At the country level, a 2011 research paper in Lancet, one of the top medical journals, shows that the distribution of doctors and nurses in Thailand becomes increasingly skewed toward private hospitals in urban areas over time.
Among the first group to flow into the private sector are specialist physicians, since their services are in high demand by medical tourists. Public hospitals already lack enough specialists, as reflected in long waiting times for advanced procedures. To make the matter worse, Thailand has become an aging society, and senior citizens will comprise 20% of the population by 2035. Most of Thailand's elderly are in the low-income group and will therefore rely heavily on public hospitals. Furthermore, the “internal brain drain” might also erode medical education in Thailand, because a large number of specialists might leave public medical schools to private hospitals.
To cope with these challenges, the government should relax immigration rules on language fluency in order to slow down the "internal brain drain" process in the short term. Indisputably, quality control is most crucial. The public’s health must first and foremost be protected. Both local and foreign personnel need to show their competence in exams and clinical skills. Yet, physicians serving patients who are mostly or entirely foreigners should not be required to have proficiency in speaking Thai. Hiring foreigners would allow private-sector hospitals and medical tourism to continue to grow without luring away as many of the healthcare professionals who now serve Thais at public hospitals.
Bridging the HR gap in the long run requires education reform, so that more doctors, nurses and technicians are trained in Thailand. The current rate at which the system produces medical workforce is, and will be even more, inadequate. Severe shortage of physicians, nurses, and pharmacists would hamper Thailand’s aspiration to be a top-notched medical tourist destination. The reform may extend to hospitals and public health facilities re-organizing work processes to make more efficient use of limited human resources.