Development of Policy Recommendations and Measures to Promote Physician Retention in Mae Hong Son Province

Abstract

Mae Hong Son Province is facing a critical physician shortage. As of 2025, only 48.28% of the required physician workforce is in active service (84 out of 174 positions), resulting in a physician-to-population ratio of 1:3,414 — approximately twice the national average. This study aimed to investigate factors influencing physician retention and to develop policy recommendations to promote sustainable physician retention in Mae Hong Son Province.

A mixed method research design was employed, analyzing five key domains: socioeconomic factors, psychosocial factors, infrastructure and environment, organizational and service factors, and labor market competition, across all seven hospitals in the province. The sample comprised 149 participants, comprising physicians (current and former, 2020–2024), public health administrators, and executives from supporting organizations. Research instruments included a rating scale questionnaire, semi-structured interview guide, and focus group discussion guide. Data were collected between October and December 2025. Quantitative data were analyzed using descriptive statistics and stepwise multiple linear regression, while qualitative data were examined through content analysis.

The findings revealed that 11 predictor variables collectively explained 55.4% of the variance in physicians' intention to remain (R² = 0.554, p < 0.001). The three most influential factors were physician participation in work development decisions, quality of schooling available for physicians' children, and adequate multidisciplinary team support in the management of complex cases.

Policy recommendations were formulated across four levels — organizational, provincial, regional health zone, and national — with key measures including the revision of special area allowances to accurately reflect local degrees of hardship, the establishment of local admission quotas for medical students with origins in the province to foster community commitment, and the development of a clearly defined Special Professional Track to support career advancement. Achieving sustainable physician retention in remote areas requires an integrated approach combining economic incentives, psychosocial support, and organizational management, implemented systematically across all policy levels.