Now, and after spending more than 3 years working in Saudi Arabia (KSA) I guess I can summarize my experience in a way that can benefit others.
We have to agree though, that life experiences remain personal and unique and are totally "in the eyes of the beholder". For those of you know me also know that I have spent most of life in KSA. I came to KSA when I was 6 months old (obviously with my family) and stayed here until I finished my high school; after which I left only to come back again to work. Both of those experiences are different and I cannot it really make any connections between them. I will focus my observation on the most recent experience.
Also, another general rule when evaluating a life experience has to do with our tendency to fall in the trap of "comparison" rather than "objective Evaluation" and that is where confusion and contradiction start. Comparisons are a very bad way in evaluating anything in life in general, and it is even more when you want to evaluate complex structures such as a life experiences.
So for an "objective Evaluation" of this experience I will cover the following Domains:
1. Current Work Experience
2. Professional growth potential
3. Financial
Other Domains that have to be considered when moving to a new place include:
1. Social-Familial
2. Personal
3. Same factors in relation to spouse
Those are really personal and vary between a person and another and cannot be generalized
• Let us with my work experience.
I have to start with this because I can feel how important it is. The satisfaction that you get when you serve in a place when you are “needed” is immeasurable. When you see how a patient prays for you because he feels that you gave him/her something that he could not find at any other place……….this feeling – I can testify for that- is even greater when you are in Syria, it is the “NEED” factor.
As I have mentioned in my previous post, when I came to Saudi Arabia I did not even have my Hematology-Medical Oncology Boards with me. That meant I would not be eligible for a full consultant level (you should have a specialty Board and a 3 years experience beyond the Board). So I had to compromise, and that was a little tough in the beginning. In that position I had to accept to work “under” other physicians whom I considered at a “lower” level of competency. Although as soon as I passed my Board Exams I got promoted for a full Consultant Level for the reasons mentioned below.
With no other option in site I had to figure out how to solve this and fast. And the most efficient and time proven method is “working harder”. The nice aspect of working here is what I call “easy competition”. I remember my days back at the Cleveland clinic how it was a little challenging to compete with others who are already functioning at their extremes. Will, here it is different. Maintaining a step ahead of others is not hard. Don’t get me wrong, obviously it is not a piece of cake but not impossible.
As physicians, and for many different reasons, our most valuable “merchandise” is our “clinical competency”. You can be a great “researcher” or a brilliant hospital administrator; but without a distinguished “clinical competency” you will not get the full benefits of being a physician. It is the most important tool to help our patients and for others to learn from us. Working to improve my clinical competency was feasible since our hospital is the major oncology referral center for the whole western KSA. The number of patients, complexity of cases and our resources are all advanced compared to other hospitals. I tried to establish myself as a reference in Lymphoma (not forgetting other diseases) since first I do like lymphoma and second I noticed it to be a common disease. Within relatively a short period of times I succeeded in achieving this. I was trusted in my hospital in that regards and I started being known on a national level in that regard as well. The nice thing about working in one of the major Governmental Hospitals in KSA (King Fisal Specialist Hospitals-Riyadh & Jeddah, National Guard-Riyadh & Jeddah, and King Fahad Medical City-Riyadh) is that you have the potential of being known on a National Level. You get to give lectures in National Conferences, Accept referrals from others, others calling you for your opinion, patients hearing about you and seeking to see you directly and drug companies seeking your satisfaction.
The other aspect which I liked about my current position is the opportunity to learn some medical administration stuff; and I am especially referring to Quality Improvement in Medicine. I had no prior knowledge in QI and I had to learn my way around. This is a unique opportunity since the QI field is a growing field in hospitals at the Middle East and there are not many people with QI qualifications around so many hospitals do give opportunities for their physicians to participate in this effort. The major hospitals I mentioned above are leading in the region with this effort and the ways I see the future is that many are going to follow. There are many sources and courses you can get over the internet; I specifically guide you to the Institute for Health care Improvement (www.IHI.org) which is the front runner in QI-medicine. They do offer many online courses (some for free) and for people living in the US, they do have many live courses. I encourage people to get some training in this and practice it if they can; it will be in very high demand in the Middle East in the short future. During the last 3 years I have foreseen several QI projects (some I designed by myself) including treatment guidelines, drug utilizations, improving medication safety and development of clinical pathways.
My hospital is a teaching hospital (medical students, residents, fellows) and interacting with them taught me that teaching others is a very nobel thing to do and it would be a major source of satisfaction on the long run.
Finally, I had the opportunity to explore and learn about the field of Health Informatics developing medical software, but this is a story by itself and I will devote a whole post for this story.
As you can see, what I mentioned above is “positives” or things I learned, but life is not all pink and I am sure you all have heard some “stories” that are negative. But as I have mentioned in my first post; I will try to lean toward positive thinking.
• Professional growth potential
This is an important thing to consider for physicians and in any setting. It is not only about what you are doing now nut where would you be 10 years from now. In my view’ this is the major weakness when it comes to working in the Gulf region in general. All the effort I have mentioned above may not necessarily translate into an objective professional growth. I guess if I remain in my Hospital 10 more years and put the same effort I will not be much different from where I am right know. I am not talking only about my salary but you know this factor that they use to weigh different scientific journals and they call it “Impact factor” I believe that each one also has an impact factor and your professional growth is measured with this impact factor. The individual impact factor grows by two ways; the growth of the institution in general and the personal effort. Well, here you will grow with the growth of the institution but not necessarily with your personal effort. I have to say the within the coming 10 years there will be significant growth in the health care institutions in general in the whole Gulf region and that fir sure will reflect on the people working for those institutions but that is a different talk by itself.
The problem is simply due to this thing called “this is an equal opportunity work place” which what makes the US different, well in the Gulf region it is the opposite. Many other factors are taken into account when it comes to promotions other than your achievements.
I would site this number one reason for wanting to move on for another setting
• Financial
I will not dwell much into this point, I am sure you all have an idea about that income range in the Gulf area. I just have to mention some points:
o Unlike the US, there are not that many differences between different sub-specialties when it comes to the salary.
o The average basic salary is around 10-11 K USD per month, tax free, and the differences between one place and the other is mainly in other benefits (i.e. paying the children school fees, how many tickets per day, do they have private business patients,)
o Life here has become gradually expensive, and although what you make is more than enough to live a very high quality life but to save something significant is something different.
As I said above, there are other domains to think about before you take a decision to move to the Gulf area, mainly the personal-social-familial aspects. Those are also complex to measure and think about and certainly you could not generalize any ones experience in that regard.
I only to have to mention one thing, being in Jeddah made us close to Makkah and, you could imagine, is something that surpasses everything else. You ability to ride your car and be in AL-HARAM within 35 minutes (exactly the time needed from me to reach to AL-HARAM from my place) is indescribable. It played a major factor in making me accept everything else, and I thank Allah for this blessing.
I am also eager to hear from others who have or had a working expereince as a physician in the Gulf Region
Next post will be about “why to move on now and how”
We have to agree though, that life experiences remain personal and unique and are totally "in the eyes of the beholder". For those of you know me also know that I have spent most of life in KSA. I came to KSA when I was 6 months old (obviously with my family) and stayed here until I finished my high school; after which I left only to come back again to work. Both of those experiences are different and I cannot it really make any connections between them. I will focus my observation on the most recent experience.
Also, another general rule when evaluating a life experience has to do with our tendency to fall in the trap of "comparison" rather than "objective Evaluation" and that is where confusion and contradiction start. Comparisons are a very bad way in evaluating anything in life in general, and it is even more when you want to evaluate complex structures such as a life experiences.
So for an "objective Evaluation" of this experience I will cover the following Domains:
1. Current Work Experience
2. Professional growth potential
3. Financial
Other Domains that have to be considered when moving to a new place include:
1. Social-Familial
2. Personal
3. Same factors in relation to spouse
Those are really personal and vary between a person and another and cannot be generalized
• Let us with my work experience.
I have to start with this because I can feel how important it is. The satisfaction that you get when you serve in a place when you are “needed” is immeasurable. When you see how a patient prays for you because he feels that you gave him/her something that he could not find at any other place……….this feeling – I can testify for that- is even greater when you are in Syria, it is the “NEED” factor.
As I have mentioned in my previous post, when I came to Saudi Arabia I did not even have my Hematology-Medical Oncology Boards with me. That meant I would not be eligible for a full consultant level (you should have a specialty Board and a 3 years experience beyond the Board). So I had to compromise, and that was a little tough in the beginning. In that position I had to accept to work “under” other physicians whom I considered at a “lower” level of competency. Although as soon as I passed my Board Exams I got promoted for a full Consultant Level for the reasons mentioned below.
With no other option in site I had to figure out how to solve this and fast. And the most efficient and time proven method is “working harder”. The nice aspect of working here is what I call “easy competition”. I remember my days back at the Cleveland clinic how it was a little challenging to compete with others who are already functioning at their extremes. Will, here it is different. Maintaining a step ahead of others is not hard. Don’t get me wrong, obviously it is not a piece of cake but not impossible.
As physicians, and for many different reasons, our most valuable “merchandise” is our “clinical competency”. You can be a great “researcher” or a brilliant hospital administrator; but without a distinguished “clinical competency” you will not get the full benefits of being a physician. It is the most important tool to help our patients and for others to learn from us. Working to improve my clinical competency was feasible since our hospital is the major oncology referral center for the whole western KSA. The number of patients, complexity of cases and our resources are all advanced compared to other hospitals. I tried to establish myself as a reference in Lymphoma (not forgetting other diseases) since first I do like lymphoma and second I noticed it to be a common disease. Within relatively a short period of times I succeeded in achieving this. I was trusted in my hospital in that regards and I started being known on a national level in that regard as well. The nice thing about working in one of the major Governmental Hospitals in KSA (King Fisal Specialist Hospitals-Riyadh & Jeddah, National Guard-Riyadh & Jeddah, and King Fahad Medical City-Riyadh) is that you have the potential of being known on a National Level. You get to give lectures in National Conferences, Accept referrals from others, others calling you for your opinion, patients hearing about you and seeking to see you directly and drug companies seeking your satisfaction.
The other aspect which I liked about my current position is the opportunity to learn some medical administration stuff; and I am especially referring to Quality Improvement in Medicine. I had no prior knowledge in QI and I had to learn my way around. This is a unique opportunity since the QI field is a growing field in hospitals at the Middle East and there are not many people with QI qualifications around so many hospitals do give opportunities for their physicians to participate in this effort. The major hospitals I mentioned above are leading in the region with this effort and the ways I see the future is that many are going to follow. There are many sources and courses you can get over the internet; I specifically guide you to the Institute for Health care Improvement (www.IHI.org) which is the front runner in QI-medicine. They do offer many online courses (some for free) and for people living in the US, they do have many live courses. I encourage people to get some training in this and practice it if they can; it will be in very high demand in the Middle East in the short future. During the last 3 years I have foreseen several QI projects (some I designed by myself) including treatment guidelines, drug utilizations, improving medication safety and development of clinical pathways.
My hospital is a teaching hospital (medical students, residents, fellows) and interacting with them taught me that teaching others is a very nobel thing to do and it would be a major source of satisfaction on the long run.
Finally, I had the opportunity to explore and learn about the field of Health Informatics developing medical software, but this is a story by itself and I will devote a whole post for this story.
As you can see, what I mentioned above is “positives” or things I learned, but life is not all pink and I am sure you all have heard some “stories” that are negative. But as I have mentioned in my first post; I will try to lean toward positive thinking.
• Professional growth potential
This is an important thing to consider for physicians and in any setting. It is not only about what you are doing now nut where would you be 10 years from now. In my view’ this is the major weakness when it comes to working in the Gulf region in general. All the effort I have mentioned above may not necessarily translate into an objective professional growth. I guess if I remain in my Hospital 10 more years and put the same effort I will not be much different from where I am right know. I am not talking only about my salary but you know this factor that they use to weigh different scientific journals and they call it “Impact factor” I believe that each one also has an impact factor and your professional growth is measured with this impact factor. The individual impact factor grows by two ways; the growth of the institution in general and the personal effort. Well, here you will grow with the growth of the institution but not necessarily with your personal effort. I have to say the within the coming 10 years there will be significant growth in the health care institutions in general in the whole Gulf region and that fir sure will reflect on the people working for those institutions but that is a different talk by itself.
The problem is simply due to this thing called “this is an equal opportunity work place” which what makes the US different, well in the Gulf region it is the opposite. Many other factors are taken into account when it comes to promotions other than your achievements.
I would site this number one reason for wanting to move on for another setting
• Financial
I will not dwell much into this point, I am sure you all have an idea about that income range in the Gulf area. I just have to mention some points:
o Unlike the US, there are not that many differences between different sub-specialties when it comes to the salary.
o The average basic salary is around 10-11 K USD per month, tax free, and the differences between one place and the other is mainly in other benefits (i.e. paying the children school fees, how many tickets per day, do they have private business patients,)
o Life here has become gradually expensive, and although what you make is more than enough to live a very high quality life but to save something significant is something different.
As I said above, there are other domains to think about before you take a decision to move to the Gulf area, mainly the personal-social-familial aspects. Those are also complex to measure and think about and certainly you could not generalize any ones experience in that regard.
I only to have to mention one thing, being in Jeddah made us close to Makkah and, you could imagine, is something that surpasses everything else. You ability to ride your car and be in AL-HARAM within 35 minutes (exactly the time needed from me to reach to AL-HARAM from my place) is indescribable. It played a major factor in making me accept everything else, and I thank Allah for this blessing.
I am also eager to hear from others who have or had a working expereince as a physician in the Gulf Region
Next post will be about “why to move on now and how”
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