BackgroundComprehensive policies for rural retention of medical doctor and other health professional, including education strategy and mandatory service, have been implemented in Thailand since the 1970s. This study compared the rural attitudes, intention to fulfil mandatory rural service and competencies between medical graduates’ from two modes of admission, normal and special tracks.MethodsThree cross-sectional, self-administered questionnaire surveys were conducted in April 2010, 2011 and 2012. The questionnaire was distributed to all new medical graduates in the annual Ministry of Public Health meeting to allocate workplaces for the 3-year mandatory service.FindingsThe majority of students were recruited through the normal track (56 to 77%) from medical schools in Bangkok (56 to 66%), having mostly attended secondary schools in Bangkok. A majority of special track graduates came from secondary schools in provincial cities (76 to 79%). All three batches came from well-educated parents.A slight difference in rural attitudes was observed between tracks. Univariable analysis found statistical associations between the intention to fulfil the 3-year obligation and special track recruitment and attributes on rural exposure. Multivariable analysis showed that graduates recruited through the special track had a 10 to 15% higher probability of fulfilling the mandatory service.Special track graduates scored higher on four out of five competencies, notably procedural skills, but normal track graduates had higher competency on clinical knowledge in major clinical subjects.ConclusionSince special track recruitment resulted in a higher probability of fulfilling mandatory service and competency, increasing the proportion of special track recruitment and improving the effectiveness of policies addressing physician shortage were recommended.
Background: Inequity in health workforce distribution has been a national concern of the Thai health service for decades. The government has launched various policies to increase the distribution of health workforces to rural areas. However, little is known regarding the attitudes of health workers and the factors influencing their decision to work in rural areas. This study aimed to explore the current attitudes of new medical, dental and pharmacy graduates as well as determine the linkage between their characteristics and the preference for working in rural areas. Methods: A cross-sectional survey was conducted, using self-administered questionnaires, with a total of 1,225 medical, dental and pharmacy graduates. They were participants of the meeting arranged by the Ministry of Public Health (MOPH) on 1-2 April 2012. Descriptive statistics using mean and percentage, and inferential statistics using logistic regression with marginal effects, were applied for data analysis. Results: There were 754 doctors (44.4%), 203 dentists (42.6%) and 268 pharmacists (83.8%) enrolled in the survey. Graduates from all professions had positive views towards working in rural areas. Approximately 22% of doctors, 31% of dentists and 52% of pharmacists selected 'close proximity to hometown' as the most important reason for workplace selection. The multivariable analysis showed a variation in attributes associated with the tendency to work in rural areas across professions. In case of doctors, special track graduates had a 10% higher tendency to prefer rural work than those recruited through the national entrance examination. Conclusions: The majority of graduates chose to work in community hospitals, and attitudes towards rural work were quite positive. In-depth analysis found that factors influencing their choice varied between professions. Special track recruitment positively influenced the selection of rural workplaces among new doctors attending the MOPH annual meeting for workplace selection. This policy innovation should be applied to dentists and pharmacists as well. However, implementing a single policy without supporting strategies, or failing to consider different characteristics between professions, might not be effective. Future study of attitudes and factors contributing to the selection of, and retention in, rural service of both new graduates and in-service professionals was recommended.
BackgroundThe demand for nurses is growing and has not yet been met in most developing countries, including India, Kenya, South Africa, and Thailand. Efforts to increase the capacity for production of professional nurses, equitable distribution and better retention have been given high strategic priority. This study examines the supply of, demand for, and policy environment of private nurse production in four selected countries.MethodsA scoping systematic review was undertaken to assess the evidence for the role of private sector involvement in the production of nurses in India, Kenya, South Africa, and Thailand. An electronic database search was performed, and grey literature was also captured from the websites of Human Resources for Health (HRH)-related organizations and networks. The articles were reviewed and selected according to relevancy.ResultsThe review found that despite very different ratios of nurses to population ratios and differing degrees of international migration, there was a nursing shortage in all four countries which were struggling to meet growing demand. All four countries saw the private sector play an increasing role in nurse production. Policy responses varied from modifying regulation and accreditation schemes in Thailand, to easing regulation to speed up nurse production and recruitment in India. There were concerns about the quality of nurses being produced in private institutions.ConclusionStrategies must be devised to ensure that private nursing graduates serve public health needs of their populations. There must be policy coherence between producing nurses for export and ensuring sufficient supply to meet domestic needs, in particular in under-served areas. This study points to the need for further research in particular assessing the contributions made by the private sector to nurse production, and to examine the variance in quality of nurses produced.
IntroductionThai pharmacy education consists of two undergraduate programs, a 5-year Bachelor of Science in Pharmacy (BScPsci and BScPcare) degree and a 6-year Doctor of Pharmacy (Pharm D). Pharmacy students who wish to serve in the public sector need to enroll in the public service program. This study aims to compare the perception of professional competency among new pharmacy graduates from the three different pharmacy programs available in 2013 who enrolled in the public service program.MethodsA cross-sectional survey was conducted among new pharmacy graduates in 2013 using a self-administered, structured, close-ended questionnaire. The questionnaire consisted of respondents’ characteristics and perception of professional competencies. The competency questions consisted of 13 items with a 5-point scale. Data collection was conducted during Thailand’s annual health professional meeting on April 2, 2013 for workplace selection of pharmacy graduates.ResultsA total of 266 new pharmacy graduates responded to the questionnaire (response rate 49.6%). There were no significant differences in sex and admission modes across the three pharmacy programs. Pharm D graduates reported highest competency in acute care services, medication reconciliation services, and primary care services among the other two programs. BScPsci graduates reported more competence in consumer health protection and herbal and alternative medicines than BScPcare graduates. There were significant differences in three competency domains: patient care, consumer protection and community health services, and drug review and information, but no significant differences in the health administration and communication domain among three pharmacy programs.ConclusionDespite a complete change into a 6-year Pharm D program in 2014, pharmacy education in Thailand should continue evolving to be responsive to the needs of the health system. An annual survey of new pharmacy graduates should be continued, to monitor changes of professional competency across different program tracks and other factors which may influence their contribution to the health service system. Likewise, a longitudinal monitoring of their competencies in the graduate cohort should be conducted.
BackgroundThis study forecasts physician supply between 2012 and 2030 using cohort analysis, based on future production capacity and losses from the profession, and assesses if, and by when, the projected numbers of physicians would meet the targets of one doctor per 1,500 population, as proposed by the 7th National Conference on Medical Education in 2001, and one per 1,800, proposed by the Ministry of Public Health (MoPH) in 2004.MethodsWe estimated the annual loss rate that best reflected the dynamics of existing practising doctors, then applied this rate to the existing physicians, plus the newly licensed physicians flowing into the pool over the next two decades (from 2012 to 2030). Finally, the remaining practising physicians, after adjustment for losses, were verified against demand projections in order to identify supply gaps.ResultsThailand has been experiencing an expansion in the total number of physicians, with an annual loss rate of 1%. Considering future plans for admission of medical students, the number of licensed physicians flowing into the pool should reach 2,592 per annum, and 2,661 per annum, by 2019 and 2030 respectively. By applying the 1% loss rate to the existing, and future newly licensed, physicians, there are forecast to be around 40,000 physicians in active clinical service by 2016, and in excess of 60,000 by 2028.ConclusionThis supply forecast, given various assumptions, would meet the targets outlined above, of one doctor per 1,800 population, and one per 1,500 population, by 2016 and 2020 respectively. However, rapid changes in the contextual environment, e.g. economic demand, physician demographics, and disease burden, may mean that the annual loss rate of 1% used in this projection is not accurate in the future. To ensure population health needs are met, parallel policies on physician production encompassing both qualitative and quantitative aspects should be in place. Improved, up-to-date information and establishment of a physician cohort study are recommended.
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