Millions of people come to Bangkok for medical care. They get everything from face-lifts to heart-bypass operations. These medical tourists have helped boost the Thai economy, but there's a downside. Doctors in Thailand have become so busy with foreigners that Thai patients are having trouble getting care.
When medical tourists come to Bangkok, they usually go to places like Bumrungrad Hospital. It's a private facility, downtown, near the fancy hotels. It has a sushi bar, interpreters who speak Arabic and Mandarin, and VIP suites with marble bathrooms.
Most Thais can't afford it. They're more likely go across town to Siriraj Hospital, along the banks of the Chao Phraya River.
Doctors in Demand
Siriraj was founded by the royal family more than a century ago to provide free care to the Thai people. It treats more than 2 million patients a year.
The outpatient waiting room looks a bit like Grand Central Station. On a very hot day. With no air conditioning.
Hundreds of patients are squeezed onto old wooden benches. Many more are slumped in wheelchairs or lying on gurneys.
Malai says she has come in from the district of Phetchaburi because she feels sick and her legs hurt. She also has hepatitis. She left her home at 3 a.m. to travel three hours to the hospital.
She will probably have to wait several hours to get two or three minutes with a doctor. Then she'll wait some more for test results or a prescription. Malai says she won't get home until 9 p.m.
A recorded message asks for patience. It's a constant reminder that Siriraj doesn't have nearly enough doctors.
And neither do other hospitals that accept people covered by Thailand's basic health plan.
The Pay Factor
The problem is money. Doctors don't get paid much for working at public hospitals, so many won't. The ones who do tend to moonlight at private facilities.
Dr. Suwit Wibulpolprasert is an adviser to the Thai Ministry of Health. He says even public doctors depend on private patients.
His wife, for instance, is a radiologist who works five days a week at a medical school and then at a five-star private hospital on Saturdays.
"What she earns in one day per week is about almost three times what she earns in five days at public medical school. So we survive," he says, laughing. "We serve the public at the same time we serve the private."
Wibulpolprasert's wife is trying to follow the teachings of Thailand's Prince Mahidol. In the 1920s, the prince called on Thai doctors to treat the poor as they would their own families.
But Wibulpolprasert says many young doctors don't feel this obligation.
After medical school, most of them have to work in a provincial hospital for at least a couple of years. Wibulpolprasert says once that's done, they tend to head for the private sector.
"And this is the so-called river of no return," he says. "They never go back."
The doctor shortage isn't a new problem for Thailand.
During the Vietnam War, Thai doctors left in droves to work for the U.S. military. Then they started leaving for other countries, where they could earn more money.
The shortage gets worse every time a doctor leaves the public sector to take care of medical tourists.
Other Avenues for Revenue
The river of no return is flowing swiftly at Siriraj.
Dr. Damras Tresukosol is a cardiologist here. He says the doctors he loses are often the most skilled.
"I just heard that one of my colleagues resigned from this hospital. He is one of the best cardiac surgeons who can perform congenital heart operations," he says, slumping a bit. He looks around the small meeting room. "I'm very afraid ... that if we don't change anything, good doctors will leave and work for private."
So Tresukosol is trying a radical experiment just outside the meeting room.
High above the teeming outpatient department, Tresukosol has created a new center for cardiac care.
The fifth floor is like one of those swanky private hospitals downtown. Tresukosol notes the television, refrigerator and sofa. There's an entertainment area for relatives. It's private, modern, home-like.
"So that's the idea," he says.
There's even a marketing slogan.
"This is our motto: We provide good hands and better hearts," Tresukosol says, laughing.
The idea is simple: Attract some private patients to Siriraj, so doctors here can earn more money without leaving for another hospital.
Siriraj isn't focusing on medical tourists. The cardiac unit hopes to get Thai people willing to pay a bit extra for special care and no waiting, or expats who want more amenities and privacy than they would get in a typical public hospital.
It's a big leap for a hospital with a royal mandate to care for the common person. But Tresukosol says the new unit will help fulfill that mandate.
"We have our own motto. The motto belongs to the king's father. His motto is to treat the poor as ourselves," he says. "But to survive in this globalization, we have to look forward and try to bring in more patients who are affordable to this unit, to give us some revenue to treat the poor."
Attracting Patients
It's too soon to know whether the cardiac unit will make money or keep doctors at Siriraj. But it has brought some new patients.
Robert Morris and his wife retired to Thailand a few years ago. When he began having heart problems, he came to Siriraj.
"Right now, I'm a post-pacemaker implantation patient. It was implanted yesterday at 1 in the afternoon," he says.
Morris is not exactly the average patient. He used to run a big Veterans Affairs hospital in Denver. And he knows a lot about Siriraj.
"This is the facility where the king would come. If the king can come here, I certainly can come here," he says.
Even with more patients like Morris, Siriraj will never be able to pay doctors as much as places like Bumrungrad.
But Tresukosol says the private patients will make it easier for doctors to follow the lead of Prince Mahidol.
The prince left Thailand to get an MD at Harvard. Then he came back to spend his life caring for the poor.
Produced by Rebecca Davis.
Copyright 2023 NPR. To see more, visit https://www.npr.org.
