Rapid growth of the industry will create a stronger demand for already scarce skilled labor. As of now, Thai schools graduate just 2 doctors and 12 nurses per 100,000 population each year; which is about one third or one fourth the rate of Singapore. Nursing schools in the Philippines produce 6 times as many graduates each year as their Thai counterparts. At this rate, the supply of health workers in Thailand would not be able to catch up with the fast growing demand.
For these reasons, Thai hospitals will need to recruit doctors, nurses and technicians from abroad. Potentially, the rules on cross-border hiring will become easier under the AEC. And the AEC will increase harmonization of standards and technical regulation, making it easier to integrate foreign staff. Yet, several obstacles remain, including the language barrier and licensing procedures. It will take time to agree on setting professional qualifications across borders. Caution is appropriate, given the need to ensure high standards and safety.
If the limited pool of health professionals is left unresolved, the rapid expansion of the health care industry could threaten the public healthcare system by draining resources into the private sector. The so-called “internal brain drain,” or a flow of human resources from public to private hospitals, has been ongoing, because of the scarcity of medical staff. When the AEC kicks in and propels growth of the industry, this phenomenon could exacerbate disparities in healthcare access in Thailand. Already the pay gap between the public and private sectors in Thailand remains as high as 6-11 times for physicians since 1997. 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.