End the lottery system for state-funded doctors! Health Ministry overhauls physician retention, adjusts internship criteria with new compensation tied to workload
Thailand's Health Ministry is scrapping the lottery system for assigning state-funded doctors, instead offering volunteers priority access to preferred training and study grants. The new approach combines workload-based compensation tied to
On May 8, 2569, Dr. Somruks Chungsaman, Permanent Secretary of the Ministry of Public Health, revealed new guidelines for physician workforce allocation and management. He explained that Thailand's current healthcare challenge is not simply a shortage of doctors but rather a distribution problem and the need to align workforce management with actual workload demands across different regions.
Thailand currently has a physician-to-population ratio of approximately 1 to 900, compared to developed countries at around 1 to 600. While workload assessments indicate a shortfall of 20,000-30,000 full-time equivalent physicians, the ministry believes allocation decisions should be based on actual hospital workload rather than population ratios alone.
"The ministry is currently surveying all regions within three months to determine how many physicians each hospital—from 30-bed community hospitals to 600-700 bed regional centers—should have based on actual workload, including bed capacity, patient volume, and population served," Dr. Somruks said.
The primary issue is that most physicians work in the private sector or large hospitals, leaving Ministry of Public Health facilities, particularly in remote areas, severely understaffed. The ministry is implementing a new compensation system based on workload and productivity rather than uniform salaries, especially for high-demand specialties such as internal medicine, surgery, obstetrics, pediatrics, and emergency medicine.
Many specialist physicians work considerably harder than their counterparts in less demanding fields but receive equal salaries, prompting younger doctors to pursue easier specialties or careers in cosmetic medicine instead. The ministry is considering increasing special hardship allowances for positions in areas with over 40% physician shortages from 5,000 baht to 15,000 baht, and 10,000 baht for areas with 20-40% shortages.
Regarding state-funded physicians and medical interns, the ministry has implemented a new system allowing medical students and interns to voluntarily work in shortage areas first in exchange for priority selection of further study grants and preferred training locations.
"Previously, many state-funded physicians drew lots, got assigned to unwanted areas, and quit after the first year. This year we announced 30 shortage hospitals needing 205 physicians total. Those who volunteer get immediate priority in selecting further study opportunities. As a result, 180 first-year interns and 180 graduating medical students have already volunteered," Dr. Somruks stated.
Provinces with severe physician shortages include Bueng Kan and Sisaket, where the ministry is accelerating solutions, particularly regarding work systems and support from senior physicians and staff.
Dr. Somruks noted that the most common complaint from state-funded physicians is not compensation but lack of mentorship and teaching support. The ministry has received formal complaints through the Medical Council and established a fact-finding committee to address the issue.
