The Nation


Dire need for doctors in rural areas

Study finds most medical graduates come from cities, prefer to stay there

Yes, working in remote areas with few facilities and a heavy workload is tough, but it's not that bad to work there, one doctor says. People simply need to adjust their lifestyle and point of view towards rural areas. Dr Puttaraksa Deesin is the director of Tha Khanto Hospital in Tha Khanto, a small district in Kalasin, in the Northeast. He knows well how hard - and how happily - one can work in a rural area. Most physicians, however, prefer to work in urban areas, where there are big public and private hospitals. This trend has resulted in a severe shortage of physicians in rural areas. Puttaraksa is different. He quit a private hospital many years ago to work at a provincial hospital and moved later to the district hospital. He was well rewarded for work at the private hospital, where his income was three times that in his current one. "If you are single and like tranquil and natural areas, you can live and work happily in a district like me. There is no convenience store, no ATM, no entertainment venues and few food shops here, but I adjusted my views and lifestyle," he said. "I now work here happily, and so would you. "Having only two doctors here - including me - we work very hard, taking turn to take care of patients, but our relationship with the patients is much different from those working in urban areas. Rural people are nice. We are quite intimate. I don't have any problems about legal charges against me," he said.

However, Puttaraksa said most medical students were from families in urban areas, so it was difficult to push them to work in rural areas.

Nonglak Pagaiya, manager of the Human Resources for Health Research and Development Office (HRDO), confirmed that most newly graduated physicians opted to live in urban areas, and this was one of the main reasons for the lack of physicians in rural areas. Nonglak cited a survey of 574 newly graduated physicians last year that showed up to 77 per cent lived in urban areas, while only 21 per cent said their home towns were in remote areas. (The other 2 per cent did not identify their home towns.) "Most [doctors] are urban people. So it is really hard to have them work in rural areas," she said. Puttaraksa said working in a district hospital, especially one in a small district with few facilities, could discourage physicians. This is why Nonglak wants the government to continue the One District One Doctor (ODOD) project, plus the Collaborative Project to Increase Production of Rural Doctors (CPIRD). These focus on identifying good students in rural areas and giving them the chance to study medicine, in a bid to increase the number of physicians in rural hospitals. Records from 2003-2007 show fewer physicians trained through the CPIRD had left the Public Health Ministry than those not recruited under the project. Dr Thinakorn Noree, an HRDO researcher, said training available to physicians prepared to spend their own money to learn to be specialists also caused doctors to quit jobs with the ministry within a few years. "Medical schools should not allow them to be trained if they have not worked for public hospitals for three years in return" after the country spends about Bt1.8 million teaching each of them, he said. Nonglak said the HRDO backed a proposal to increase the fine imposed on physicians who quit the Health Ministry within a few years from just Bt400,000 - an amount set back in 1973 - to Bt1.8 million. The HRDO plans to put these proposals to the National Commission on Human Resources for Health on May 26, to make it easier to retain doctors in rural areas.

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