The dispute between the Ministry of Public Health and the Rural Doctors Society over the government's new pay scheme, officially known as the pay-for-performance (P4P) system, has quickly developed into a confrontation between several groups on both sides of the divide.
On Tuesday, the Medical Council, the Dental Council, the Nursing and Midwifery Council and the Pharmacy Council joined the fray in support of the ministry's decision to adopt performance-based pay.
This was not a good sign for the state-run medical profession in general and, especially, members of the public in need of medical services.
At the core of the conflict is the bonus payment on top of the basic salary payable to medical personnel, including doctors, dentists, nurses and medical assistants, working in rural or remote areas.
Previously, such workers received hardship allowances in the form of a lump sum depending on the type of work they did. Doctors, for instance, received bigger allowances than dentists and nurses.
But as of April 1, the hardship allowance was partly superseded by the P4P system. Under the new format, medical personnel still receive half of their hardship allowance, but the rest is paid according to their performance.
Rural doctors have cried foul over the new system, claiming they will receive less pay while their workloads will remain the same. They say they will have to work harder than ever to maintain their pay, which won't be easy as they are already overworked.
The doctors have also said the scheme will increase their paperwork and, in turn, reduce the number of hours they are able to spend with patients.
On the opposite side of the debate, the ministry has claimed that the P4P system is a much fairer way to award bonuses than the old system of paying hardship allowances in a lump sum.
The new scheme will provide an incentive for medical personnel in rural areas to work harder, it said. This in turn will improve productivity, raise the quality of services and also help ease the brain drain problem within state-run hospitals.
The new pay scheme was a top-down decision from the Public Health Ministry without any input from rural doctors, although a few rural hospitals, namely the Parn district hospital in Chiang Rai and Makarak district hospital in Kanchanaburi, were involved in trials of the scheme.
Moreover, the public, who will be at the receiving end of the system, were left out in the cold.
The huge amount of paperwork that comes with the scheme is bound to lead to increased workloads, as medics are now required to maintain daily records, which will later be used to determine bonus payments.
Under the system, each medical activity is given a score. For example, for dental workers, a front tooth resection scores 30 points, while a back tooth resection gets 54 points.
Nurses, meanwhile, get 1,545 points for taking care of an emergency case, 1,027 points for an urgent case and 512 points for non-urgent cases.
The two main rival groups _ the ministry and the Rural Doctors Society _ must sit down together and iron out their differences in a responsible and mature manner, to solve the dispute over the system, and to make sure people living in rural areas don't suffer because of it. If necessary, Prime Minister Yingluck Shinawatra may have to step in to convince both sides to come to the negotiating table.