Dozens Of Doctors Resigning Over Controversial P4P System, Including 11 Specialists

[webfact]

MEDICAL PERSONNEL
Dozens of doctors resigning
PONGPHON SARNSAMAK,
TANPISIT LERDBAMRUNGCHAI
THE NATION


Dr Arak Wongworachart, a former president of the Rural Doctors Society

146 to quit over controversial P4P system, including 11 specialists

BANGKOK: -- The Public Health Ministry's new medical salary system has prompted 146 doctors nationwide to resign from rural and urban hospitals, affecting medical services for people in local areas.

Some doctors have chosen to work at private hospitals after learning that the ministry's new medical salary system would cut their additional allowances, they say unfairly.

Among the doctors are 11 specialists who provide medical care for complicated conditions, according Dr Arak Wongworachart, a former president of the Rural Doctors Society.

To date, 3,425 doctors work at 723 rural hospitals across the country.

Under the Public Health Ministry's system - from yesterday - 614 of 736 rural hospitals nationwide will cut allowances, based on remoteness, for their medical workers.

"The resignation of doctors and specialists from rural hospitals has seriously affected the medical services for people living in remote areas - meaning people will have to travel long distances to get treatment at hospitals in [their nearest] town," he said.

The total number of doctors who resigned from hospitals nationwide was calculated by the Rural Doctors Society during February and March, after the ministry initiated its plan to adjust the additional allowance for medical workers.

'PAY FOR PERFORMANCE'

Previously, the allowance for medical workers was based on the remoteness of their posts and the number of years they had worked. Now the new allowance, which took effect yesterday, is based on their workload [a pay for performance concept known as P4P].

"[The medical workers] have said clearly in their resignation letters that they had quit from state hospitals because they were unhappy with the new medical salary system - not because they wanted to continue their education, as the Public Health Minister Pradith Sinthawanarong had told the media," Arak said.

"It was clear they resigned because they were unhappy with the new rate of allowances, not because they wanted to continue their education," he said.

Dr Sukanya Sing-trakul, a specialist physician who has just submitted her resignation letter to her hospital's director, said she was quitting because she did not agree with the ministry's P4P system, which would create a workload for medical workers instead of encouraging doctors' efficiency.

"Today we really work hard at the hospital. So, don't think we don't have choices," she said.

Previously, Sukanya resigned from a state hospital to continue her education, after which she decided to continue working at the hospital where she could receive the ministry's allowance. But since the new salary system has taken effect, her allowance will be cut by Bt25,000 - a large amount from her earnings.

"I always believed in sacrificing for the public, but now it's time for me to go and work at a private hospital," she said.

Previously, two Chaiyaphum doctors resigned from Ban Thaen hospital and moved to an urban location as they were affected by the P4P system.

SCHEME DAMAGING HEALTH SYSTEM

"Both were worried about receiving lower allowances under the system," said Dr Dusit Khumchaiyaphum, a director of Chaiyaphum province's Ban Thaen hospital.

In response to the Public Health Ministry's new medical salary system, at least 80 rural hospitals in five deep southern provinces had issued statements opposing the ministry's system, saying even if they were to continue receiving the allowance based on remoteness and the P4P system, they strongly disagreed with the ministry as its scheme would damage the public health system in the long term.

"From now on, no doctor will provide treatment to patients [merely from the goodness of] his heart. Doctors will provide care for patients because it will earn them more and more in allowances," Dr Sanchai Pongthanyawiriya, a director of Pattani province's Ya-ring,said.

A 24-year-old medical intern, who wanted to be anonymous, said he did not agree with the Public Health Ministry's paying allowances for medical staff based on the volume of their work as it would create competition among medical staff. In rural areas, he said, the number of patients needing care is smaller, meaning medical workers would receive reduced allowances based on the amount of work.

"Personally, I will quit the state hospital and go to work at a private facility after I finish my internship in next three years, as I can get a higher salary," he said.

But medical intern, Dr Chanont Hadsoi, 24, who will work in the deep south for his internship, said he agreed with the ministry as the new system would be fair.


-- The Nation 2013-04-02

[Mampara]

"[The medical workers] have said clearly in their resignation letters that they had quit from state hospitals because they were unhappy with the new medical salary system - not because they wanted to continue their education, as the Public Health Minister Pradith Sinthawanarong had told the media," Arak said.

Some are paid to cover up the truth. Some are paid to confuse the public. Some are paid to sell new ideas and theories! Whatever the case, a secret doesn't stay secret long time!

[expat888]

Nationwide, 146 + 11 doctors doesn't sound like much.

Anyway, with the new tax proposal for foreigners here, that should be enough to keep these guys in their BMWs.

[chainarong]

Regardless of who the government of the day is , vote with your feet, if you don't like the system, this has been implemented by individuales, many times over, with variations, even to leaving one's country because of the direction , system, etc etc, it's when you can not do this , that hate , depression, violence anti social behaviour etc sets in.

[virtualtraveller]

That's what happens when you have an underfunded 'free' medical for 64 million people, paid for by only 5 million.

[Bobobirdiebuddy]

This should be no surprise - rural doctors have huge work loads, get very little pay and, clearly earn no respect from this government. They underfund public health and now they are sticking it to the very people who help rural populations. This is what happens when politicians run the Ministry of Public Health instead of health care professionals. Remember, Chalerm was, at one time, Minister of Public Health - a man who knows nothing of the problems that need to be faced. And I hope that when doctors start deserting rural hospitals, those rural folk who are Red Shirts remember why.

[MikeOboe57]

Nationwide, 146 + 11 doctors doesn't sound like much.

Anyway, with the new tax proposal for foreigners here, that should be enough to keep these guys in their BMWs.

You clearly have no clue about the salaries paid to doctors in state hospitals. Why don't you familiarize yourself first with this topic before you post about "BMWs". And it is not 146 + 11 but 146 including 11 specialists which will seriously affect the rural hospitals.

This is just the first wave of resignations triggered by this idiotic P4P scam.

Isn't it just amazing, that everything this Government touches turns to [fill in suitable expletive]? They are no doubt extremely capable in this regard.

[hellodolly]

Nationwide, 146 + 11 doctors doesn't sound like much.

Anyway, with the new tax proposal for foreigners here, that should be enough to keep these guys in their BMWs.

Read the article.

There are only 3,425 doctors.

As has been stated here the loss of 5% of the doctors will not help the quality of care and the competition for cases is in no way going to increase the quality of care.

This government in it's fill it's own pockets schemes is not going to add any help to the medical staff until they can figure out how to personally fill there pockets.

Lets see now borrow how many billions of baht to purchase rice at unsalable prices and cut the money being poured into the Medical for the country.

[expat888]

Nationwide, 146 + 11 doctors doesn't sound like much.

Anyway, with the new tax proposal for foreigners here, that should be enough to keep these guys in their BMWs.

You clearly have no clue about the salaries paid to doctors in state hospitals. Why don't you familiarize yourself first with this topic before you post about "BMWs". And it is not 146 + 11 but 146 including 11 specialists which will seriously affect the rural hospitals.

This is just the first wave of resignations triggered by this idiotic P4P scam.

Isn't it just amazing, that everything this Government touches turns to [fill in suitable expletive]? They are no doubt extremely capable in this regard.

You are misinformed about the quality of care in these hospitals. You are making general assumptions that all the care in these hospitals are good. They are not. You are making assumptions with apparently no experience in them. I have. I contend that these doctors will not be missed.

[HeavyDrinker]

Nationwide, 146 + 11 doctors doesn't sound like much.

Anyway, with the new tax proposal for foreigners here, that should be enough to keep these guys in their BMWs.

You clearly have no clue about the salaries paid to doctors in state hospitals. Why don't you familiarize yourself first with this topic before you post about "BMWs". And it is not 146 + 11 but 146 including 11 specialists which will seriously affect the rural hospitals.

This is just the first wave of resignations triggered by this idiotic P4P scam.

Isn't it just amazing, that everything this Government touches turns to [fill in suitable expletive]? They are no doubt extremely capable in this regard.

You are misinformed about the quality of care in these hospitals. You are making general assumptions that all the care in these hospitals are good. They are not. You are making assumptions with apparently no experience in them. I have. I contend that these doctors will not be missed.

When you have a dying child in your family and you are desperately looking for medical help up in the heart of rural Thailand, let us then see how much you 'contend' professional medical help won't be missed.

For many in less fortunate financial straits than we are, this is their ONLY option no matter how poor you may think the quality of care may be.

Think before you post...

Edited April 2, 2013 by HeavyDrinker

[MikeOboe57]

Nationwide, 146 + 11 doctors doesn't sound like much.

Anyway, with the new tax proposal for foreigners here, that should be enough to keep these guys in their BMWs.

You clearly have no clue about the salaries paid to doctors in state hospitals. Why don't you familiarize yourself first with this topic before you post about "BMWs". And it is not 146 + 11 but 146 including 11 specialists which will seriously affect the rural hospitals.

This is just the first wave of resignations triggered by this idiotic P4P scam.

Isn't it just amazing, that everything this Government touches turns to [fill in suitable expletive]? They are no doubt extremely capable in this regard.

You are misinformed about the quality of care in these hospitals. You are making general assumptions that all the care in these hospitals are good. They are not. You are making assumptions with apparently no experience in them. I have. I contend that these doctors will not be missed.

How you come to the conclusion that I am misinformed is a mystery, as I did not make any "general assumptions that all care in these hospitals are [sic!] good". I simply refuted your silly statement that these doctors can afford BMWs as you obviously have no idea what a doctor in a state hospital gets paid. Why don't you read the posts you answer to?

And your rather pompous statement that "these doctors will not be missed" is also lacking any substance. It will be those doctors that are highly sought after by the private hospitals that will leave, not the quacks that try to have an easy life and, according to some Government official, do private business during working hours, as this will not be accepted and tolerated in a private hospital.

My son is orthopedic surgeon in a state hospital, so I know what I am talking about. And btw he, too, will apply for a job in a private hospital in a few years at the latest, as he is working his [expletive] off at his current workplace (and to note: without being able to afford a "BMW").

[dudeinthailand]

Nationwide, 146 + 11 doctors doesn't sound like much.

Anyway, with the new tax proposal for foreigners here, that should be enough to keep these guys in their BMWs.

What new tax proposal are you referring too?

Thanks.

[drdoom6996]

Good, maybe the PTP will have an outbreak in their ranks and need them. What will YL, I mean Taksin, do then. Go to another country as all the poor folks can do as well.

[Fullstop]

"From now on, no doctor will provide treatment to patients [merely from the goodness of] his heart.

Hippocrates is weeping.

[belg]

i wonder, if all those doctors can suddenly work in private hospitals (much better salaries) , then WHY THEY NEVER DID THAT before ?

would it be fair to say: doctors study for free in exchange of a 10 year contract working into a government hospital to pay off their free education ?

[MikeOboe57]

i wonder, if all those doctors can suddenly work in private hospitals (much better salaries) , then WHY THEY NEVER DID THAT before ?

would it be fair to say: doctors study for free in exchange of a 10 year contract working into a government hospital to pay off their free education ?

Probably because the did not have the feeling that they are being [expletive] by the Government until now? High speed treatment of patients as the base for calculating a doctor's pay is as stupid as it can get.

I wonder when the lower classes wake up and realize that "their Government" is making their lives miserable. But I guess this will never happen. 500 THB for voting "correctly" is a great eraser of bad experiences.

[khunken]

This rather shows up the hypocrisy of PTP supposedly being supportive of the rural population. Actually hypocrisy is too mild a description - it's a lie.

It's a case of an arrogant minister refusing to listen to doctors who are paid a small allowance (relative to what they could earn at a private hospital) to live in remote areas & provide a decent health service to local people.

P4P is a recipe for ripping people off by just seeing as many patients as possible in the shortest possible time. I suspect the pharma companies will be happy with pills being substituted for proper diagnosis which is precisely what happens in a certain private hospital off Soi Nana in Bangkok.

[expat888]

Nationwide, 146 + 11 doctors doesn't sound like much.

Anyway, with the new tax proposal for foreigners here, that should be enough to keep these guys in their BMWs.

You clearly have no clue about the salaries paid to doctors in state hospitals. Why don't you familiarize yourself first with this topic before you post about "BMWs". And it is not 146 + 11 but 146 including 11 specialists which will seriously affect the rural hospitals.

This is just the first wave of resignations triggered by this idiotic P4P scam.

Isn't it just amazing, that everything this Government touches turns to [fill in suitable expletive]? They are no doubt extremely capable in this regard.

You are misinformed about the quality of care in these hospitals. You are making general assumptions that all the care in these hospitals are good. They are not. You are making assumptions with apparently no experience in them. I have. I contend that these doctors will not be missed.

How you come to the conclusion that I am misinformed is a mystery, as I did not make any "general assumptions that all care in these hospitals are [sic!] good". I simply refuted your silly statement that these doctors can afford BMWs as you obviously have no idea what a doctor in a state hospital gets paid. Why don't you read the posts you answer to?

And your rather pompous statement that "these doctors will not be missed" is also lacking any substance. It will be those doctors that are highly sought after by the private hospitals that will leave, not the quacks that try to have an easy life and, according to some Government official, do private business during working hours, as this will not be accepted and tolerated in a private hospital.

My son is orthopedic surgeon in a state hospital, so I know what I am talking about. And btw he, too, will apply for a job in a private hospital in a few years at the latest, as he is working his [expletive] off at his current workplace (and to note: without being able to afford a "BMW").

In your opinion.

So your son had to start somewhere and a state hospital is all he could get. Once he gets experience he would move on to a better hospital, right?

Edited April 2, 2013 by expat888

[expat888]

i wonder, if all those doctors can suddenly work in private hospitals (much better salaries) , then WHY THEY NEVER DID THAT before ?

would it be fair to say: doctors study for free in exchange of a 10 year contract working into a government hospital to pay off their free education ?

Probably because the did not have the feeling that they are being [expletive] by the Government until now? High speed treatment of patients as the base for calculating a doctor's pay is as stupid as it can get.

I wonder when the lower classes wake up and realize that "their Government" is making their lives miserable. But I guess this will never happen. 500 THB for voting "correctly" is a great eraser of bad experiences.

"lower classes". That sounds a bit elitist. I assume you are not in that class, lower I mean.

[MikeOboe57]

i wonder, if all those doctors can suddenly work in private hospitals (much better salaries) , then WHY THEY NEVER DID THAT before ?

would it be fair to say: doctors study for free in exchange of a 10 year contract working into a government hospital to pay off their free education ?

Probably because the did not have the feeling that they are being [expletive] by the Government until now? High speed treatment of patients as the base for calculating a doctor's pay is as stupid as it can get.

I wonder when the lower classes wake up and realize that "their Government" is making their lives miserable. But I guess this will never happen. 500 THB for voting "correctly" is a great eraser of bad experiences.

"lower classes". That sounds a bit elitist. I assume you are not in that class, lower I mean.

Ouch, I violated the Rules of Political Correctness. So what. But to make you feel better I will from now on call them "people with financial disabilities".

[hellodolly]

Nationwide, 146 + 11 doctors doesn't sound like much.

Anyway, with the new tax proposal for foreigners here, that should be enough to keep these guys in their BMWs.

You clearly have no clue about the salaries paid to doctors in state hospitals. Why don't you familiarize yourself first with this topic before you post about "BMWs". And it is not 146 + 11 but 146 including 11 specialists which will seriously affect the rural hospitals.

This is just the first wave of resignations triggered by this idiotic P4P scam.

Isn't it just amazing, that everything this Government touches turns to [fill in suitable expletive]? They are no doubt extremely capable in this regard.

You are misinformed about the quality of care in these hospitals. You are making general assumptions that all the care in these hospitals are good. They are not. You are making assumptions with apparently no experience in them. I have. I contend that these doctors will not be missed.

I can say that about doctors in up scale private hospitals.

[expat888]

Probably because the did not have the feeling that they are being [expletive] by the Government until now? High speed treatment of patients as the base for calculating a doctor's pay is as stupid as it can get.

I wonder when the lower classes wake up and realize that "their Government" is making their lives miserable. But I guess this will never happen. 500 THB for voting "correctly" is a great eraser of bad experiences.

"lower classes". That sounds a bit elitist. I assume you are not in that class, lower I mean.

Ouch, I violated the Rules of Political Correctness. So what. But to make you feel better I will from now on call them "people with financial disabilities".

My point is you have an emotional attachment to this topic: Your son. You are biased. Your son took a job at a government hospital to start his career and you are upset over his treatment. In fact, this is normal for a starter in a particular field to get stepped on. Most people have it tough in the beginning and they work their butt off with no appreciation. That's the real world.

You addressing these people as "lower class" identified you as something higher. With your son being a doctor it would be safe to assume you feel superior to most people. So your "lower class" comment just served to identify you.

[MikeOboe57]

Probably because the did not have the feeling that they are being [expletive] by the Government until now? High speed treatment of patients as the base for calculating a doctor's pay is as stupid as it can get.

I wonder when the lower classes wake up and realize that "their Government" is making their lives miserable. But I guess this will never happen. 500 THB for voting "correctly" is a great eraser of bad experiences.

"lower classes". That sounds a bit elitist. I assume you are not in that class, lower I mean.

Ouch, I violated the Rules of Political Correctness. So what. But to make you feel better I will from now on call them "people with financial disabilities".

My point is you have an emotional attachment to this topic: Your son. You are biased. Your son took a job at a government hospital to start his career and you are upset over his treatment. In fact, this is normal for a starter in a particular field to get stepped on. Most people have it tough in the beginning and they work their butt off with no appreciation. That's the real world.

You addressing these people as "lower class" identified you as something higher. With your son being a doctor it would be safe to assume you feel superior to most people. So your "lower class" comment just served to identify you.

Again you are making baseless assumptions. I am not going to follow you there.

The topic is that this Government wants to cut doctors' salaries and pay them instead according to the number of patients treated per hour, or better the number of patients they wave past their desks, as this is what will happen.

And it is not about doctors fighting for their privilege to collect BMW cars by the dozen, hardly any of these doctors could even afford one with their salaries, it is about the beginning exodus of doctors from state hospitals and the inevitable decrease in quality of treatment for those who cannot afford private hospitals and who in their majority support this sorry excuse for a government.

Unlike the legendary King Midas who turned everything he touched into gold, this Government turns everything it touches into, politely put, natural fertilizer.

[ZhouZhou]

the health system experts of the forum who are bashing the current government for this should not forget that this new p4p system was conceived under the previous Democrat-led administration.


it is actually only a re-zoning of that was is counted as remote. remoteness bonus will payed to 122 hospitals down from 736 previously.
guess that means for that real real deep remote areas is still the extra bonus paid. So it encourages doctors who want to get that remote allowance to move to the real remote areas where they are probably most needed.
under the new system also dentists, nurses and and pharmacists will get remoteness allowance. previously it was only for doctors. so that sounds good for nurses and dentists in remote areas. not on duty doctors will not get their automatic bonus anymore, like it was before.


if you look at the numbers of doctors claiming now to leave, you should also keep in mind that there are probably a lot of doctors in not so remote areas with a heavy workload also toying with the idea to leave if the don't get paid more. the p4p system please them and keeps them from quiting and going to private hospitals.

you cannot make everybody happy and in many places of the world a salary is probably lower in rural areas compared with a salary in urban areas, but living costs are also different.

[Konini]

Does anyone know how much the doctors get paid and how much they'll lose?

Just curious.

[hellodolly]

i wonder, if all those doctors can suddenly work in private hospitals (much better salaries) , then WHY THEY NEVER DID THAT before ?

would it be fair to say: doctors study for free in exchange of a 10 year contract working into a government hospital to pay off their free education ?

That would explain why only 5% are resigning instead of 50%.

[hellodolly]

the health system experts of the forum who are bashing the current government for this should not forget that this new p4p system was conceived under the previous Democrat-led administration.

it is actually only a re-zoning of that was is counted as remote. remoteness bonus will payed to 122 hospitals down from 736 previously.

guess that means for that real real deep remote areas is still the extra bonus paid. So it encourages doctors who want to get that remote allowance to move to the real remote areas where they are probably most needed.

under the new system also dentists, nurses and and pharmacists will get remoteness allowance. previously it was only for doctors. so that sounds good for nurses and dentists in remote areas. not on duty doctors will not get their automatic bonus anymore, like it was before.

if you look at the numbers of doctors claiming now to leave, you should also keep in mind that there are probably a lot of doctors in not so remote areas with a heavy workload also toying with the idea to leave if the don't get paid more. the p4p system please them and keeps them from quiting and going to private hospitals.

you cannot make everybody happy and in many places of the world a salary is probably lower in rural areas compared with a salary in urban areas, but living costs are also different.

The p4p system will encourage doctors to hurry through with the visits they make there by giving them more money, As a result the patient will get less care.

the doctors will over work them selves and not be able to give the best care they could due to being tired and no time to think between patients,

It will be interesting to see how many doctors are left in the government hospitals once the system has been going for a few years and some doctors no longer are indebted to the government to stay at a state hospital.

I see you agree that it is a bad plan you are already starting to blame Abhist for it.

[ZhouZhou]

the health system experts of the forum who are bashing the current government for this should not forget that this new p4p system was conceived under the previous Democrat-led administration.

it is actually only a re-zoning of that was is counted as remote. remoteness bonus will payed to 122 hospitals down from 736 previously.

guess that means for that real real deep remote areas is still the extra bonus paid. So it encourages doctors who want to get that remote allowance to move to the real remote areas where they are probably most needed.

under the new system also dentists, nurses and and pharmacists will get remoteness allowance. previously it was only for doctors. so that sounds good for nurses and dentists in remote areas. not on duty doctors will not get their automatic bonus anymore, like it was before.

if you look at the numbers of doctors claiming now to leave, you should also keep in mind that there are probably a lot of doctors in not so remote areas with a heavy workload also toying with the idea to leave if the don't get paid more. the p4p system please them and keeps them from quiting and going to private hospitals.

you cannot make everybody happy and in many places of the world a salary is probably lower in rural areas compared with a salary in urban areas, but living costs are also different.

The p4p system will encourage doctors to hurry through with the visits they make there by giving them more money, As a result the patient will get less care.

the doctors will over work them selves and not be able to give the best care they could due to being tired and no time to think between patients,

It will be interesting to see how many doctors are left in the government hospitals once the system has been going for a few years and some doctors no longer are indebted to the government to stay at a state hospital.

I see you agree that it is a bad plan you are already starting to blame Abhist for it.

that argument has flaws. as an assumed money obsessed doctor will not be able to create more and more patient visiting him. the number of visiting patient will be probably the same.

too many patients - too little time means they are understaffed.

better salary with p4p will maybe decrease the workload for each doctor in a hospital working under that rule because now the doctors are less likely to leave for a job in a private clinic and additional other doctors might think about to start to work in a hospital with many incoming patients and lots of work , because now it pays out. previously it doesn't matter is you had worked at a slow place with few patient or one with heavy workload in an urban centre.

.

i am not blaming Abhist for it. i don't even call it a bad plan.

[Bluespunk]

"From now on, no doctor will provide treatment to patients [merely from the goodness of] his heart

Yeah, right. That's why they do the job. However that little gem aside, I am amazed at the stupidity of this govt who, it appears, will do anything to save money to pay for their rice bill and expensive train sets. They clearly do not have a clue about anything they are doing, except filling their own pockets. This, I admit, they are superb at.

[PoodMaiDai]

Can someone just blame Thaksin so we can close off this thread and move on?