Abstract
Over the past 5 decades the government initiated compulsory three years rural service and scaled up the production. Although the number of physicians is constantly increasing, there is a lack of policy to control their mobility. The distribution of physicians varies over area and time, increases, or decreases in their number are important issues for the healthcare system. This study aimed to examine associated factors and synthesized policy options to increase the supply of rural physicians. Mixed method descriptive research design was conducted. Data collection process comprised of STEEPV analysis from document review, expertises indepth interview, rural physician stock and flow analysis, survey of factors associated with rural retention among 121 last 5 years graduated physicians, applied DCE method to determine job preference among 400 last year medical students and introduced Modified Delphi method comprising panelist with 32 expertises to develop policy options. Findings showed that 1. ageing society, chronic diseases, urbanization, technology disruption are major driving forces to transform health care system in Thailand. 2. COVID-19 impacts are still to be determined. 3. primary care is a foundation of population health improvement, any where any time service is needed. 4. Tele-health, Digital health and rapid change of advance medical & information technologies can reduce the geographical imbalance in the health workforce and increase health care accessibility. 5. urban facilities, specialist residency training and low intensity of workload are preferable job characteristics among young generation of physicians. 6. rural background physicians retain in rural areas longer than others 7. Ten policy options with high impact to retain rural physician and high possibility to implement include 1) targeted admission 2) promote task shifting & sharing among health professionals with appropriate training and regulation 3) senior/expertise supervision system 4) Telemedicine/Tele-consultation strengthening 5) prosecution support 6) fair performance based payment 7) career advancement 8) good work-life balance and manageable workloads 9) cooperation among all sectors to share resource in local area 10) Decentralized HR management in the regional level to improve performance. This study suggested to improve important interventions of compulsory service, taking multiple factors of rural retention into distribution strategy. Increasing reasonably penalty rate, non-civil servant employment and demand side financing for medical students are policy measures that should be improved based on the evidence from further studies.
