Physician Retention in Community Hospitals of Thailand: A Case Study of Changwat Nakhon Ratchasima - การคงอยู่ของแพทย์ในโรงพยาบาลชุมชนของประเทศไทย: กรณีศึกษาจังหวัดนครราชสีมา

Abstract

            The objectives of this study were to explain phenomena of physician turnover and retention in community hospitals of Thailand; search for main factors related to physician retention in community hospitals; develop model of physician retention in community hospitals of Thailand. Methodology was divided into 3 steps: 1) review of physician retention phenomena from the past until present and relevant literatures to develop theoretical model of physician retention in community hospitals of Thailand; 2) qualitative study divided into 2 parts, firstly by analyzing general information of 65 existing physicians from the Personnel Division, Nakhon Ratchasima Provincial Health Office and secondly by in-depth interviewing 39 existing physicians (60%) in April, 2008 and then to modify the model; 3) quantitative study which tested generalization of the model by existing physicians survey in community hospitals all over country. In the second step, it was found that average length of stay in community hospitals of existing physicians in Changwat Nakhon Ratchsima was 9 years (SD 7.4, min-max 2.2 - 26.2); lowest (3.1 years) in age interval 25 - 30 years; highest (23.5 years) in age interval more than 50 years. Physician retentions varied with age, marital status, hometown or habitation, position and type of learning. The in-depth interview revealed that 3 factors related to physician retention: 1) Personnel factors: good rural attitude, suitable work load, suitable income to motivate physician retention ; 2) Community hospital factors: hospital size, hospital administration, relationship with hospital administrators and staffs; 3) Community factors: developed community size, social recognition, and kinship responsibility. A causative model for physician retention in community hospitals was proposed in this study. Quantitative study on existing physicians nationwide should be conducted. The results were contributed to solve physician retention problems in Changwat Nakhon Ratchasima and develop physician retention policy of Thailand.

Key words: physician retention, community hospital, Changwat Nakhon Ratchasima