Public healthcare system facing doctor shortage, workload concerns
The Public Health Ministry has taken a close look at the reported shortage of physicians and the reasons behind the heavy workload of personnel in an attempt to improve conditions for all involved in the country’s healthcare system including ensuring they enjoy a good work-life balance in the future.
Deputy minister Dr Taweesin Visanuyothin noted that the shortage of personnel is across all healthcare professions including physicians, nurses and radiologists.
There are 24,649 physicians within the public health system, which accounts for 48% of all physicians nationwide. They are responsible for caring for approximately 75-80% of the population, with a physician-to-population ratio of 1:2,000, a workload that is considered relatively heavy.
The combined production capacity for physicians in both the public and private sectors is approximately 3,300 per year. Out of this total, one-third is produced by the Ministry of Public Health. The allocation process involves a consortium committee responsible for allocation decisions, and there are multiple affiliated organizations involved.
A study of the reform plan for human resources and health service tasks by the ministry between 2018-2027 found that the system requires approximately 2,055 physicians to enter the system each year. However, the allocation has only been around 1,800-1,900. For example, in 2023, there were 2,759 graduates, but only 1,960 of them were allocated.
The remaining allocation is provided to various institutions such as the Ministry of Defense, 6 regional medical institutions, and other government agencies. This allocation is in line with the increase in skilled physicians or intern doctors who are required to undergo training in 117 designated hospitals set by the Medical Council of Thailand. In 2022, the capacity for accepting intern doctors was 3,128, but only 2,150 were allocated, accounting for 68.7%.
A survey on workload conducted between November 15-30, 2022 counted 65 hospitals where healthcare professionals worked more than 40 hours per week. Specifically, there were 9 hospitals where the workload exceeded 64 hours per week, 4 hospitals where it exceeded 59, 11 hospitals where it exceeded 52, 18 hospitals where it exceeded 46, and 23 hospitals where it exceeded 40 hours per week. To date, as part of a plan implemented in phases of 3, 6, 9, and 12 months, 20 hospitals have successfully reduced their working hours.
Of the more than 19,355 physicians recruited in the past 10 years (2013-2022), only 226 physicians resigned in their first year, accounting for 1.2%. This relatively low rate is due to the requirement for physicians to undergo skill enhancement before pursuing further studies. In the second year, 1,875 physicians resigned, accounting for 9.69%This group has the highest number of resignations as they are eligible to pursue further studies.
In the third year, 858 physicians resigned, accounting for 4.4%. Furthermore, there were 1,578 physicians who resigned after completing their funding, accounting for 8.1%. When combined with physicians retiring at a rate of 150-200 per year, there are a total of 655 physicians leaving the system annually. Further studies have shown that of physicians remaining in the system, those with the Collaborative Project to Increase Production of Rural Doctors (CPIRD) programme can comprise as much as 80-90% of the system, as they are selected from local residents.
Dr Taweesin also emphasised that the care of personnel in all professions focuses on four aspects, which have been implemented consistently.:
• Salary: Discussions have been held with the Central Accounting Office to negotiate and request adjustments to various forms of compensation to align with workload and the economy.
• Welfare measures: Including accommodation, environmental conditions, safety, and various facilities.
• Career advancement: Discussions with the Ministry on increasing the staffing framework and the elevation of positions.
• Workload: There is still a need to produce more physicians and request additional allocations to supplement the system.
The new staffing framework announced for the years 2022-2026 sets a target of 35,000 physicians by 2026. There have also been discussions with the ministry regarding the management of personnel in new formats and diverse employment opportunities.
