BANGKOK: Large crowds and long queues are common in almost every Thai public hospital. Rural hospitals in particular are suffering from a severe shortage of doctors and most are short on funds.
According to the Thai Medical Council, there are just over 50,000 doctors in the country - with almost half of them clustered in Bangkok. The unequal distribution of medical practitioners means hospitals in rural areas are overcrowded with only a handful of doctors.
Some observers say the shortage of doctors comes from a more systematic failing of the Thai healthcare system.
“Speaking from my personal experience - the reason why the public healthcare system in Thailand is failing is the attitude of most administrators and management,” said Dr Witawat Siripracha, a former doctor and director of Lanta Hospital in southern Krabi province.
“I was working as a director of a hospital and had to attend many meetings,” he said. “Senior administrators often overlook young doctors. Some even said we shouldn’t care much about the young doctors because they will be gone after three years of service.
“Instead of nurturing young doctors to work more closely with the community as a family doctor, we drive them away to the private sector."
Like Dr Witawat, many young doctors and other medical staff are overworked, suffering poor health. Reports show some have even died in road accidents because of extreme fatigue from long working hours.
According to the standard ratio of one doctor per population, one doctor should be responsible for about 1,500 people. The lack of doctors in many rural areas has driven the number to as high as 7,000.
“Back then, I was one of the six interns and had to work double shifts for 26 days straight,” said Dr Witawat. “The older doctors rarely showed up because they had their private clinic to run, so the young doctors had to run the show.”
The government is trying to produce more doctors each year but many are concerned that this approach of quantity over quality may create an even bigger problem in the future.
To meet the challenge of shortage, the government launched the Primary Care Cluster scheme in late 2016, commonly known as the "family doctor programme".
A FAMILY DOCTOR TEAM
The programme is still in its infancy and has not been publicised much.
It basically involves a family doctor team which consists of a general practitioner, four nurses, four medical academic experts, a pharmacist, a dentist, a doctor who studied Thai traditional medicine and staff from the Ministry of Public Health.
The team is responsible for a specific number of patients in a certain area and will work closely with the community by providing an early diagnosis or provide house calls if needed.
“The family doctor will act as a one-stop service for the patient,” explained Dr Boonchai Theerakarn, a senior official from the Thai Ministry of Public. “They will provide an early diagnosis and follow-up.
“They will also help patients coordinate with hospitals if the illness needs further treatment by a specialist.”
The family doctor programme will mainly involve doctors and medical personnel from state hospitals. The government is also hoping to receive cooperation and support from doctors in private hospitals, but experts say this could be problematic.
PUBLIC VS PRIVATE HOSPITALS
Thai public hospitals are already struggling with doctors leaving to join the private sector for better-paying jobs. Higher salary, better benefits, shorter working hours and less strain by the bureaucratic system are more than enough to persuade new generation doctors to work either in a private hospital or clinic.
Fah, a doctor who works in one of the largest public hospitals in Bangkok, said she is going to move to a private hospital once she has paid all her tuition back.
“Sometimes, I work 50 or 60 hours a week. I rarely have a break on weekends to spend time with my family," she said. "I don’t always receive my salary on time. I notified my supervisor about the issue, but he said that he’s not in charge of the policy.”
Freshly graduated doctors are required to work in a public hospital for at least three years as an intern in order to pay back their tuition fees.
Many private hospitals in Thailand are willing to pay at least US$5,800 a month, compared to a monthly salary of US$1,800 at public hospitals.
And because of the high patient to staff ratio, doctors at public hospital have little time to diagnose illnesses properly or to have a deep and meaningful interaction with patients.
Dr Boonchai added that social attitudes towards doctors also put a strain on the government’s health budget.
“Because many people think that general practitioners are young and inexperienced, patients prefer to see the specialist right away,” Dr Boonchai said. “Instead of allocating the right medical personnel to the right job, many public hospitals end up with a shortage of specialist doctors and, not to mention, it is more expensive to hire specialists.”
If the family doctor programme serves its purpose, it could help people like Nuchaya - a 47-year-old woman from Ang Thong province. She makes regular trips to Bangkok with her father to visit a nephrologist.
Nuchaya’s father suffers from a chronic kidney disease. It was late before her father discovered the illness and by the time he saw a doctor, it had reached a state where he required dialysis at least three times a week.
“He thought it was just regular fatigue,” said Nuchaya. “Maybe he didn’t have enough rest. He went to a local pharmacy and bought some medicine and took supplements, but his condition did not improve.”
HEALTHCARE A POLITICAL ISSUE
State subsidised healthcare has been an important political issue for various Thai governments for decades, and the military government hopes that the new family doctor scheme will go a long way in addressing the public’s demand for such services.
The military government has been hinting that it might end universal healthcare, which has been around for more than a decade, because of the financial burden on the state.
But veterans like Dr Witawat said the overemphasis on public sector investment, like the family doctor initiative, might not be the right answer to improve people’s access to healthcare.
He thinks the government should look at utilising the potential of the private sector in areas with poor distribution of doctors and help out with people’s medical bills instead.
“Doctors don’t have to stay in the public sector,” he said. “If you really want to help patients, go join the private sector. Not only will they take care of you better, they have the resources and capability to help the patient.”