thailand is a developing country in southeast asia with an acknowledged requirement for improvement of the national medical system . although the new ( western ) system in medicine has been introduced to thailand for about a century , the present status of medicine in thailand is still not as good as those developing countries in europe and usa . this is in spite of the fact that the country is well known as a hub of medical tourism abroad . focusing on endocrinology in thailand , it is classified as a specific branch of medicine that is taught in medical schools . as far as the post - graduate training system is concerned , there is no specific resident training for endocrinology . however , specific postresidency training , fellowship in endocrinology is available . to be an endocrinologist this is considered a very long period compared with the period for training for other specialties , such as neurology ( only 9 years ) . annually , up to 5 million patients with endocrine disease are recorded in thailand , and this is significantly higher than the number of endocrinologists in thailand ( the present number is 474 ) . the primary care of common endocrine disorders , such as diabetes mellitus and thyroid disease is still delivered by the general practitioner . the other reasons that there are very few endocrinologists in thailand include the following : ( a ) this specialty is not a  money - making  specialty . the newly graduated physician would like to join the other branches that make more money , such as cardiology and neurology , ( b ) there is no -additional salary for endocrinologists although this kind of specialist knowledge is still inadequate , similar to some specialists , such as pathologists and radiotherapists , who get -additional salary , and ( c ) not all medical schools can train the endocrinology specialists . lack of education and financial constraints are still major problems in thailand , similar to many other developing countries . focusing on education , not only the problems of very long training period , and lack of good training centers ( only 6 medical colleges offer specific endocrine courses ) , but also limitations in the present training curriculum can be seen . interestingly , the specialty training curriculum in thailand is still not approved and certified by the international standards . lack of local experts in endocrinology leads to weakness of the endocrinology society in thailand . the specific society of endocrinology has been present in thailand for years ( 1981 ) but it does not function well . at present , there are very few professors of endocrinology in thailand , and most are not well accepted by scientific society . the rate of scientific publication is low , and this leads to poor recognition of thai endocrinology . focusing on the medical economics aspect , the huge number of endocrine patients in thailand implies the need equally strong funding . however , based on the general universal coverage principle in thailand , the average payment for all kinds of diseases by the thai government might not be sufficient for some endocrine cases that have a high management cost . apart from the general problems , some unique problems in thailand can be seen . due to the tropical nature of the country the good examples are hiv - related endocrinopathy , malaria - related endocrinopathy , and diabetic foot ( with superimposition of tropical fungus and bacterial infections ) . however , the more important consideration is of the thai culture , which is a buddhism - based culture with mixed indian and chinese roots . superstitious belief is very common , and patients usually use unacceptable alternative treatment when they get endocrine dysfunction or diseases . sometimes , some rare endocrine disorders are perceived as spiritual processing . this can be called a thai culture bound condition that modifies the endocrinology presentation and disease course . examples of superstitions are usage of holy water from buddhist temples hoping for disease cure and usage of horoscope indeed , buddhism has both positive and negative effects on endocrine care . for positive effect if the patients do not get standard treatment but use only superstitions , the disease will worsen . finally , focusing on the problem of endocrine disorder among buddhist monks , there is a previous report showing that the buddhist monks have a trend of lower incidence of disorder , which might be due to the strict lifestyle in medical practice . the unique challenges in thailand can be explained as the complex situation of ( a ) lack of good education and training system , ( b ) lack of specialists and experts , ( c ) lack of funding for management and poor resource allocation , and ( d ) the problem in management due to rooted thai culture and belief . how to manage these problems implementation of quality system for assurance on all education and service process in medicine has just been set for about 5 years . however , the system is not effective and seems to focus on paper work , and not the actual practice . in addition , the auditors are not well trained and do not have good quality . to solve the problem of the case management , hence , the present solution is the strengthening of the quality of the family physician to cope with the basic endocrine problems . this is via the continuous medical education system and use of new technology for case management . based on the concept that prevention is better than correction or treatment , many screening programs for common endocrine disorders in thailand are promoted . those examples include the neonatal screening program of hypothyroidism and screening for diabetes mellitus and its complications in population aged more than 35 years . the use of new tools , such as point - of - care testing technology has just recently implemented , over the past few years . it is hoped that thailand will be able to achieve an increase in the coverage of screening and monitoring endocrine and metabolic disease . the future direction of endocrinology is hard to predict . it is the hope that there will be sufficient number of endocrinologists in thailand , working within a good preventive and treatment system . however , with the unstable situation in thailand at present , it is very hard to make a commitment . at least , improved acceptance of the standards and quality in endocrinology practice , by general practitioner and endocrinologists might be successful in improving endocrine care in thailand .
thailand is a developing country in southeast asia with a nationally acknowledged requirement for improvement of the medical system . at present 
 , endocrinology is a specific branch of medicine that is taught in few medical schools . 
 there are very few endocrinologists in thailand , who are unable to cope with the large number of patients with endocrinology problems . 
 primary care for common endocrine disorders , such as diabetes mellitus and thyroid disease , is still the domain of general practitioners . in this article 
 , the author will present unique challenges and unique solutions of endocrinology practice in thailand .