“Do we know the problems? We do, but there are these things called medical ethics and sacrifice that constrain us. If we don’t see the patients who are waiting, how is it going to work? If we can do it. If we can endure it, just endure it,” said Dr. Poowanai Sarkhampee, Hepato-pancreato-biliary Surgeon at Sunpasitthiprasong Hospital in Ubon Ratchathani, who shared his thoughts with Thai PBS World on the harsh working conditions of medical personnel in Thai state hospitals, which has become a hot topic on social media.
In state hospitals, doctors, interns and nurses alike have to endure long hours, sometimes working 24 hours in a row, just to make sure the patients get the medical attention they need. The unhealthy workload has led to the number of new medical personnel dwindling and these problems have existed for a long time.
Demand and supply
While qualified medical professionals are in short supply, the number of patients keeps rising. When the doctor-to-patient ratio becomes disproportional, the workload increases to the point that some people to just leave the profession altogether.
Dr. Poowanai explained the situation from his personal experience during his early years at a 10-bed community hospital, which served up to two hundred outpatients per day. The doctor would have only a few minutes to see each patient. This is on top of doing night shifts and inpatient rounds, among other things.
He said he does not think working these kinds of hours is right, but it is how the system has been so far, with severe understaffing in many hospitals.
It is not a surprise that medical personnel in Thailand are in short supply, given the harsh and unhealthy working conditions, not to mention the compensation packages for doctors at state facilities, which have remained unchanged for decades.
In their first year after graduation, fresh medical interns will be sent to provincial hospitals across the country. Dr. Poowanai said that’s the first time they face the real world, compared to studying in a training hospital, where they have army of experts and professionals providing support.
The harsh working conditions begin there, the first year of internship, and it’s ongoing unless they leave the system. This has led to fewer 2nd and 3rd year interns in rural area, before they can qualify to begin their medical specialty studies. Even then, after specialty graduation, they will loop back into the same working cycle “Because of the doctor shortage,” said Dr. Poowanai.
The surgeon said he has put up with the working conditions this long because being a surgeon was his childhood dream and he has a clear purpose and goal for what he wants to do. He understands, however, that a work-life balance is important, especially with the younger generation. “It is right that you have to be in good health before you can treat others, but a good work-life balance is difficult in our public health system,” he added.
Two sides to the problem
Dr. Poowanai said there are actually two sides to the problem; the demand, which is the number of patients, and the supply, which is the number of medical staff available to treat them.
We have heard many discussions and suggestions concerning the supply shortage, but the topic of demand is something rather sensitive. It is a part of the equation, but it has not been addressed.
Thailand is praised for its Universal Healthcare Coverage, which makes healthcare more accessible for everyone, but it also brings unnecessary outpatients to the hospital.
Health literacy is the answer. The National Health Security Office, or NHSO, has mentioned this before. If Thailand is able to educate people, so that they learn how to take care of themselves primarily and know when to seek a doctor’s attention, the number of people flocking into state hospitals will be much lower.
This is in line with what Dr. Poowanai suggests. From data, together with his experience, more than half of the outpatients waiting to see doctors in state hospitals do not necessarily need to be there. This does not include people who come into the emergency room at midnight when their condition is nowhere near an emergency.
When the demand for medical staff reduces, that will also lower the pressure to produce more.
The system needs to change
As for short-term solutions, Dr. Poowanai said that high-ranking people in the medical system need to show their commitment, that they understand the problem and that they are willing to change to build trust among the next generation of medical personnel.
For long-term solutions to the doctor shortage, changing the mindset is the priority. People need to understand that the current system does not work and needs to be changed.
The second issue is the income. “The doctors in state hospitals should get paid at a level commensurate with their work. It doesn’t have to be as high as in a private hospital, but it should be enough to make a living,” said Dr. Poowanai, adding that they can’t say money is not important. “That is difficult to say in this time and age”.
Lastly, it’s about security and safety. Doctors should be assured of their security, that they have good welfare and, if they end up in lawsuits and whatnot, the system would understand them. This issue is not often discussed. Often doctors would be isolated and left fighting lawsuits by themselves, without support from the system, the ministry or the hospitals.
Doctors and interns haven’t asked for any special treatment or privileges. They are just seeking better working conditions. Everyone knows the current system does not work and that it has been in this state for a very long time. Until the ministry and agencies concerned make real changes, the doctor shortage is just going to get worse.
No one wants to see the medical system collapse. No one wants to see our doctors and nurses overworked and driven out of the system. Something has to change.
By Tulip Naksompop Blauw
