Using soft system methodology to improve the high turnover rate of general practitioners in Thailand's community hospitals

The Thai government's plan to shift to personal-based medical services faces challenges due to healthcare provider shortages and high doctor turnover. Despite efforts to increase medical students, turnover persists, overburdening doctors and harming patient care and satisfaction. In order to address these challenges, targeted strategies are needed to decrease the turnover rate of general practitioners (GP) in Thailand’s community hospitals. Objectives of this study are (1) To define the reasons and their associations with the turnover rate of GPs in Thailand’s community hospitals, (2) To understand the cause of the turnover rate of GPs in Thailand’s community hospitals both surface and underlying perspectives and (3) To suggest and evaluate potential strategies for retaining GPs in Thailand’s public healthcare system.Various aspects of the healthcare system in Thailand are discussed, including its history, recruitment strategies, healthcare coverage, patient-centered care, hierarchical culture, and the importance of the relationship between doctors and patients. This research utilised the soft system methodology, photo elicitation, causal layered analysis, and thematic analysis. The study aims to provide transformative changes and constraints that exist. The participants were chosen and included 15 individuals divided into two groups, consisting of volunteers who responded to a social media post and experts in various fields.Six main themes emerged from the data: (1) personal factor, (2) Imbalance workload and income, (3) organisation system and organisational culture, (4) government policy and universal healthcare system, (5) primary care and patient-based system, and (6) myths and metaphors. The study emphasises improving GPs' quality of life, with adequate rest being crucial. A stable GP workforce is vital for enhancing patient care, health outcomes, and satisfaction. The Ministry of Public Health (MOPH) should address high GP turnover in community hospitals by providing growth opportunities, transparent training, reduced workloads, health literacy promotion, and patient-related issue management through a bottom-up policy approach. Ensuring GPs complete their tenure in community hospitals benefits both doctors and MOPH.