Thai Doctor Assignments

[PeteC]

There's more to this story than meets the eye at first glance. See the highlighted sections below. It makes no sense to me that even for more money a person would opt to go to a war zone where the local dialect and food is more difficult IMO than that in Issan. I think what we're seeing/reading here is the same prejudice we often see between Bangkok people and country people, and the root of the Red Shirt problem. Bangkok people simply don't want to associate with dark skinned northeast farmers. The below new doctors talk as if they'll be living in a hut and bathing in a stream. Issan does have aircon and running water you know. I guess I could compare it to a New York City kid becoming a doctor at Columbia University and going to work in Mississippi about 60 years ago. Yep, I guess that's where Thailand is, about a half century plus behind concerning mentality. Pete

News » Local News
Doctors flock to South as Northeast loses patience
Graduates enter strife-torn regions to help out - and to gain more benefits

http://www.bangkokpost.com/news/local/3 ... s-patience
* Published: 5/04/2010 at 12:00 AM
* Newspaper section: News Bangkok Post

There were grimaces amid the cries of glee as thousands of medical graduates drew lots to decide in which province they will serve their rural internship.

For the first time, this year's competition to work in the southernmost provinces was fierce, unlike in the past when most new graduates refused to work there due to the insurgent violence.

Positions available at such remote district hospitals as Sungai Kolok in Narathiwat and Betong hospital in Yala were filled within half an hour of the first draw.

The surge to the South has, however, led to serious shortages in the Northeast.

But for Bangkokian Suparasmi Tuannawarat the South, despite the dangers, offers her more satisfaction - and money. She is among nine doctors competing for six positions available at Sungai Kolok district hospital. And she is among two female doctors who secured the position.

"I'm very happy with my decision and am excited to work there," she said while waiting in line to receive a letter of appointment to work at the hospital as early as this week.

"Because of the violence, people there are having problems getting access to medical services. I can help them because I am now a doctor."

The 24-year-old graduate from Siriraj Hospital said she decided to work in Sungai Kolok after learning from doctors who had previously served their rural internships there that the situation was not as bad as people think.

Her parents, while concerned for her safety, respected her decision. Dr Suparasmi said she aimed at working in Narathiwat until the completion of the internship period because she wanted to put her medical knowledge into practice to help local residents and gain as much experience as possible.

Dr Suparasmi said as much as she wanted to help people in the South, she admitted financial incentives offered to graduates to work in the danger zone were part of the appeal for the increasing number of doctors wanting to go there. Each doctor will receive about 80,000 baht a month, compared to the average 50,000 baht for those working in other rural areas.

The Public Health Ministry revised its payment rate for doctors working in the southernmost provinces of Narathiwat, Pattani and Yala.

As well as offering more cash, the ministry promised to allow doctors who work in the three provinces to transfer to other areas, or go for specialist training, after two years instead of three years.

But while financial incentives and better opportunities attract graduates to the South, the problem of doctor shortages in the Northeast has become more serious than ever.

Working as a doctor in the deep South is not nearly as tough and dangerous as many people believe, said Pasakorn Wanchaijiraboon, acting director of Narathiwat's Sukhirin Hospital.

He said one of the key problems involved was the difference in language. More Muslim doctors who graduated from Islamic countries would help ease the workload in the South.

In Thailand, there are 30,681 doctors serving an estimated 65 million population. Most of them work in urban areas. The proportion of doctors to patients per population in the Northeast is 1:5,300, compared to 1: 3,300 in the South and 1:850 in Bangkok.

One of the ministry's solutions is to transfer young doctors to work at community hospitals in the Northeast for a few months to ease the shortage in remote provinces during their three-year internship.

Surachat Chuaychob, a medical graduate from Prince of Songkla University's faculty of medicine, said he drew a lot which required him to work at Si Sa Ket hospital for three months before returning to serve the rest of his internship in his southern hometown of Nakhon Si Thammarat.

Dr Surachat said he had never been to the northeastern province before, but hoped he would be able to cope with the harsh environment and cultural differences.

This year, hospitals in the lower northeastern province of Si Sa Ket need 30 doctors while Buri Ram and Surin each need 35 new doctors for community hospitals. It takes up to four hours before these positions can be filled by drawing lots.

"When it comes to Isan (Northeast), people think about the harsh environment. It's quite understandable why most new doctors do not want to work at hospitals there, especially when there is no financial incentive," said Narathiwat doctor Pasakorn, who is serving his second year internship and was invited to coach new doctors.

Born and raised in Bangkok, Dr Pasakorn said difficulties to fit into different cultures and environments were also factors which make the Northeast unpopular with new doctors born and raised in urban areas like him.

He said health authorities should also increase incentives for doctors working in the Northeast to temporarily tackle the doctor shortage as a short-term solution, while a long-term project of producing local doctors to serve their local communities has not yet been completed.

"Although we choose to serve our internship in remote provinces, it does not mean we'll be there forever," he said.

"At the end of the day, most doctors will leave and further study in their specialised areas. That's why producing more local doctors is the answer."

The Public Health Ministry aims to have 10,678 more doctors by the year 2014 working at rural communities to solve the crisis and meet the desired proportion of doctor to patient per population of 1:1,500. A total of just 1,748 doctors work in their own communities.

[charlesh]

Perhaps 1 of the recent graduates treated this bloke (see below). Medicine equates to greedy people wanting to help themselves. Hippocrates would turn in his grave!
Put your life at risk for 80K Bht compared to 50K ?

The 44-year-old Sydneysider - we'll call him D - had one of the world's great jobs. A Thai resident for eight years, D worked on the island of Koh Samui, taking tourists on underwater adventures as a dive master and scuba-diving instructor.

Danger was never far away; of Koh Samui's population of 50,000, about 700 people die each year in motorcycle accidents alone. Despite its idyllic reputation, Koh Samui is "an incredibly dangerous place," D says.

One day, about a year ago, D woke up urinating blood. Nothing could have prepared him for the nightmare he says followed.

The hospital on Samui sent him home with a suspected urinary tract infection. Several days later he returned to hospital, collapsed and was admitted to intensive care with what would be diagnosed as a rare blood disorder known by the abbreviation TTP - a condition where the blood starts clotting and requires extensive transfusions. Until the 1980s, there was no known treatment and it was fatal in about 90 per cent of cases.

But the bigger danger, as it transpired, was that D's travel insurance had expired shortly beforehand. After two days at the hospital in Samui (the bill, roughly $10,870 at last year's exchange rate, is still being disputed), D was evacuated to a private hospital in Bangkok in a charter flight that cost about $13,000 - nearly three times the original quote.

After 10 days in intensive care and four days in a ward, D was billed for 2 million baht (about $86,950 at March 2009 exchange rates).

According to D, the bill included items such as water and chemist's supplies for 10 times the going street rate. D queried the most extreme price mark-ups.

The hospital agreed to deduct 500,000 baht. But then, "as I was preparing to leave, the hospital accountant appeared in my room with four burly Thai hospital security guards and told me I could not leave until I had discharged my bill in full".

"They knew I had a plane to catch and was still very ill [he had to spend another five weeks in hospital in Australia and undergo three months of outpatient treatment] and having given them all my credit cards, from which they took in excess of $30,000 (maxing them all out), my efforts to try and contract to pay the rest in monthly instalments from Australia proved futile.

"I had to contact my parents and they ended up giving their credit card details over the phone, which led to another $25,000 being deducted. The accountant said if I could not discharge my bill the police would be called and I would go to Thai prison. He was fully aware of my medical condition and knew without further treatment I would die."

D says the hospital staff had been made aware of his lack of medical insurance from the start, had not transferred him to a cheaper hospital as he requested and he says he was underquoted for the cost of treatment.

D asked for identity to be withheld so he can return to Thailand. "The hospitals are incredibly powerful and have a hell of a lot of clout with the police, local authorities, immigration," he says.

[Khundon1975]

"D's travel insurance had expired shortly beforehand".

I feel sorry for Mr D but he had been in Thailand for 8 years, so he must have been aware just how important health insurance is and that he must keep up the payments.

That's why it pays to check insurance is in place. Allowing his insurance to run out was his mistake, not the hospitals. If it was still running, the insurance company would have haggled the prices down.

I wonder how many people have run up huge bills and flown home after agreeing to pay later, then reneged on the deal? Of course, if Mr D died, then the hospital would have got nowt for their work.

A lot of people come to the UK, supposedly for a holiday, then book into A&E complaining of some medical problem. They get medical (emergency) treatment, then disappear back home without paying. So the Thais are just being careful. I wish the NHS was more careful with my tax money, where visitors are concerned.

Maybe the answer to the doctor shortage in Issan, is to set up a teaching/university hospital in the North East, that will give the students a few years to get used to the primitive lifestyle.