Education strategies for doctor retention : Thai experience โดย นพ. ฑิณกร โนรี ช่วง Building the Future Health Workforce and Workforce Planning and Policymaking ในการประชุม The Asia Pacific Action Alliance on Human Resources for Health (AAAH) ครั้งที่ 10

1. Building the future health workforce, planning and policy making
Education strategies for doctor retention
: Thai experience
Thinakorn Noree, MD., PhD.
Senior researcher
International Health Policy Program

2. Thailand: Basic information
• Population: 66,188,503 (2017)
• GDP per capita: 6,593 USD (2017)
• CHE per capita: 216 USD (2016)
• Life expectancy (M/F): 72/78
2
• Health system: Pluralistic, public dominate
80
20
Fig 1 : Number of Beds
Public
Private
75
25
Fig 2: Service utilization
Public
Private

3. Challenges in the past
• Severe external brain drain to US in 1970
• Overall shortage
• Geographical maldistribution

4. 4
HWF in Thailand mainly rely on domestic source
Doctor: 21 medical schools (19 public, 2 private) - 3,000/year
1. Increase production
Fig 3: HWF per population ration between 1979-2009

5. 5
Urge new medical schools to
locate outside Bangkok
• New medical schools and nursing
schools located outside BKK
• However, all schools still located in
urban area
BKK Outside BKK
Med 8 13
Fig 4: Location of medical schools
2. Building strong institutions

6. 6
• Budget subsidy in HWF training and education in
public sector
o Doctor 60,000 USD/student
o Living expense of 200 USD/month for special
tract for doctor training (ODOD program)
3. Government investment in HWF training

7. 7
1. Institutional quality assurance
• All schools are accredited by Ministry of Education
• All curriculum are approved by the profession
councils
2. New graduate quality assurance
• All new medical graduates have to pass the licensing
examination for permission to practice
• Doctors have life-long license
• Some professions have to relicense every 5 years
4. Assuring education quality

8. 8
• Rural recruitment policy for doctor started in 1974
• Collaborative Project to Increase Production of
Rural Doctor (CPIRD) started in 1995
• Collaboration between medical schools (MOE) and
regional hospitals (MOPH)
• At first start with 8 medical students in KhonKaen
Hospital in North-eastern part of Thailand
• Currently 1,131 medical students per year (36% of
total doctor production capacity)
• Currently 19 medical schools and 39 Medical
Education Centers under MOPH
5. Target recruitment

9. CPIRD: Collaboration between MOE and MOPH
39 Medical Education Center
(under MOPH)
19 medical schools
(under MOE)

10. Rural
Recruitment
Local Training
Hometown
Placement
Provincial
Recruitment
(provincial pool)
3
Yrs
3 Year return
service
at hometown
province
Clinical year at
39 regional
Hospitals
(under MOPH)
3
Yrs
Pre – Clinical
years
13 med schools
(Under MOE)
CPIRD Approach
Concept – Rural recruitment, local training and hometown placement

11. Annual production capacity
8
31
133 141
249 255 279 306
348
417
448
737
800
872
902
0
100
200
300
400
500
600
700
800
900
1000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
CPIRD Program
11
1,131 new enrollments in 2018

12. Community Engagement through Primary Health Care

13. Outcome  Better retention
13
o 10 years observation of graduates between 2001 and 2007 (5,578 normal
track versus 1,088 CPIRD graduates)
o Higher rural retention among CPIRD than normal track
Survival rate between CPIRD and Non-CPIRD program

14. Result: CPIRD program between 1995-2017
Total
5,828
doctors
85%
In public
sector
95%
In their
hometown
68%
In District
Hospital
• Attrition rate 0.4%
• Passing licensing examination = 99.6%
• Placement = 49.3% of total new doctors in MOPH

15. 15
• 1979 – Primary healthcare base, increase rural
training
• 1995 – CPIRD program
• 2013 – Established Health Professional Educational
Reform Commission  Transformative learning
o More inter-professional learning
o Early community exposure – start in year 1
6. Reform medical curriculum

16. 7. Compulsory public service (Doctor, Dentist)
External brain drain problem
• External brain drain of Thai doctors to USA since 1970
• Compulsory public service  started in 1972
• All new medical graduate have to work in public service
for 3 years (ODOD -12 years)
Compulsory year Fine (USD)
Normal tract 3 13,000
CPIRD program 3 13,000
ODOD program 12 67,000
16
• Fine will be increase to 83,000 USD

17. 1999 20152007
2,001-5,000
5,001-10,000
>10,000
≤500
501-1,000
1,001-2,000
Result: more doctor and better distribution
1 Doctor per population : 2,359 (2000)  1,184 (2017)

18. 18
• Increase health need (aging, NCD)
• Increase expectation of patients
• New generation of medical students
Future challenges

19. thinakorn@ihpp.thaigov.net