Abstract
Since 1967, the Thai government has implemented policies to address physician shortages by increasing medical production and enforcing a three-year mandatory service contract for graduates from public institutions, or allowing them to pay a maximum fine of 400,000 THB in lieu of service. However, Thailand continues to face persistent physician shortages, which remain a major challenge for the health system. For more than two decades, the medical internship program has played a crucial role in preparing newly graduated doctors who complete their first year of compulsory service before continuing their second and third years in various hospitals. The program also serves as an essential prerequisite for admission into residency training in many specialties. Nevertheless, the current system faces numerous challenges, including excessive workloads, physician allocation that does not match actual service demands, inadequate and disproportionate salaries, poor work–life balance, deteriorating working conditions, difficult travel requirements, and training systems or organizational cultures that are not conducive to learning. These issues affect the satisfaction and retention of medical interns within the system. This study aimed to examine the current situation, analyze factors influencing the retention of medical interns, and synthesize policy recommendations to improve the management system for medical interns in hospitals under the Office of the Permanent Secretary, Ministry of Public Health. A mixed-methods approach was employed, consisting of a document review, health workforce data analysis, a survey of first- to third-year compulsory-service physicians who had previously participated in the internship program, in-depth interviews with hospital executives and clinical trainers, and expert panel discussions to formulate policy recommendations. The findings revealed that medical interns had a median workload of 85 working hours per week, experienced disproportionate workloads relative to income, and exhibited high levels of burnout. At the same time, many hospitals lacked adequate mentoring systems, rational duty allocation, and essential welfare support, and did not have a centralized real-time information system for workforce planning. Key push factors influencing resignation included excessive workload, poor work–life balance, insufficient income, and ineffective management systems. Conversely, pull factors supporting retention included strong mentorship, supportive working environments, opportunities for specialty training, and appropriate welfare benefits. The synthesis of empirical evidence led to six major policy recommendations: (1) improving physician allocation using algorithms and real-time workload data, (2) strengthening workforce management and support at the regional level, (3) establishing a centralized real-time workforce monitoring system, (4) enhancing mentorship and internal support systems within hospitals, (5) implementing integrated health workforce planning, and (6) reforming training curricula and regulatory frameworks to meet future workforce needs. These recommendations align with the “Triangle that Moves the Mountain” framework and the World Health Organization’s “Six Building Blocks of Health Systems.” In conclusion, comprehensive improvements to the medical internship management system, supported by modern and robust information systems, are essential for retaining physicians within the system and constitute a key mechanism for strengthening the long-term quality and sustainability of Thailand’s health services.
