The pay-for-performance scheme announced by the Public Health Ministry will damage the public health system in the long run, doctors say.
The new medical salary system announced by Thailand's Public Health MInistry 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, protesting doctors say.
Among the doctors are 11 specialists who provide medical care for complicated conditions, according to 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 in Thailand 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.
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.
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 25,000 baht (US$851).
"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.
"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 scheme, 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.
Pongphon Sarnsamak and Tanpisit Lerdbamrungchai
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