According to my work experience as a rural doctor in rural community hospital in Thailand and there are also about 2000 rural doctors working in about 700 community hospitals across the country, I think that the important issue is how to retain these rural doctors in rural areas with dignity and value to community as well as high quality in academics. Also, I want all of us would be accepted as a discipline and counted as one of a specialist.

                  In my opinion, rural medicine should be a sub-specialty of either family medicine or general practice, which there should be more training for at least a year regarding rural health. Then, after completion of the program, there should be motivation strategies to be used for retention of those graduates, which may include salary and benefit, and career development. For instance, adjunct position which will be attached with the university medical school may be one of the strategies. The context of rural medicine should include family medicine, preventive medicine, community medicine, health services management, rural health, and Thai socio-political system etc.

                 Therefore, if we start this tract as from an undergraduate level the roadmap to this career may be shown as below: Medical student—Internship—generalist—General Practitioner --- Family physician--- Rural Physician

                  Establishment of rural medicine in Thailand must be conducted as academic perspective not as a social or political perspective. There should be asked for benefit in the first place but there should show the importance, role and unique identity of rural medicine for Thai society; therefore, I would like to propose a plan to develop rural medicine in Thailand as followings:

1.  Rural Medicine is a discipline We should treat rural medicine as a discipline and strengthen its own principle and making an acceptance at the international level by doing data collection regarding this particular and then publish them as standard textbooks.

1.1 Study concepts of general practice and family medicine and integrate them and select only the important issues for working in rural communities.

1.2 Do review literatures regarding rural medicine and rural health.

1.3 Study, research about roles, missions, abilities from Thai rural doctors who are staying in rural communities for a long period of times and who have been granted best rural doctors’ awards, and all of stakeholders who are taking part in rural communities.

2. Identity Formation Identity formation can be occurred from the established principles which have been done from the number 1. The identity formation is very important. Before launching this idea to the public, we must push an effort to find out the identification of the term “rural medicine” in order that it would be clear and sound enough for publics to understand who they are and what they do. It must not be ‘the old whisky in the new bottle’.

3. Public Image There must be public relation’s activities which can help promote the rural medicine, such as, selection of the best rural doctors’ awards should be acknowledged through the medias, and other public activities with which the rural doctors have been involved should also be promoted through the public relations.

4. Public Communication Public communication is another way to promote rural doctors.

5. Society/College Encouraging rural doctors to help promote the importance and identity of rural medicine by establishing of the Thai rural medicine association and then develop to be the Thai College of Rural Medicine later. Then, through the college, promoting training and curriculum development may be achieved

6. Training program Introduce vertical integration strategy to the government and propose guideline for training of rural doctors as followings:

- Recruit the high-school students (Year 10) in the ‘One doctor for one district’ project and conduct some activities which will be done by the networking of schools, hospitals and university. There may be 8 to 10 students per network.

- The content may include activities which are dealt with learning the rural community and the activities should be conducted continually.

- There may be some academics activities, such as tutoring for basic education for entrance examination. This is to strengthen basic education for these cohorts in order that they would have basic competencies in studying medicine.

- There should be special grant or scholarship for these students and also available seats for them. There may be tutorial sessions through mentors for these students during the pre-clinical years study. There must also be rural health as a compulsory subject.

- During the clinical years, university should contribute academic support to the clinical training sites both in provincial and community hospitals. Learning system may be replicated from Australian rural medical training system and may include activities in rural communities.

- There may have tutorial session for strengthening these students for medical license examination in order to make them feel confident even though they have training from the outside-university hospital.

- After graduation, they should be assigned to work at their hometown or in the community hospitals which are the network of the university hospital. They should be allowed to have on-the-job training for post-graduate family medicine which is accepted by the Thai college of GP/FP.

- After they complete that training, there should be one more year training at the similar hospital and after this sub-specialty training, they may be allowed to change the working places but within the community hospital context.

7. Motivation Motivation is to encourage rural doctors to work in rural areas with happiness. The strategies may include financial, family, career advancement, academic advancement, research, and published papers which may be either at the national or at the international level etc.

8. Networks There should have networking with the other rural doctors in other countries through their colleges or institutions in order to do professional development to maintain and develop the capabilities of rural doctors.

Phichet Banyati, MD,MPH(Hons), Family Medicine, General Practitioner, Prenetive Medicine

Director of Bantak Community Hospital Bantak District,

Tak Province, Thailand

E-mail : [email protected]