywords: shared decision-making, patient-centered care, South Korea, physicians, health communication, survey, implementation barriers, consultation time, reimbursement, public health, clinical practice, health services research