Physician Recruitment in the Middle East: Use a Rifle, not a Shotgun

By Mark McPhee, M.D.

Successful recruitment of physicians in Middle Eastern countries requires a relatively long timeline along with careful advance planning to address three critical areas: selection, recruitment and retention.

Selection

Perhaps the major factor in producing a solid pipeline of qualified applicants for open positions on the medical staff is careful planning and cultivation of markets in specific countries around the world — along with customized methods within those particular markets to craft an attractive message emphasizing your unique opportunity to physicians in your targeted specialties.

This can be an expensive and time-consuming process, since world markets vary widely, but “narrowing the field” to a few likely countries where recruitment history is positive, your contacts are good and physician supply/demand may work decisively in your favor is very basic to the value equation for selection. In essence, the first principle is: “use a rifle not a shotgun” for physician selection and marketing.

The second selection principle is to “carefully set the bar” for specific qualifications you are seeking for successful candidates in your targeted specialties (board certifications, advanced qualifications, years of practice, quality metrics performance, academic experience, etc.) — and then stick to that bar. Ratios may be high between numbers of potential candidates vs. qualified candidates vs. realistically achievable recruits in a given market, so set the bar carefully.

Guidance should come from the physician leadership of your medical staff, especially physicians who have alumni, specialty or other relationships in your target countries. Physicians recruit other physicians, so a great place to start in any specialty would be one or two physician senior leaders or “key” highly productive physicians who can maintain the bar you set in their specialty and thus help to successfully recruit to it. It is worth the extra money and effort to seed your recruitment effort with such “key” physician talent upfront.

The third selection principle is to convincingly show potential recruits that they will be able to “create and sustain a level of practice” in your organization commensurate with the level they have become accustomed to in the countries where they have trained and worked. Many very well-qualified physicians have family, friends, colleagues or other ties to the Middle East or areas in close proximity. These physicians will carefully explore good opportunities to return to the region, or move to a better opportunity within it, provided the quality of practice and quality of life you offer meets or exceeds their current standards.

Recruitment

Although it is generally true that physicians recruit physicians, the process in the Middle East may be both cumbersome and long, so an excellent, responsive medical staff office and a human resources infrastructure to ease the process is pivotal to physician recruitment success.

Of course, your organization’s recruitment “package” must be both competitive and attractive, including salary and benefits. This is especially important in difficult-to-recruit specialties and/or key, highly productive or leadership physician positions. Contributions to retirement/pension as well as tax considerations are not customary in the area, so it is important to pay detailed attention to “allowances.” These monies enable a higher quality of life, subsidizing education for eligible family members as well as housing, car, travel, home leave, professional or other expenses for the physician.

Assuming an overall compensation package can be negotiated within acceptable limits, a recruitment visit to your organization including the candidate recruit, the spouse and, potentially, other family members (despite the expenses incurred) may be absolutely critical to the eventual success of your recruiting effort. Myths about life in the Middle East abound, and “myth busting” head-on allows the candidate and family to better assess critical quality of life and practice issues that often are key factors in decision making. In fact, many organizations purposefully orchestrate such visits heavily or primarily around the spouse and family, since addressing their concerns is frequently pivotal to a favorable outcome.

After a successful package negotiation and visit, meeting or exceeding physician and family expectations during the often lengthy and potentially frustrating licensing and credentialing process may strain your medical staff office and HR team resources. Physicians can be demanding and impatient, even with respect to processes beyond your control, so setting appropriate expectations and responding well to individual concerns during this process will be critical.

Candidates should be informed in advance and in detail of specific requirements for licensure and credentialing, which may include both oral and written examinations even for senior physicians. Depending upon the country, unusually detailed and often duplicative documentation and security background clearances may be required. Especially following “Arab Spring,” physician candidates should be made aware that security reviews and criteria for acceptance may be very strict.

Retention

Long term, a very important factor in physician recruitment is retention — especially since the recruitment cycle in the Middle East is long and expensive. For continuity of care and building high clinical quality standards within your organization, prevention of excessive physician turnover is critical. The goal should be retention of physicians for four or more years if possible, so longer contracts with appropriate “out” or penalty clauses for early exit may be appropriate.

Some organizations encourage a pre-employment battery of tests to better assess the “fit” for an expatriate before concluding contractual negotiations, in order to assess the candidate’s suitability and the likelihood of long retention.

After hiring, the process of “onboarding” both the physician and family may be disproportionately predictive of long retention in the Middle East, so making all aspects of this front-end process (greeting, housing, banking, car, driver’s license, visa, school induction, etc.) as seamless and convenient as possible should be an important goal of the human resources team and the medical staff office.

Physicians must be welcomed and well acculturated from the get-go to medical staff bylaws, rules and regulations, quality measurement expectations and personal/unit performance on quality report cards at or above measurable acceptable standards.

Also, the physician and family must have detailed orientation to (and acceptance of) the cultural and legal customs and traditions of the country. A range of acceptable behaviors, personal and professional, should be established. For successful retention of staff, “culture trumps all other factors,” and continued attention to this principle maximizes the great advantages of living in the Middle East: unexcelled hospitality and service along with unparalleled attention to the values, quality and importance of family life for all professionals.

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