Need for Internal Medicine Subspecialists in Thailand
Amorn Leelarasamee MD, FACP*,**,***, Tanin Intragumtornchai MD, FACP*,****,
Supasit Pannarunothai MD, PhD*****, Sudsawat Laohavinij MD, PhD******,
Boonsong Patjanasoontorn MD, FACP, FCCP, FCCM*******, Surajit Suntorntham MD, MBA, FACP********,
Rungroj Krittayaphong MD, FACP**, Chureeratana Bowonwatanuwong MD, FRCPT*********
The Human Resource Working Group of the Royal College of Physicians of Thailand*
Affiliation :
*The Royal College of Physicians of Thailand
**Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
***Faculty of Medicine, Siam University, Thailand
****Faculty of Medicine, Chulalongkorn University, Thailand
*****Centre for Health Equity Monitoring Foundation, Thailand
******Rajavithi Hospital, Ministry of Public Health, Thailand
*******Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand
********National Health Security Office, Thailand
********* Internal Medicine Department, Chonburi Hospital, Thailand
Background : Matching supply side of the Internal Medicine (IM) subspecialists to the demand for complex medical care at
referral medical centers would lead to more efficient health system management and ultimately optimal clinical outcome. The
second decade of the universal health coverage policy in Thailand has raised the awareness on how to reach equitable utili-
zation goals of good quality medical services, while barriers of accession have been removed. More accurate evidence-based
human resource planning is timely needed.
Objective : To estimate the number of the ten subspecialists in internal medicine (neurologist, cardiologist, endocrinologist,
gastroenterologist and hepatologist, nephrologist, hematologist, oncologist, rheumatologist, pulmonologist, and infectious
disease specialist) needed for complex medical care based on the workload in the year 2013.
Material and Method: The present study applied a needs assessment model with evidence-based approach. Claimed data of
inpatients in the year 2013 from the three government insurance schemes (the Civil Servant Medical Benefit, the Social Security
and the Universal Health Coverage schemes), and out-patient data from Universal Coverage System were used to estimate
demand for subspecialists. The Human Resource Working Group of the Royal College of Physicians of Thailand agreed on
the conceptual framework to estimate the need for ten subspecialists based on clinical activities of outpatient consultations,
inpatient ward rounds and non-operating room procedures on medical cases of respective diagnosis related group with severe
and catastrophic comorbidities and complications by the Thai-DRG version 5. Representatives from the Associations of IM
subspecialties approved the lists of ICD-10 diagnosis and ICD-9-CM procedure codes specific to each subspecialist care
and proposed assumptions on rates of consultations from other specialists. Surveys were done to subspecialists in 6 major
provincial clusters and representatives from IM subspecialty Associations asking time spent on main activities of patient
care. The number of full-time-equivalent (FTE) subspecialists needed was calculated by multiplying the clinical workloads
measured in minutes spent for each activity (ward round, ward work, inpatient and outpatient consultations) to get the total
time needed, then divided by the available time for clinical activity of one subspecialist.
Results : From 5.9 million inpatient discharges in the year 2013, primary responsibility of patients in respective severe and
catastrophic DRGs related to specific subspecialist workloads were summed up for teaching hospitals and regional hospitals
ranging from as lowest the 2,849 cases for rheumatology to the highest 24,610 cases for gastroenterology and hepatology.
The number of inpatient non-operating room procedures by ICD-9-CM as listed by IM subspecialty Associations ranged from
8 times for endocrinologists to 22,927 times for cardiologists for the whole year. Of ten subspecialists, the estimated numbers
of cardiologist, nephrologist, neurologist, gastroenterologist and hepatologist, endocrinologist, oncologist, rheumatologist,
hematologist, pulmonologist and infectious disease subspecialist needed at teaching and regional hospitals were 516, 241;
345, 144; 312, 143; 195, 124; 189, 45; 137, 170; 90, 47; 96, 111; 203, 87 and; 129, 44 respectively according to the workload
recorded in the year 2013. The forecast FTE found the overall gap of discrepancy at 7 percent. If the distributions of these
subspecialists in public and private hospitals were taken into account, the gap of discrepancy in public hospitals increased
to 47 percent.
Conclusion : The demand-based forecast for the number of subspecialist needed was made possible with assumptions on
conceptual framework for case selection, the rates of consultation and time-spent related to activities of patient care. The estimated numbers of subspecialists were anticipated far from optimum since the workload in the year 2013 was derived as
a consequence of pre-existing suboptimal infrastructure of healthcare system. In addition, the deficit of subspecialists may
increase in the near future when highly efficient, non- or mildly invasive, time-consuming procedures of acute illness increase.
Sustainable matching demand and supply of human resource for health needed further validations of these assumptions.
Keywords : Internal Medicine subspecialists, Internal Medicine subspecialty, DRG database, demand-based forecast, human resource for healthcare system
All Articles
Download