Insiders Guide for British Physicians migrating to Saudi Arabia.

This blog intends to offer step by step guide to the British physicians who are intending to move to Saudi Arabia. You may also be interested in reading my previous blog on the topic “Why British Physicians are deserting for desert” to give you some insight into the benefits of moving to the Middle East. This article offers you practical advice on what to do if you wish to relocate, mainly to Saudi Arabia as that is the placed I am experienced with.

How to get the right job;

Obviously the first step in moving to Middle East, especially Saudi Arabia is to get the right job. Unfortunately it is not always the easiest of the tasks as jobs are not available on a single portal like BMJ and the prospective employers vary a lot from government, semi-government, private, industry related and multinational companies. Those organizations that employ western trained consultants are usually the best in the market and often provide good packages and work conditions.

Below are some of the steps you may like to follow to find the right job;

1. Your CV (Resume) should be understandable to the local audience. Health sector here is mainly driven by North American influence; hence terminologies used by them would be better understandable here. For example it is better to write “Board in Pediatrics attained in 2012” rather than “CCT in Paediatrics in 2012”. Terms like JCPTGP and PEMTB would not make any sense to them. For General Practitioners, it is better to write “Consultant Family Physician” rather than “GP” as the word GP is assigned to simple graduates here. Similarly the job titles related to training like FY1, FY2, ST5 etc would not be understood here. Better not to write the abbreviations. Your CV should not be 1 page short and should not be like a 30 page biography. A brief summary of your qualifications, experience, practical skills, management experience and involvement in Quality improvement activities should be good enough and should cover 3-4 pages maximum.
2. You should not think of moving to Middle East in general if you are not a Consultant or trained Family Physician. If you move here as a registrar than the likely scenario is that you will be stuck in that role for rest of your life and packages would not be that good either. Ideally you should be a Consultant with 2-3 years post- board (CCT) experience.
3. Most recruitment in Saudi Arabia happens through recruiters based in USA or Europe. These recruiters would often advertise on their websites (you can google search) or would advertise in the BMJ. Some other companies like John Hopkins Aramco Healthcare or Dr Soliman Habib hospitals often do direct recruitment as well by holding interviews at various places in UK. As a British Consultant you are likely to be employed by one of the below organization;

• King Faisal Specialist Hospital (Riyadh/Jeddah)
• National Guard Hospitals
• King Fahad Hospitals
• Military Hospitals
• John Hopkins Aramco Healthcare (Damam)
• Dr Soliman Fakeeh Hospital (Jeddah)
• Dr Soliman Habib Hospital (Riyadh)
• KAUST Health (part of Soliman Fakeeh Jeddah)
• International Medical Center (Jeddah)
• Dallah Hospital (Riyadh)
• Al-Dar Hospital (Riyadh)
• British Aeronautical Engineering (BAE Systems Damam/Taif/Tabouk)

There are few other organizations that often do the recruitment but above are the few main employers in the three big cities. First four are considered government sector tertiary care hospitals. You can also visit the website of each of these organizations and email them your CV

4. Once you are called for an interview, either through a recruiter or direct contact, you will be expected to be interviewed through video link. Most organization interview through Skype (so you should have a skype ID and write it on your CV) or through a specific Web meeting site. Ensure that you are well dressed, ideally in a dress shirt and tie as this is the official work dress for expats.

5. Most if not all of the above organizations would like to offer job to the individual who are not just a good clinician but have excellent communication skills and good team member. If you know Arabic than it is a huge advantage but it is not absolute essential. Healthcare industry is very ‘quality’ driven and most of your prospective employer would have some kind of international accreditation. The most sought after is JCIA but others like Australian and CBAHI are also common. An excellent candidate would have visited the JCIA website and would have some idea about the standards required for accreditation. You will be expected to get involved in some quality and performance improvement activities and would be expected to help improve hospital Key Performance Indicators (KPI’s). Hence some knowledge of quality improvement activities would be advantageous. As a British hospital or primary care physician you are regularly involved in such activities in the form of audits, introducing new services, implementing clinical guidelines, preparing of CQC visits and QOF etc.

6. It is fairly competitive to get a job in a good organization in Saudi Arabia so better to avoid the questions about the salary and packages in the first interview. You do not want to give an impression that this is the only motive that drives you to move here. General population in Saudi Arabia is more liberal that you may expect hence saying that you want to move due to religious reasons is also not a good answer. Motive to relocate should mainly be to experience the new healthcare model, offer what you have learnt by your training in UK and opportunity to work in a quality organization etc etc.

7. Once you are selected your employer/recruiter would contact you. The recruitment process is usually very slow here, unless your employer is desperately short of staff. Hence PATIENCE is a virtue and you do not have to contact the employer every other day. If you do not understand why I have written patience in capital than you will understand it well after few months.

What a good job offer should look like;

Once selected, you will be sent an initial job offer. I am often contacted by colleagues in the west getting advice about the packages they are getting and what to negotiate. What type of package you get depends a lot on which organization is employing you, how senior you are and what other perks you are getting. Mentioned below are some of the salient features of a typical job offer to a British trained Consultant with more than 1 year experience;

1. Take home salary may start from 40,000SAR (8350GBP) per month. There are obviously some variations but if you are being offered anything less than 40K than you need to negotiate or move on and if you are offered more than 50K than you are in for a real good deal. Most Consultants would be offered something in the range of 50K SAR per month.
2. You should be offered a furnished accommodation. Size of accommodation usually depends on the size of family rather than status. Most of the houses would be furnished and would be in either hospital accommodation or a compound. Compound living is something which lots of expats experience in Saudi Arabia as they offer a high standard living inside four walls. If your employer is offering you the housing allowance than make sure that this housing allowance enables you to rent a house/flat in a sought after location near a good school. Housing rents can be checked through simple google search. However what rate of housing allowance you get is usually as per hospital policy and is rarely negotiable, but it gives you an idea if it is better for you to take the hospital accommodation or rent on your own.
3. You should be offered once a year return tickets to your country of origin. Most organization would offer you and your dependents business class tickets but some would pay you the cash for tickets.
4. Some organizations would pay you full or part fee for an international school while others may add it as an allowance on top of your basic salary.
5. How much annual leave you get vary from one organization to other but the labor law entitles you for 30 calendar day vacation every year, vacations for Eid (Muslim festival twice a year) and Saudi National day.
6. You may also be offered a paid study leave. Some organizations offer expenses towards your study but others may just give you a leave.
7. End of service benefits are usually calculated on the basis of the number of years you work i.e 1 month salary after 2 years of work etc. It is important to note that end of service benefit is based on your basic salary and not the total take home salary.
8. Your working hours on average would be around 45 hours a week, 5 days a week. However it varies significantly as number of on call and clinics vary. Due to weather conditions most hospitals offer split shifts with break during the day. If you are a Muslim than your working hours would reduce to 30 hours a week during one month of Ramadan. It is important that you clarify from the HR exactly how your working hours, clinics and on call would work. 

Sometimes you do have a room to negotiate the salary but do not spend too long in doing that. Once you reach to the agreement than sign the job offer and send it back to the HR.

Steps from accepting the job offer to relocation;

This is where a good recruiter, good employer and pro-active approach from you would expedite the process. It can range from one month to one year or even longer barring some hick ups on the way. The steps also keep on changing based on the change in regulations of various government organizations that are involved. Hence the steps mentioned below are true as of June 2017. Basic idea is to check you are genuine, your qualifications are authentic and you are fit to work and able to register with the regulatory body. These steps also vary as certain government organizations might have to satisfy less legislation compared to private sector ones.

Below are some of the steps you are likely to encounter after signing the job offer;

1. Your prospective employer should send you a signed, attested job offer and a contract. It should be attested by Chamber of Commerce and Ministry of Foreign Affairs.
2. You would need to get your qualifications, CCT and last 5 years’ experience verified and attested. The attested job offer sent by the employer would be required for this step. Below official website link would provide you all the necessary information; http://attestation.uksacb.org/
3. Recent changes in the regulations of Saudi Cultural Attaché mean that your training certificates, membership qualifications and experience certificate would not be verified by them. They would only verify your UK academic certificates. For physicians these other qualifications need to be verified by Data Flow. This is a good step as data flow verification is used to register you with Saudi council for Health Sciences (SCFHS, equivalent to GMC here), you need to have that anyway. Now you will be expected to have it while you are abroad and it saves duplication. Secondly it is much more efficient and avoids a big bottle neck that used to happen at SACB. You can access SCFHS and Data Flow through the below link; http://www.scfhs.org.sa/en/registration/Certificates/Pages/default.aspx
4. While your document verification and attestation process is ongoing you need to get the Police Clearance (which is different from CRB) and get a medical. Police clearance certificate information can be obtained through the below link; https://www.acro.police.uk/police_certificates.aspx
5. Visa Medical can be done by any qualified physician and authenticated by Common Wealth Office or it can be done by professional physicians located in London who regularly do medicals for Saudi embassy. They charge a hefty fee, while the option one is much cheaper and takes around the same time. Medicals would usually involve bloods tests for general health check and infectious diseases and a chest x-ray.
6. While you are undergoing the above process your employer would apply for a visa for you. If they do not already have the visa than this process can take long, depending on the organizations Saudization rate and other factors.
7. Once your documents are verified and all the above steps are completed than you are ready to submit this all to the Saudi Embassy in London along with the electronic visa your employer has sent you. Please do not resign from your existing job and make travel arrangements until you get the visa in hand. These days Saudi embassy does not take direct visa applications, you have to go through the approved agents. I have experienced the below agent, they are good, but there may be others around; https://www.a1visaservices.com/contact-us
8. Once you receive your visa, you are good to go. If you have a family, your employer would send you an invitation letter on the basis of which you will apply for your family’s visa. This process can take another week or so.
9. The final step is for your employer to send you the tickets and that would be the start of an exciting new chapter in your life.

In my later blogs I will touch upon the steps you have to go through upon your arrival to the kingdom. Hopefully the information mentioned above would be useful for you to get your dream job and move to this wonderful place many of us now call home.
 

Treat or not to Treat... Ramadan guide for Physicians

This guide is for both Muslim and non Muslim physicians to enable them to deal with the patients who are fasting. 

During the holy month of Ramadan billions of Muslim across the globe fast from dawn to dusk for a full lunar month. They day begins at the later third of the night when they wake up to prepare for meal (Sahoor) and eat till the early hours of dawn. Fasting hours start before the call for morning prayers. During the hours of fasting they abstain from eating, drinking and smoking, a real ‘Nil by Mouth’. Fast is completed at dusk as soon as the sun sets. This meal is called “Iftaar”. Most Muslims would open the fast with dates and water, than culture tales over and various dishes are prepared to satisfy the eyes and the stomach. This usually follows by long night of prayers and some sleep. The whole cycle goes on for 29 to 30 days.

Physicians all over the world usually face a challenge when dealing with Muslim patients while they are fasting as they are often not trained into dealing with such cases. To make the matters worse, often the patients who are fasting are themselves not fully aware of the religious rulings around fasting and sickness. The guide below is an effort to address some of those dilemma’s. These guidelines are based on the guidance issued by Saudi Ministry of Health.

Before we look in to the rulings related to each treatment modality, it is important to know the Quranic verses that talk about fasting. Allah says in Quran;

“O those who believe, fasting is prescribed upon you, as it was prescribed to those before you, that you may become righteous” 2/183

“(fasting) a certain number of days, so whoever among you is sick or on a journey then an equal number of other days (should be made up). And for those who can afford it there is a ransom, the feeding of a needy person. Then whoever does good of his own accord, so it is better for him. And that you fast, it is better for you only if you knew.” 2/184

“ The month of Ramadan is that in which the Quran was revealed, a guidance for mankind, and clear proofs of guidance, and the criterion. So whoever of you witness this month, then he must fast in it. And whoever is sick or on a journey, then an equal number of other days (should be made up). Allah intends for you ease, and he does not intend hardship for you, and (He wants) that you should complete the count, and you glorify Allah for having guided you, and that you may be grateful (to Him).” 2/185

Hence it is clear from this verse and the verse before that the people who are sick are excused from fasting. If the sickness is temporary than they can make up the numbers once they are better or if it is long term than they have to give charity and feed particular number of poor. However the issue happens when the believer is not that sick not to fast but has to take certain medications for treatment. If the medicine cannot be given a twice daily dosage i.e to be taken at dawn & dusk than the following rules will apply.

1. Asthma Inhalers:    ALLOWED    (Inhalers are inhaled to the lungs, intention is not for the stomach, hence the fast is not broken. However smoking breaks the fast as it is an addiction and it also goes to the stomach)
2. Oxygen:    ALLOWED         (Goes in to the lungs and we normally breathe air which has oxygen)
3. Sublingual tablet:    ALLOWED/NOT ALLOWED   (They dissolve in to the blood stream rather than going to the stomach. However if swallowed, it breaks the fast)
4. Eye drops:    ALLOWED      (Eye drops are small dosages which often get absorbed in the eye and do not reach to the stomach. The are also not nutritious)
5. Nasal Drops    NOT ALLOWED       (Nose has a direct passage to the stomach and their is a Hadith (sniffing water up deeply except when you are fasting).
6. Ear drops & irrigation:   ALLOWED     (If the ear drum is not perforated. Ear irrigation should not be done when ear drum is perforated but in case it is done than the fast may break as middle ear is connected to the throat)
7. Insulin Injection (Diabetes):   ALLOWED       (They are not nutrients and cannot be considered as food or drink)
8. Blood sample for analysis:   ALLOWED        (It is small amount and does not weaken the body)
9. Blood donation:    NOT ALLOWED       (Weakens the body. Its analogy is with cupping which is not allowed)
10. Renal Dialysis (both types):    NOT ALLOWED        (It includes nutrients from which body can benefit, hence considered as food and drink. Its is permissible for such patients not to fast)
11. Anal Suppositories:    ALLOWED/NOT ALLOWED      (Allowed if it does not have nutrients/ Not allowed if it has nutrients like salt, sugar or other electrolytes that can help body)
12. Insertions in Urogenital system:    ALLOWED      (No anatomical relation between these ares and digestive system. They are also not considered as food or drink)
13. Oesophageal speculum/endoscopy:    ALLOWED/NOT ALLOWED       (A speculum which is not covered by oily material or solutions is allowed. However speculum which is covered or any instrument which uses water to wash the lens is not allowed. Endoscopy is Not allowed as it uses water, which goes in to the digestive tract)
14. Local Anaesthesia:    ALLOWED         (It is not a nutrient, does not go into the digestive tract and does not cause loss of consciousness)
15. General anaesthesia    ALLOWED/NOT ALLOWED     (If a person is unconscious for the whole day than majority of the scholars are of the opinion that it breaks the fast. However it doesn't break the fast if person regains the consciousness for the part of the day as intention of fasting was secured with part of day time. One should also consider the risk of ingesting liquids during the anaesthesia, which would break the fast. Better for such patients not to fast)
16. Injections:    ALLOWED/NOT ALLOWED       (Fast is not broken with Diagnostic injections like contrast and therapeutic injections which are not nutritious like antibiotics. These can be given iv or IM. However if the injections have nutrients like glucose or electrolytes than fast is broken whether given IM or IV)

Physicians, whether Muslims or non Muslims, have the right to inform patients not to fast or break their fast if it is causing harm to their body or an obstruction to an essential treatment.

I hope the above guidelines would give the reader some direction when you face the dilemma of treat or not to treat a fasting patient.

References;

1. The provisions of the medical breaking the fast, MOH & King Fahad hospital Saudi Arabia (Adel Al-Naheit)
2. International Islamic Fiqh Academy, affiliated to the Islamic Conference.
3. Contemporary actions that nullify fasting by Sheikh Dr Khaled Bin Ali Al-Moshaiqeh
4. Fatwa in fasting patients, department of religious enlightenment at MOH.
5. translation of verses from Tafheem Ul Quran.

Why British physicians are deserting for 'desert'....

British trained physicians are considered one of the best in the world as they are trained in the concept of evidence base medicine to ensure cost effective and safe practice. These physicians are passionate not just about providing the high quality care to their patients but also protecting and developing the National Health Service (NHS). However over last few years we have witnessed a trend where a significant number of junior and senior physicians decided to leave the NHS and pursue their careers in the foreign lands. Most of them decide to move to Canada and Australia but over last 5 to 7 years a significant number decided to prefer Middle East over their life in UK. The ones who relocate to Middle East were mainly Consultants and GP’s, considered as the senior most staff working in NHS.

In this blog I would try to explore what Middle East has to offer and why so many British Physicians are choosing to relocate their.

Middle East (Saudi Arabia, UAE, Qatar, Oman, Kuwait) have seen significant economic growth over last two decades. Like other areas, health sector enjoyed a significant boom thanks to the investments from private & government sectors. It was soon followed by American and European health companies who followed various models to be part of this growing sector. That generated a huge demand for western trained physicians as the local market was willing to pay higher rate to attract the quality.

Below are some of the attractions that one may enjoy working in Middle East;

1. Most of the times western trained physicians will be recruited for tertiary care well funded advanced hospitals, big private hospitals attracting paying clients, multi-national companies or well sought after projects in the government or semi-governmental areas. This would give an unprecedented experience and exposure to work in a multi cultural environment with a different healthcare model. Where they do not have to experience heavy bureaucracy or budget cuts. This gives them freedom to implement all what they have learnt in NHS.
2. Local community in general highly regards doctors and gives them the well deserved status. Litigation and claim culture has not hit these shores yet, hence the medical defence industry is in its infancy. Physicians are unlikely to pay the high burdensome payments to Medical defence organisations.
3. Tax free attractive salary which most of the times would be higher than the gross salary they were getting in UK. With a falling value of British pound the salary package gets even more attractive.
4. Better living standards with spacious free housing, most of the times in well furnished compounds and western grammar school education for children. Most companies would also support towards the school fee. 
5. Opportunity for career development as most companies would offer paid study leaves. The local health regulators have fairly well developed CPD system, requiring physicians to gather certain number of CPD points. This created a positive culture of learning and development which foreign physicians fully utilise and benefit from.
6. All year round sunshine, with ample opportunities to enjoy sun, sea and sand.
7. Geographic location of the Middle East offers easy access to top holiday locations in Africa, Europe and Asia.
8. Finally believe it or not, it is safe, very safe. Safer than London, Birmingham or Manchester.

All of the above temptations were already difficult to resist but the deteriorating situation of NHS over last 7 to 8 years has made this decision easy for some. It is hardly surprising why some of the highly trained physicians decide to leave their homes and move off shores. They choose to desert the organization they have dearly served for ‘desert’ which is more greener than many thought and become part of the biggest export Britain does.

In my later blogs I would shed some light on the practical aspects of this move and the steps one has to follow and difficulties you have to overcome to migrate.

Why do I need a Website...

The idea of the website started with one page bio on the square space. Securing a domain name and having a page on the internet opened up new horizons for me when I started using that web link on my social pages, email signatures and even as business card. The natural next step was to create a resume on the web to allow me to showcase my achievements and to project the organizations I am proud to link with. Hence the current website.

This is the first experiment and I aim to build it gradually to a comprehensive forum to link all my professional and social activities and to have a single point to link with my professional colleagues, patients, friends and employers. Any suggestions to improve the page are most welcome. You can submit your comments through the 'Contact Us' section.