training

Type of Training – Residency

Length of Training – 3 years (with course work) or 5 years (without course work)

Year Family Medicine established – 1999

Number of family medicine residents graduating each year – unknown

Number of institutions that offer family medicine – Currently, 38 FM training programmes exist in Thailand. 11 of them are based in universities and 27 are based in major teaching hospitals.

practice

Number of family doctors – 6,400

Physician to population ratio – 100:100,000

DALY: 20,525/100,000 individuals (due to all causes).

Life Expectancy:

• Females 2017: 80.0 years

• Males 2017: 73.0 years

Mortality rate 2017:

• Males: 199 per 1,000 male adults.

• Females: 91 per 1,000 female adults.

Infant Immunization-HepB3: % of 1-year-old children received: 99%

College of Family Physicians (Y or N):

• Yes: The Royal College of Family Physicians of Thailand (RAFPT).

Training

The undergraduate medical education is 6 years long, after which an undergraduate MD graduate can practice as a certified general practitioner without any further training, while a family physician needs an additional graduate MD training for 3 years (Wiwanitkit, 2016). The 3 yearlong graduate MD or specialist-training program is available but it is not mandatory (Wiwanitkit, 2016).

In 1969, the Thai Medical council approved general practice as a specialty. In 1992, the residency training programs were revised (Prueksaritanond et al., 2001; Arya et al., 2017). The first postgraduate residency program started in 1973 and was three years long (Prueksaritanond, et al., 2001; Arya et al., 2017). By the late 1980s, a total of 9 programs were set up, out of which 7 of them were in Bangkok and the other 2 were in the North (Prueksaritanond et al., 2001; Arya et al., 2017). The program consisted of curricula objectives, clinical rotations in various disciplines that included a general practice block within provincial or community hospitals (Prueksaritanond et al., 2001; Arya et al., 2017). The lack of a general practice department was a weakness of the program (Prueksaritanond et al., 2001; Arya et al., 2017). In 1999, only 216 (1.7%) of the 12,500 Thai board-certified physicians went to receive the specialty general practitioner training (Prueksaritanond et al., 2001; Arya et al., 2017).  In the same year, the general practice residency, in which the General Practitioners Association had a little role, was revised to the family medicine residency training (Williams, et al., 2002; Arya et al., 2017).  In June 1999, three-year family practice program was set up in 5 locations and started with only 9 trainees, this program focused on outpatient care and conceptual elements that define family medicine such as continuity of care and the biopsychosocial model (Williams et al., 2002; Arya et al., 2017). These programs were situated in family practice sites, regional, and provincial hospitals rather than university teaching hospitals in order to grow apart from specialty training programs (Williams et al., 2002).  As the number of residents increased each year, in 2002 the program reached a peak of 60 trainees (Arya et al., 2017). The College of Family Physicians was then established to have the central role in postgraduate education (Prueksaritanond et al., 2001).

Family medicine model of training has existed for a long time and over a period of time the curriculum has evolved (Wiwanitkit, 2016).  The first family medicine department was established at a Faculty of Medicine, Chiangmai University (Wiwanitkit, 2016). Family medicine is a compulsory subject in all the Thai medical universities, which started as a new specialty in the past century when the Western medical system reached Thailand. This discipline has developed over the past three decades (Wiwanitkit, 2016). The Thai government approves and accredits the board and degree of family medicine that is issued by Royal College of Family Physicians (Wiwanitkit, 2016). The Thai medical council allowed both general practitioners and physicians in other specialties to acquire family medicine board certification, which resulted in hybrid family physicians (Wiwanitkit, 2016).  This was a strategy that the council used to increase the number of family physicians to correspond to the PCU setting (Wiwanitkit, 2016).

As of 2002, 2 medical schools have established family practice departments: the Ramathibodi campus of Mahidol University in Bangkok has incorporated a 2 weeks in family practice into the curriculum out of the 6 year program; and Chiang Mai University in the northern city of Chiang Mai has incorporated 6 weeks in the fourth and fifth years with a focus on sociocultural issues of health and illness in the family and on medical service issues (Williams et al., 2002).

The general trend is the medical school graduates first work for the government for three years before entering a residency-training program. But in the case of family medicine, graduates can enter training for family physician immediately without working for the government due to the shortage of this specialty. Majority of the younger generation chose the route of becoming a family physician (Jaturapatporn & Dellow, 2007).  Family Medicine is usually not the first choice for residency training for MD undergraduate (Wiwanitkit, 2016).

A study on whether family medicine training in Thailand affects patient satisfaction with primary care doctors found that family medicine training program is associated with better reports in terms of satisfaction from patients in primary care regarding communication skills and patient enablement compared to doctors practicing without completing residency-training programs (Jaturapatporn & Dellow, 2007). Residents, who had not completed their training program, were also evaluated higher than general doctors (Jaturapatporn & Dellow, 2007). Thus, this study highlighted the importance of family medicine training in order to produce an efficient primary care workforce since family medicine is a specialty with specific requirements in terms of knowledge, skill, training needs, support and resources (Jaturapatporn & Dellow, 2007). This study was conducted in a primary care clinic within a tertiary hospital, hence in order to generalize the results, a more representative population of doctors in required (Jaturapatporn & Dellow, 2007).

practice

As of 2015, there are approximately 6,400 certified family physicians, which together constitute approximately one-fifth of overall physicians practicing all across Thailand (Wiwanitkit, 2016).  The ratio of family physician to population is only 1:1000 (Wiwanitkit, 2016).

There are three groups of doctors: Faculty physicians are doctors with postgraduate qualification in family medicine/general practice; General Doctors are doctors with no postgraduate training in family medicine/general practice; and Residents are doctors receiving training in the three year postgraduate family medicine/general practice program (Jaturapatporn & Dellow, 2007). These three groups of doctors practice medicine similarly and have the same authority to order tests, prescribe medication, and make referrals to the specialists (Jaturapatporn & Dellow, 2007).

General practitioners, who have no specialty training, are expected to practice without specific knowledge, as a family physician, hence this distorts the family physician system (Wiwanitkit, 2016).The Thai people prefer to seek specialist care because they do not understand the importance of family medicine (Wiwanitkit, 2016). Primary Care Units (PCUs) have been established in every district, according to the universal health coverage declaration (Wiwanitkit, 2016). This is way of promoting the family medicine system, which is unique since it is the first time that a specific family medicine unit has been set up (Wiwanitkit, 2016).

Family medicine in Thailand has a close relationship to the local alternative medicine since family medicine is a one branch of primary care (Wiwanitkit, 2016). Medical students learn about alternative medicine in their curriculum, hence family medicine practitioners can practice alternative medicine (Wiwanitkit, 2016). There are separate schools for Thai alternative medicine; hence graduates from these schools cannot perform family practice legally since they have not studied about modern medicine (Wiwanitkit, 2016).