Mandatory rural service for health care workers in Thailand.

CONTEXT: Throughout its history, the main problem for Thailand's health system in has been an inadequate number of physicians and other healthcare workers in rural areas. Due to this, for decades in Thailand, rural service has been mandatory for healthcare workers. ISSUE: Thailand's mandatory health service system commenced in 1889 and has been continuous until the present (2010). Under this system, all early-career health workers from public professional schools serve in rural areas as a governmental worker to maintain the rural health workforce. The system has ameliorated the shortage of physicians in rural areas by substantially decreasing the emigration of Thai physicians to foreign countries. Recently, an increasing number of healthcare workers have been streamed from mandatory rural service to urban private hospitals, leaving the mandatory rural service system at risk. This has led to a deterioration of shortage of rural healthcare workers. A number of strategies have been implemented in an attempt to solve this problem, such as one-year rural service prerequisite for specialist training for all new medical graduates; a special program in medical schools to produce rural physicians; setting a special salary rate for rural physicians; and founding new medical schools in rural areas. LESSONS LEARNED: Thai mandatory rural health service has succeeded in ameliorating the shortage of rural health workers although it has its own limitations and problems. In order to maintain effectiveness, the system requires continuous amendments in response to rapid changes in the medical and economic landscape in Thailand.