3-7-2023 (BANGKOK) The issue of work-life imbalance among medical personnel in Thailand continues to plague the country’s healthcare system, with recent evidence coming from a doctor-turned-actress who took to Facebook to express how her overwhelming work schedule at a provincial hospital had wreaked havoc on her life, ultimately leading her to resign from her position. This serves as a stark reminder that the Public Health Ministry must urgently find a solution to create a better and fairer working environment for doctors and medical staff across the nation, all while upholding the highest standards of medical care in public hospitals.
Jaruayporn Srisasalux, deputy director of the Health Systems Research Institute (HSRI), highlighted the detrimental impact this situation has on the public health system. She emphasized that the younger generation’s attitude towards work has shifted, with a greater emphasis on achieving a healthy work-life balance. Younger individuals are more inclined to seek opportunities elsewhere if their needs are not met. Moreover, doctors perceive the income they receive from state-owned hospitals as inadequate compensation for the heavy workload they bear. While an average salary for a general doctor in a state hospital hovers around 50,000 baht, they can earn double that amount by working in private hospitals.
According to Srisasalux, one possible solution is to address the shortage of doctors by recruiting more medical professionals. However, in reality, this is a challenging task for state-owned hospitals due to budgetary constraints and regulations that hinder the implementation of effective solutions.
To tackle this issue, Srisasalux proposed that the Ministry of Public Health should adopt the model successfully implemented at Banphaeo General Hospital (Public Organisation) and extend it to other hospitals nationwide. Banphaeo General Hospital underwent a transformation from a state-owned hospital to a public organization in 2000. This transition was part of the government’s initiative to streamline bureaucracy and reduce the state’s financial burden.
This shift allowed the hospital to operate independently, managed by professionals who possess the freedom to expand the hospital’s business lines, generate additional income, and recruit more doctors and medical staff. The increased flexibility provided by this organizational structure enables the hospital to address various challenges, including staffing shortages and budgetary limitations.
Srisasalux also highlighted another critical issue arising from the politicization of public health. The government’s previous commitment to ensuring universal healthcare access for all citizens through the 30-baht universal healthcare scheme created unintended consequences. The policy, which aimed to serve 49 million individuals holding the universal healthcare card, lacked proper screening processes, leading to individuals who were not in need of financial assistance benefiting from the program. In order to safeguard the long-term sustainability of the country’s public health system, Srisasalux stressed the importance of revising this policy.
Regarding the shortage of doctors, Srisasalux emphasized that increasing earnings, improving welfare, and providing guarantees for career advancement would help attract more doctors to remain employed in government hospitals. Currently, there are 60,000 doctors nationwide, with 24,649 working under the Ministry of Public Health. However, the doctor-to-patient ratio in Thailand stands at 10.27 doctors per 10,000 people, significantly lower than countries like Singapore, Japan, South Korea, and the UK, where the ratios range from 25 to 30 doctors per 10,000 people.
Meanwhile, Dr. Attaporn Limpanyalert, deputy chief of the National Health Security Office (NHSO), acknowledged the burden faced by overworked doctors and medical staff and assured that the NHSO is actively working to alleviate this issue. Starting from October 1, the NHSO will implement adjustments to its database system to reduce the time doctors spend on administrative processes.
In the interim, the NHSO is collaborating with private hospitals to offer additional beds to patients covered by the universal healthcare scheme. Currently, only 100 out of approximately 1,000 private hospitals in the country cooperate with the NHSO. Dr. Limpanyalert stated that approximately 500 beds are currently available, and this number is expected to reach 1,000 beds soon. The NHSO has also established partnerships with 1,000 pharmacies nationwide to provide primary care for patients with minor illnesses, aiming to reduce the number of hospital visits.
Dr. Chutinart Chinudomporn, coordinator of the Thai Frontline Physician Union, expressed her dissatisfaction with the Ministry of Public Health’s slow progress in addressing the issue of overworked doctors and medical staff. She recalled working 120 hours per week when she was employed by a government-run hospital. Since moving to a private hospital, she now works approximately 40 hours per week and receives a higher salary. Dr. Chinudomporn noted the lack of short-term measures taken by the ministry to tackle the root causes of the problem. She warned that without effective solutions, efforts to produce more doctors would ultimately benefit private hospitals.
Dr. Chinudomporn concluded, “An average of 455 doctors resign from state-owned hospitals nationwide each year. If we do not develop a strategic policy to address this problem, we will not see any improvement in the foreseeable future.” The urgency of the situation necessitates the immediate implementation of comprehensive measures that prioritize the well-being of medical personnel and ensure the sustainability of Thailand’s healthcare system.
