Thai Doctors Fleeing Public Health Network

[george]

The great white-coat exodus

BANGKOK: -- New doctors are fleeing the public health network because of poor pay rates and overwhelming workloads

More than 2,000 doctors have quit their jobs at state-run hospitals over the past four years. The number represents more than half of the new medical doctors entering the country’s healthcare system in the same period.

The reasons for the exodus, which has thrown the government hospital system into crisis, include heavier workloads, low incomes and growing pressure from risks of legal action.

These factors have coincided with unprecedented demand for physicians in the private healthcare industry.

The growth of private hospitals at the expense of the government system is now being seen as an adverse consequence of the government’s policy to make Thailand the medical hub of the region.

In 2001, 269 doctors, or about 31 per cent of new doctors who graduated in that year, resigned from state-run hospitals. The figure rose to 58.6 per cent in the following year and then soared in 2003 when more than 77 per cent, or 795 new doctors, walked off the job.

“Had this happened in Japan, the health minister would have been held responsible and would have resigned long ago,” said Dr Cherdchoo Ariyasriwatana, a committee member of the Medical Council of Thailand.

The crisis in 2003 prompted the Medical Council to call a brainstorming seminar to figure out ways of slowing down the resignations. It came up with a package of proposals to lift morale among the remaining doctors.

The council also surveyed the opinions of doctors across the country, including those still working at state hospitals and those who had resigned.

The survey found almost four in 10 doctors who were still working at state hospitals had thought of resigning. Another three remained undecided, and the rest said they had never thought of leaving their jobs.

Those considering quitting their jobs complained about workloads, unreasonable incomes and growing pressure from the government’s Bt30 low-cost healthcare scheme.

Those who were undecided said they were waiting to see what the government would do to solve their problems.

Last October the government reacted to the Medical Council’s proposals by approving an Bt8-billion package to elevate pay and incentives to keep doctors in the state-run system. The money was to be paid out in instalments up to 2007 – Bt2.87 billion in fiscal 2004, Bt3.5 billion to Bt5 billion in fiscal 2005, and the rest in fiscal 2006.

The tragedy is that more than seven months later, not a single baht has reached hospitals or the doctors because of bureaucratic red tape.

The Public Health Ministry is still working out the details of the new payments, explained Dr Pipat Yingseri, the ministry’s deputy permanent secretary in charge of the pay-hike plan.

“It’s been like a domino effect,” Pipat conceded. “In the long run, fewer and fewer people will remain in this profession.”

He said small state-run hospitals lacked general practice physicians and the larger ones needed more specialists, especially general surgeons and orthopaedic and heart-disease specialists.

“Just for one operation, a surgeon at a private hospital makes about Bt20,000,” Pipat said. “This is higher than the salary his counterpart at a state hospital earns for a whole month.”

He acknowledged that the Bt30 healthcare scheme, which was implemented in 2001, had brought an influx of more than 20 million people, uninsured by any other health scheme, into the state system, causing workloads at some hospitals to double.

Pipat said the new Health Act also created a lot of pressure on doctors at state hospitals. Because of the way the law was written, doctors at state hospitals are these days more prone to lawsuits than their counterparts in the private system.

--The Nation 2005-06-15

[george]

100 patients a day, no rest, no support and no sympathy

“I’m in a dilemma . . . today a private hospital offered almost 10 times my present salary for me to work with them fulltime. What do you think?” asked a message posted in the “doctors’ room” web board of www.thaiclinic.com, the most popular cyber-community for medical professionals.

This was one of a growing number of similar postings discussing quitting a job at a state hospital to work in the private sector.

Despite working extremely hard for the state hospital all day long, the writer, who identified himself as Tunkong, a state-hospital surgeon, said he had to moonlight at night at a private hospital because the salary he was paid at the state hospital was too little.

“So many patients these days at the state hospital, I have almost 100 out-patients every day . . . after OPD my head aches so much that I sometimes vomit,” Tunkong said. “I think it’s about time to quit being a state doctor.”

Another doctor who called himself “already resigned” posted that he resigned two years ago not because of the money but rather the unbearable work conditions.

“Already resigned” said in his message he used to work alone at a community hospital where he had to stay until midnight before putting himself on call every day for two years until an intern, whom he had requested, finally was assigned to help him.

Then “already resigned” had his first chance to visit his home after two years working at the hospital where he was sent upon graduating from medical school.

Despite trying hard to keep the intern, even paying him incentives and providing a free chauffeur-driven ride with his own money, he put up with the work for only six months. Apart from having to work alone day and night at the hospital, “already resigned” said the other significant problem was the obligation to help police verify deaths.

“It was a big burden to me

. . . it’s okay to leave patients and the hospital for a while for a nearby forensic job, but most of the time the death scene was so far away from the hospital and I had to go any time they needed me,” he said.

If he failed to show up, the police would report it to the provincial health office and the doctor received a warning rather than supportive assistance. He had tried to explain about his hospital workload and begged health officials to do something to help. Yet the answer from the chief health officer was the last straw for “already resigned”; he replied, “Why should I care about your forensic problems?”

Dr Siam Pichetsin, a former state doctor who is now a general surgeon and works for a private hospital, said he put up with the classic state doctor’s life for 10 years. The work conditions were similar to the others – about 100 patients a day, low salary and growing pressure from the Bt30 low-cost healthcare scheme.

He said he decided to quit his job at the Phetchaburi state hospital because he was denied his request to be rotated to another hospital in suburban Bangkok.

After his wife, who is also a medical doctor in Bangkok, gave birth to their first child, Siam felt he had to be around to help take care of the baby and a hospital in Pathum Thani accepted his request to move there, yet Phetchaburi hospital wouldn’t let him go and would not say why.

“Never expect doctors to always make sacrifices . . . we are also human beings, we have our own lives as you do,” Siam said. “You want a good house, good marriage, good car and good kids, don’t you? So do we.”

--The Nation 2005-06-15

[mnoorsapl]

100 patients a day, no rest, no support and no sympathy

“I’m in a dilemma . . . today a private hospital offered almost 10 times my present salary for me to work with them fulltime. What do you think?” asked a message posted in the “doctors’ room” web board of www.thaiclinic.com, the most popular cyber-community for medical professionals.

--The Nation 2005-06-15

<{POST_SNAPBACK}>

would do the same thing too if I'am a doctor.

[sriracha john]

“So many patients these days at the state hospital, I have almost 100 out-patients every day . . . after OPD my head aches so much that I sometimes vomit,” Tunkong said.

I just hope he doesn't have to consult with a fellow over-worked government doctor regarding his headaches and vomiting.

At 100 patients per day, that's 12 patients an hour, or 5 minutes spent per patient, which precludes even the most rudimentary level of basic health care and raises the potential for error to a completely unacceptable level.

Mr. T's Air Farce One private governmental plane, at a cost of one billion baht, is but one example of the government's misplaced priorities.

[thaibebop]

State run doesn't run without the state running with it.