Asian Biomedicine Vol. 9 No. 6 December 2015; 777 - 782 DOI: 10.5372/1905-7415.0906.
450
Brief communication (Original)
Foreign medical practitioners: requirements for medical
practice and postgraduate training in Thailand under
ASEAN Economic Community liberalization in 2015
Kinzang Wangchuka, Natapol Supanatsetakulb
a
Faculty of Medicine, Naresuan University, Phitsanulok 65000, Thailand
b
Department of Pathology, Faculty of Medicine, Naresuan University, Phitsanulok 65000, Thailand
Background: The ten member states that currently comprise the Association of Southeast Asian Nations
(ASEAN) agreed to cooperate to become the ASEAN Economic Community (AEC). The first targets of the AEC
are free flow of goods, services, investment, capital, and skilled labor. The eventual goal is “a single market and
production base”. The ASEAN Mutual Recognition Arrangement (MRA) for medical practitioners has been
formulated to facilitate cooperation and the mobility of medical practitioners within the AEC.
Method: We reviewed the requirements of the Medical Council of Thailand (TMC) and the Thai Ministry of
Public Health for medical practice and postgraduate training of foreign medical practitioners.
Result: In Thailand a foreign medical practitioner (FMP), holding a valid medical license from their country of
graduation, will be recognized as a legal medical practitioner only after obtaining either a temporary or permanent
medical licensure from TMC. To acquire a permanent Thai medical license, the FMP needs to register as a
member of the TMC, have graduated from a TMC recognized medical school, but also having passed all 3 parts
of the National Licensing Examination of Thailand. A Thai medical license is also required for clinical postgraduate
medical training. Thai language proficiency is mandatory for registration. There is now only one formal
international postgraduate medical training program in Thailand. Participants as observers may be exempted
from some or all of these regulations.
Conclusion: The current status of medical licensure in the Kingdom of Thailand presents hurdles that may have
to be surmounted.
Keywords: ASEAN, foreign medical practitioners, medical licensing and reciprocity, medical practice, medical
training
The Association of Southeast Asian Nations One year later, the ASEAN Charter has taken effect
(ASEAN) was established by 5 leading countries: and is the constitution of the community since 15
Indonesia, Malaysia, Philippines, Singapore, and December 2008. The 3 main pillars of the ASEAN
Thailand. Subsequently, the ASEAN Declaration Community consist of the ASEAN Political–Security
was signed on 8 August 1967 [1]. Brunei Darussalam, Community, ASEAN Economic Community (AEC),
Vietnam, Lao PDR, Myanmar, and Cambodia and ASEAN Socio–Cultural Community. The AEC
joined later [1-3]. At the 9 th ASEAN summit at aims to achieve 4 main conditions: (1) a single market
Bali, Indonesia in 2003, all members of ASEAN agreed and production base, (2) a highly competitive economic
with the Declaration of Concord II to develop the region, (3) a region of equitable economic development,
ASEAN Community by the year 2020. In 2007, the and (4) a region that is fully integrated into the global
Declaration on the Acceleration of the Establishment economy [4].
of the ASEAN Community by 2015 was announced To become a single market and production base
at the 12th ASEAN summit in Cebu, Philippines. with free flow of goods, services, investment, capital,
and skilled labor is part of the AEC Blueprint [5].
Healthcare services are among the sectors to become
Correspondence to: Natapol Supanatsetakul, Foreign Language
in Medicine Learning Support Unit (FLM-LSU), Department
coordinated. To facilitate cooperation and mobility of
of Pathology, Faculty of Medicine, Naresuan University, medical practitioners within the AEC, an ASEAN Joint
Phitsanulok 65000, Thailand. E-mail: [email protected] Coordinating Committee on Medical Practitioners
778 K. Wangchuk, N. Supanatsetakul
(AJCCM) has been created [6]. A medical practitioner permanent Thai medical license. Since 1946, only 220
(MP) holding a valid medical license of his/her country FMPs, from 22 countries, have been registered and
of origin, can apply for registration to practice medicine granted a permanent medical license by the TMC [9].
in other countries within the community and will be There are 3 principle requirements for obtaining
known as a Foreign Medical Practitioner (FMP). a permanent Thai medical license. (1) Admission to
However, such a FMP will be still subject to all local membership in the TMC. (2) A certificate from the
domestic regulations set forth by the professional university where he or she has graduated along with a
medical regulatory authority of the host country [6]. valid medical license from the country of graduation.
In Thailand, the professional medical regulatory (3) Successful passing of all 3 parts of the National
authorities are the Medical Council of Thailand (TMC) Licensing Examination of Thailand [10].
and Ministry of Public Health [6]. For registration to To register as a member of TMC, an applicant
practice medicine, both Thai MPs and FMPs need must attain the age of 20 years, obtain a medical
to fulfill all the requirements determined by the TMC. degree from a list of medical institutions accredited
For Thai MPs, this information can be easily accessed by the TMC, and have no record of misconduct,
through the TMC’s website in Thai language [7]. unlawful acts or imprisonment that would bring dishonor
However, information in other languages, including to the profession. The applicant must not have any
English, for FMPs is limited. Although some information mental disorders, chronic alcoholism, drug addiction,
is translated and already presented on the TMC’s and other diseases that may interfere with professional
English website, it does not contain all necessary practice. The registration and membership fee is 4,500
requirements to pursue a medical career in Thailand, Thai baht [10]. At present, there are 111 curricula of
which currently include a work permit for other than foreign medical schools, distributed in 28 countries,
Thai citizens. For the benefit of FMPs, the authors recognized by the TMC. They appear on the TMC
have reviewed current domestic regulations and website [9]. If the name of the medical school is not
procedures, which may undergo significant changes present on this list, the applicant needs to request the
in the future. TMC to review the medical curriculum, and obtain its
approval before the application process can begin. This
Medical practice in Thailand process may take time and there will be a processing
Legal medical practitioners, Thai MPs and FMPs, fee of 10,100 Thai baht for each applicant [10].
are required to perform their work under laws and Finally, applicants are required to pass all 3 parts
regulations determined by the TMC [7] formulated of the National Medical License Examination
as the Medical Profession Act Buddhist Era (B.E.) of Thailand (NL). The NL is conducted by the
2525 (1982), Professional Standards for Medical Center for Medical Competency Assessment and
Practitioners 2012, The Medical Council Regulations Accreditation (CMA), under Medical Competency
on Medical Ethics B.E. 2549 (2006) and other official Assessment Criteria for National Licensure B.E. 2555
announcements by the TMC. According to the AJCCM (2012) announced by TMC [11, 12]. The NL consists
2015 Goals and the objectives of the ASEAN Mutual of Part-1: 300 multiple choice questions (MCQ) in basic
Recognition Arrangement (MRA), Member States medical sciences, Part-2: 300 MCQs in clinical
of ASEAN have agreed on a policy for temporary sciences, and Part-3 in 20 stations of objective
licensing and registration for FMPs in 5 designated structured clinical examination (OSCE). The NL
categories. These include limited practice, expert visits, Part-1 and Part-2 are separately scheduled for 1-day,
education and training, humanitarian missions, and twice yearly, and offered at several testing locations
research [8]. In Thailand, the temporary license is in Bangkok and other provinces. Since 2015, almost
valid for 1 year, but renewable and granted only for all questions in NL Part-1 and Part-2 will be in English,
practice under supervision of a fully-licensed Thai MP. except for the questions associated with Thai law or
Interested FMPs in these categories can apply directly forensic medicine, which appear in Thai. The Table
to the respective healthcare institution where they plan of Specification for the NL Part-1 and Part-2 can be
to work. The institution will establish contact with downloaded from the CMA’s website [13, 14]. Only
the TMC for endorsement and clearance of documents FMPs graduated from medical schools previously
needed for a temporary license [8]. FMPs who approved by TMC are eligible to apply. There is an
wish to practice independently, have to apply for a examination fee of 3,015 Thai baht for each part,
Vol. 9 No. 6 Foreign medical practitioners in Thailand 779
December 2015
and there is no limit in attempts for taking these there were 2,835 internship positions available in
examinations. The NL Part-3 OSCE is a half-day 126 hospitals throughout the country [15]. During the
examination given 3 times a year, and is conducted 1-year internship program, an intern will practice
only in Thai. This examination is offered mainly medical skills and rotate in different medical specialties,
in Bangkok, and in one of the following provinces: mostly in internal medicine, obstetrics and gynecology,
Chiang Mai, Khon Kaen, or Songkhla. FMPs who surgery, and pediatrics. A certificate of completion of
wish to apply must have a valid foreign medical license the internship program is required for most PGMT
and pass both the NL Part-1 and Part-2 within 7 years. programs. FMPs with a Thai medical license can also
For Thai-national FMPs only, the foreign medical participate. The PGMT programs can be classified
license from country where graduated may not be into 3 major categories [17, 19].
required if they participate in the skills enhancement
internship program at a designated hospital arranged Category-1 (Encouraged specialties)
by TMC [15]. An examination fee of 5,015 Thai baht Because of the shortage of medical specialists in
will be applied, and there is no limit of attempts some fields, TMC encourages applications for PGMT
for taking this examination. In addition, FMPs are programs in (1) psychiatry, (2) child and adolescent
also required to take 2 more examinations, which are psychiatry, (3) forensic medicine, (4) anatomical
considered part of the NL Part-3. They consist of pathology, (5) clinical pathology, (6) general pathology,
modified essay questions (MEQ) and long case (7) therapeutic radiology and oncology, (8) family
examinations. Completion of all examinations, including medicine, (9) emergency medicine, (10) nuclear
NL Part-1 (MCQ), NL Part-2 (MCQ), NL Part-3 medicine, (11) oncology, and (12) hematology.
(OSCE), MEQ, and the Long case, are the same Internship experience is not required for application in
requirement for both Thai national MPs and FMPs these fields and applicants in this category can begin
[16]. their training as early as the year following graduation.
Once all these 3 principle requirements are fulfilled, The duration of training is normally 3 years, except
FMPs will be granted a life-long, permanent Thai for 4-year training programs in child and adolescent
medical license, which is valid for practice throughout psychiatry, and oncology.
the country. For personal identification, the registered
medical practitioner may request an MD Card Category-2 (Main specialties)
authorized by the TMC [7]. Currently, FMPs who are There are presently 26 specialties in this category
not Thai citizens, must also obtain a work permit. considered to be the main specialties of the PGMT
programs. They are anesthesiology, internal medicine,
Postgraduate medical training in Thailand obstetrics and gynecology, ophthalmology, orthopedics,
Postgraduate medical training in Thailand otorhinolaryngology, pediatrics, preventive medicine,
(PGMT) refers to residency or fellowship programs diagnostic radiology, rehabilitation medicine, and
in various specialties. Many organizations are involved surgery. The certificate of completion of a 1-year
in the arrangement of PGMT programs, including internship program is necessary for the application
medical teaching centers, Royal Colleges of Medical in these fields. Some programs require 2, 3, or more
Specialties, Ministry of Public Health, and TMC. years of internship before applying, to ophthalmology,
Currently, there are 50 recognized training institutions, dermatology, and plastic surgery programs.
offering PGMT programs in 80 specialties and Furthermore, an applicant who has received a
subspecialties [17]. Each year, the numbers of position government training scholarships may be considered
opening for PGMT are announced by the TMC. For as a priority. The duration of training is 3−5 years
example, in 2015 there are totally 2,363 positions depending on specialty.
available for enrollment [18]. A valid permanent Thai
medical license is required for all applicants, including Category-3 (Subspecialties)
FMPs [19]. Most of the programs require working This category consists of 43 subspecialties,
clinical experience in a hospital after graduation. For referring to as advanced PGMT or fellowship.
Thai MPs, they normally participate in the skill Applicants considered final-year residents, certified
enhancement internship program, arranged by TMC medical specialist or as Diplomats of Thai Board of
and other accredited governmental hospitals. In 2014, Medical Specialties, are eligible to apply for such
780 K. Wangchuk, N. Supanatsetakul
subspecialty fellowships. FMPs who are medical Discussion and conclusion
specialists must have a Thai permanent medical The start of the ASEAN Economic Community
licensure in order to apply. The usual duration of (AEC) is a historical event. All ten ASEAN member
training programs in this category is 2 years. states are preparing for challenging new conditions.
The process of application regularly begins by the For healthcare services and the medical profession,
end of the year before closure of applications through we have agreed to cooperate and develop ASEAN
the website of TMC [7, 19]. However, the applicant Mutual Recognition arrangements (MRA). We should
should contact the director of programs of interest as anticipate that an increasing number of qualified FMPs
early as possible because some programs may start will desire further study and wish to practice in
the selection process before the official application Thailand. These FMPs will have to fulfill all domestic
process begins. There are 2 rounds of application by Thai regulations set forth by the local professional
the TMC. For the first round, the applicants can choose medical regulatory authority. These requirements are
more than one program in order of interest. If accepted accessible through the TMC’s website in Thai and in
by any program in the first round, TMC will announce English. However, some detailed information is only
names as having been filled. The second round begins briefly stated and was omitted in the English website.
only for applicants left from the first round. Now, they FMPs who cannot read Thai, will not yet be able to
can apply for only unfilled programs left from the first obtain all of the needed information from the website
round. alone. To provide comprehensive information
The final result will be announced by the TMC. regarding this matter for interested FMPs and others,
For 2015 enrollment, the numbers of position for the the authors have attempted to summarize relevant
first and second rounds of application were 2,363 and regulations formulated by the TMC.
572 respectively. There were 1,981 applicants in the We emphasize that the FMP’s proficiency in Thai
first round, and only 182 applicants in the second language is important. Currently, there is no
round. In conclusion, there are 1,951 filled positions requirement for FMPs to demonstrate their Thai
(66.47%), and 456 positions remain open [18]. language skills in an official test. FMPs may have
little difficulty in the NL Part-1 and Part-2, because
Current international postgraduate medical most of the questions are in English. However, the
training programs NL Part-3 is only conducted in Thai. Language
In addition to the conventional PGMT programs, requirements vary among the medical licensing
FMPs who wish to continue their medical education examinations (MLE) offered by the ten different
in Thailand without registering for a permanent member states. English questions are used or used in
medical license, may consider applying for part in the MLE in most of these counties. However,
international PGMT programs of the Faculty of the MLE in Vietnam and Indonesia are conducted
Medicine of Siriraj Hospital, Mahidol University [20]. only in Vietnamese and Bahasa Indonesia respectively
Accepted residents will be granted a temporary [21].
medical license from the TMC, which is valid for 1 The European Economic Area (EEA), established
year, but renewable. Currently, there are 8 residency on 1 January 1994, is a single market that provides
and 28 fellowship international PGMT programs free movement of persons, goods, services and capital
offered in various departments. These include between the EEA member states, which now include
Anesthesiology, Dermatology, Emergency Medicine, 28 countries as the European Union (EU) and 3
Obstetrics and Gynecology, Ophthalmology, countries in the European Free Trade Association
Orthopedic surgery, Otorhinolaryngology, Pediatrics, (EFTA) [22]. According to EU legislation, free
Surgery, and Internal Medicine. These programs are movement with full registration in any EEA should
mainly conducted in English. However, Thai language become available provided that the physicians are
skills are still required for communication with patients. citizens of a member state and have completed primary
Admission requirements, courses of training, criteria training in a member state’s medical college and hold
for assessment, and available positions are varied a valid license to practice there [22, 23]. Currently,
among programs. Prospective FMPs should contact major destination countries for such migration of EEA
the program director for further information [20]. physicians are Germany, France, Italy, UK and Spain.
Factors influencing the mobility of physicians include
Vol. 9 No. 6 Foreign medical practitioners in Thailand 781
December 2015
financial motivation, better working conditions, desire of 499722 Foreign Language for Communication in
for more training, and better career opportunities. Medicine, which is an elective course for medical
Migration also reflects fundamental health care students at the Faculty of Medicine of Naresuan
systems problems in different EEA counties from University [29]. The authors wish to thank The Medical
where most physicians tend to depart. It may also Council of Thailand (TMC) and Center for Medical
deprive these countries of doctors who will be difficult Competency Assessment and Accreditation (CMA)
to replace [24]. Regulation and licensing criteria for also providing information via phone and email.
for physicians in the European countries have been
published [25]. It is important to note that many EEA Conflict of interest statement
member states still maintain their own and differing The authors have no conflicts of interest to declare.
national regulations for work application requirements
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