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In the first of a two part series, Vernon Baxter tackles the thorny topic of recruitment and discovers the Middle East is due for an HR overhaul.

Ziad Fares is very clear about the importance of medical recruitment to the Middle East.

"It is the single most important factor today for both new and established healthcare providers - finding the right people is almost a make or break situation."

Fares are an experienced industry analyst, and his comments reflect the severity of the region's HR requirements.

Yet a quick glance at the industry suggests that not everyone may have caught on. Despite an increase in demand for healthcare staff, the sector has seen the lowest wage increases of any other area, bar education, for the third year running, according to recruitment firm GulfTalent.com.

When you consider total healthcare spending in the GCC is expected to reach US$60 billion by 2025 (McKinsey & Co), it is difficult to understand why medical pay packages continue to disappoint.

Fares believes the situation is so desperate that the market will have no option but to undergo radical change, and sooner rather than later.

"Something drastically needs to be done to the salaries of healthcare workers in the Middle East - the salaries are very low and therefore you can only attract low quality healthcare workers," he reports.

Poor salaries may be the obvious symptom of an unhealthy HR sector, but recruitment is a complex issue and the region needs to develop a system capable of sustaining its ambitious growth targets.

Medical Times speaks to the experts to find out where the Middle East is going wrong and what steps providers can take to turn HR from a regional weakness into a local strength.

Betting on the house

Nearly all of the GCC countries are currently struggling with inflation and the depreciation of the US dollar, to which most currencies are still pegged. Some analysts estimate that healthcare salaries in the Middle East have decreased by 20% in real terms, while increasing 8% in the west.

In practical terms, the greatest impact has been the rising cost of accommodation.

Indeed, it is the key challenge facing Middle Easter recruiters in all sectors, according to Paul Johnson, business development director for Outsourcing Consultants, a Dubai-based consultancy active in the medical industry.

"The forward-thinking hospitals now, even in the design phase, are looking at incorporating accommodation either onsite or offsite," he explains.

While some hospitals might prefer to avoid the construction sector, Johnson argues it is a secure means of keeping a lid on housing costs, while retaining an asset for the future. "Expats all need to find somewhere to live," he reasons.

"It is a big issue for employers as they are trying to attract staff with that hanging over their head - there is no reason why hospitals can't tie in with construction companies to provide housing."

Finding affordable places to live has become such a problem that Johnson has had to recommend that in some cases candidates, should not take the job, in order to protect his firm's reputation.

"Wages in nursing aren't very attractive and certainly make it difficult to find somewhere to live in Abu Dhabi or Dubai," he states.

"We have to tell nursing staff that this is a problem and sometimes we have to advise that they don't take that particular position."

Traditionally, obtaining quality nursing staff has not been a major priority for regional HR departments, who prefer to use the money to attract western-qualified physicians.

Yet healthcare providers won't be able to continue to attract top doctors if the supporting care structure remains absent, reasons Fares.

"If you want to attract the top doctors, you need to surround them with the appropriate, high-skilled team," he says.

"Providers will spend a lot of money on attracting a surgeon but they don't spend enough money on the surrounding team - there will have to be a change in the situation, or we will not be able to attract the skill level that we want."

Gone till November

With so many expatriate staff working in the Middle East, HR departments must interact almost daily with the international community. Yet despite a handful of exceptions, most providers continue to keep international colleagues at an email's length.

A common complaint is that feedback is rare from the Middle East, and recruitment companies often feel their role is reduced to order taking.

"Basically it is high volume banging off CVs," complains Nick Sljivic, director of IMS Recruitment, one of the largest recruiters of European Union medical staff to the Middle East. Sljivic recommends that HR departments take a bit more time to develop relationships with foreign partners.

"All that happens is that you are sent a list of requirements and then you send down some CVs - in terms of feedback and the information you get most of the time it is a complete black-hole."

The Middle East's conflicting work patterns can also turn recruitment into a laboured affair, he adds. "Everything shuts down for Ramadan, everything shuts down for Eid, most people go away for the summer - as a process it is incredibly slow."

Sljivic also notices that many of the top-level medical staff are western and go home for Christmas, meaning that the work cycle is almost constantly disrupted: "Everyone comes back in September and has a look at some CVs and then it's Ramadan," he explains.

"The lead times on the process are huge."

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