The Doctor’s Dilemma in Taiwan: Balancing Personal Gain and Public Interest in a Distorted System

In Taiwan, doctors and other medical professionals have long enjoyed high social status because they are recognized as intellectual and professional elites. The public generally considers it reasonable for them to receive generous incomes that match their professional status and responsibilities. Many medical professionals similarly view their value and income potential in the same way. This social consensus has rarely been questioned—and until recently, it has largely held. 

While this assumption contains some truth, it overlooks a crucial premise: a medical professional’s success is not built on individual effort alone, but on a system of rigorous—and extremely costly—medical education that is substantially financed by the public. In Taiwan, medical tuition fees are only a fraction of their true cost. Government and academic studies estimate that training a medical student over six years—including faculty salaries, laboratory equipment, and clinical internship resources—costs roughly 5–7 million NTD. By contrast, total tuition for a six-year medical education is approximately 600,000 NTD. At National Taiwan University’s medical school, the nation’s most prestigious institution, one semester’s tuition is only about 50,000 NTD. In other words, students pay barely 10% of the actual cost of their professional training. 

This affordability is not accidental; it is the direct result of sustained public investment. Taiwan’s Medical Care Act requires medical centers to allocate operating income toward cultivating medical talent, meaning that teaching hospitals absorb enormous hidden costs on top of existing government funding. These institutional subsidies form an often-invisible pillar of Taiwan’s medical education system. In practical terms, each public medical school student receives several million NTD in indirect support through hospital funding alone. This extraordinary subsidy allows Taiwan’s medical graduates to recoup their tuition investment in as little as eight months as first-year resident physicians. By comparison, at Harvard Medical School—where total tuition approaches USD 500,000—graduates may need five to ten years to break even. Seen in this light, Taiwan’s commitment to training medical professionals is not only generous, but morally significant. 

Public subsidy is not merely financial assistance; it represents a social contract. When society shoulders the majority of the cost of training physicians, it does so with the expectation—implicit though rarely stated—that this expertise will ultimately serve the public good. It is precisely this expectation that comes into tension when increasing numbers of doctors choose to enter the highly profitable, self-pay field of cosmetic medicine, performing procedures such as silicone augmentation or filler injections. The ethical discomfort does not arise because cosmetic medicine is illegitimate in itself, but because of what is left behind. From certain perspectives, these white-coated entrepreneurs may sculpt flawless jawlines and perfect body curves, yet in doing so they appear to drift further away from the medical ecosystem that sustains lifesaving care—and from the society that made their professional success possible. This trend invites criticism, but before passing moral judgment, we must ask a more difficult question: what pressures are driving so many doctors away from the public healthcare system in the first place? 

Many critics would agree that the answer lies in Taiwan’s National Health Insurance (NHI) system. While the NHI is founded on a noble principle—ensuring universal access to basic medical care—its payment structure is deeply disproportionate to the level of professionalism, risk, and responsibility involved in medical practice. To illustrate this distortion, one needs only consider everyday pricing realities: people routinely pay 300–500 NTD for fortune-telling in underground malls, while a clinic visit costs less than 200 NTD, and even the most advanced treatment at a medical center is reimbursed at only around 500 NTD. These comparisons are not moral equivalences, but reflections of how the system assigns value. 

The contrast becomes even more unsettling when viewed alongside other service industries. A full-body massage at a spa typically costs 1,000–2,000 NTD per hour, with therapists earning 50–60% of that fee—roughly 500–1,200 NTD—for work that carries virtually no legal liability and no life-or-death consequences. Meanwhile, emergency room physicians earn approximately 600 NTD per hour, and ER nurses earn only 250–300 NTD per hour, regardless of how many lives they save or how many times they perform a literal cardiac massage during a shift. Compensation remains fixed even as intensity, risk, and emotional burden escalate. Worse still, if a rescue attempt fails—even for reasons unrelated to medical error—the team may still face lawsuits from patients’ families. In such an environment, moral injury becomes inevitable. Similar distortions affect many other medical specialties under the NHI system. 

The consequences of this imbalance are already visible. According to the 2025 university entrance examination results, admission scores for dentistry departments have nearly matched—or even surpassed—those of medical schools. This shift reflects a growing awareness among students: while physicians endure long training periods, exhausting hospital shifts, and stagnant NHI compensation, dentists often enjoy higher self-pay income and a better quality of life. The training pathways further reinforce this divergence. After graduating from medical school, physicians must complete two years of Post-Graduate Year (PGY) training, followed by additional subspecialty training, before independently performing specialized treatments. Dentists, by contrast, can usually enter clinic-based PGY training immediately after graduation and, without mandatory subspecialty certification, perform most dental procedures—including high-fee treatments such as orthodontics and implant reconstruction. The comparison is not meant to diminish dentistry as a profession, but to expose how incentive structures shape career choices. 

Under such inequitable conditions, it is unsurprising that a growing number of physicians choose to leave the public medical system, open self-pay clinics, or even abandon clinical practice altogether. This exodus directly contributes to hospital staffing shortages, making it increasingly difficult for ordinary citizens to access timely, high-quality care—ironically undermining the very goals of universal healthcare. To be clear, doctors who leave public hospitals for cosmetic clinics are not the disease; they are symptoms. The actual pathology lies in a distorted payment system that equates lifesaving medicine with fortune-telling and cardiac resuscitation with relaxation massage. When a system forces medical professionals to choose between ethical commitment and personal survival, condemnation alone is both unfair and ineffective. The more pressing question is this: what kind of society invests millions in training doctors, only to channel their expertise toward aesthetic enhancement for the wealthy few while the public healthcare system quietly deteriorates? 

Reform will not be easy, and the path forward will undoubtedly be long. Yet the direction must be clear. If we regard education as a public good and healthcare as a public right, then our system must be capable of honoring both simultaneously. I fully understand the pressures that drive doctors toward more lucrative private practice, and I do not condemn their pursuit of self-realization or financial security. However, it is equally crucial that medical professionals pause to reflect on the societal foundation upon which their careers are built. Each physician in Taiwan has benefited from millions of NTD in public subsidy—an investment made by taxpayers who trust that this support will ultimately serve the broader social good. This is not a legal obligation, but a moral one—and it is a responsibility that we, as doctors, must continue to understand, acknowledge, and hold dear.