Practicing Abroad: Plans and Processes

After completing her medical degree at Wright State University in Dayton, Ohio, Patricia Abboud, MD, served as an attending physician at Dayton Children’s Hospital and did a fellowship in pediatric critical care medicine at Cincinnati Children’s Medical Center before accepting a position at Sidra Medicine in Doha, Qatar. Sidra Medicine is a state-of-the-art facility committed to providing women and children in Qatar with tertiary healthcare services. She works as a clinician in pediatric intensive care and is the lead in pediatric critical care transport. Abboud is also the chapter lead for Joint Commission International Accreditation maintenance of accreditation.

Abboud shares her insight about what took her to Qatar and her experiences practicing medicine outside the United States.

You trained in the United States but are now based in Doha, Qatar. Could you describe your decision-making that brought you to Sidra Medicine as a medical director?

I started my career as an ICU nurse and then pursued medicine as a way to have more autonomy in my practice. I truly enjoyed patient care and my work in the ICU and hence continued in the intensive care setting as a physician.

At the time I was completing medical school, I met my now-husband, who is Lebanese. I, too, am Lebanese, but born and raised in the United States. My parents raised us to be closely tied to our roots with culture, food, and language, among other things. My husband came to the United States at the age of 19 to study at university. Due to the civil war and circumstances in Lebanon, he stayed in America.

When we started to discuss our future, returning to the Middle East and the Gulf region was part of “the deal,” if the opportunity suited our careers. This is where the idea started.

About five years out of fellowship, I started to investigate opportunities. Lebanon would seem the natural first choice, but again, for a multitude of reasons, the job opportunities were not a good fit. I found Sidra Medicine and was intrigued with the opportunity to be part of something new, with a western platform in mind, which would allow me the comforts of working in a familiar environment and put my clinical and administrative experiences to good use.

Sidra Medicine is a state-of-the-art women and children’s hospital whose vision is to be a beacon of learning, discovery and exceptional care and rank among the top academic medical centers in the world. We opened our doors almost four years ago, and we are well on our way to achieving our vision.

What does your typical workday look like?

My work as an intensivist in Doha mirrors the work schedule of an intensivist in the USA. As an administrative leader, I have protected time for my non-clinical duties. I am one of seven intensivists covering a 15-bed pediatric ICU. We also have a thriving separate cardiac ICU. We rotate primary call days with nights and weekends to cover the clinical service. In addition, we are an ACGME I program with residents and fellows. We are affiliated with Weill Cornell Medicine Qatar and have medical students rotating through the hospital as well. I am an associate professor of clinical medicine, and my appointment comes from Weill Cornell in New York.

Although Arabic is the spoken language of the country, most people speak some English. At Sidra Medicine, we have over 100 nationalities represented. English is the spoken language at work. We document in our electronic medical record (Cerner platform) in English, and all rounds, meetings, and educational sessions are in English.

It helps to have an understanding of and speak Arabic, but it is not necessary. We have interpreters, and there is usually a clinician on duty who can help translate on off-hours. I speak Arabic (thanks to the insistence of my mother), but I do not read or write fluently. This has helped in my practice to communicate with families.

Have you had to overcome cultural differences? Have you encountered differences as a woman physician leader in Doha?

Culturally, Qatar is a Muslim country and follows the laws of Islam. That being said, Qatar is also open and welcoming of all religions and nationalities. I do not have to wear a hijab (traditional dress of women in Qatar and most of the Gulf Cooperation Council region), but we are asked to respect the country we live and work in with modest dress both inside and outside of the workplace.

Regarding lifestyle, we are leading a very privileged lifestyle in Qatar. Because we are of Lebanese descent, the food, people, and hospitality are similar to our own. As I mentioned, many different nationalities and ex-pats live and work in Doha, so the entertainment, restaurants, and festivals are also multicultural.

As a woman leader in Doha, I do not feel in any way limited. In fact, the country encourages women leadership and influence. Our CEO, CNO, head of general counsel, and many medical directors are women.

I think the media propagates ideas of oppression of women in this part of the world. While there are examples in certain nations, this idea should not be a blanket statement for the entire region.

You have been in your current role since 2017. Are there any particular highlights (leadership or teaching or improvement of clinical processes) that you’d like to share with other AAPL members?

I joined Sidra at the end of 2017, just before our opening in mid-January 2018. This was a brand new Greenfield hospital. While there were people here laying the foundational work, we did not start seeing patients until opening day in mid-January.

As much as you prepare, there are going to be processes that will need to be modified or not even put in place until the gap is recognized. I was given a “blank slate” to work from regarding some of my duties, including establishing a pediatric critical care transport service and leading a Joint Commission International chapter as we were working toward our accreditation.

While the idea of working and learning from people from all over the world was part of the excitement of the opportunity, it also led to some frustration (not all in a bad way). Clearly, experienced clinicians from other parts of the world have different ways of management and workflows. I needed to maintain an open mind and collaborate with my colleagues to develop a unified and agreeable “Sidra way” of doing things. After practicing for 20 years as a physician, I learned that the American way is not the only way.

What words of wisdom can you share with other physician leaders who may want to make similar career moves away from the United States?

If you are considering a move, my first piece of advice is don’t be afraid of change. There may be something better waiting for you. I was comfortable where I was but was getting a bit too comfortable and wanted a challenge and to grow more. I felt that I had gained a strong foundation in my practice in the USA (about 11 years out of fellowship) and was confident enough to take on a new challenge. My transitions allowed me to share my leadership experience clinically, administratively, and academically.

Do your homework and be strategic in your move. I am married with three children. At the time I started considering the move, I came twice to Qatar to talk to people on the ground and see the hospital for myself. This was in addition to many Skype calls with the CMO and chief of critical care at the time.

When I moved, I came alone for the first six months. This gave me the opportunity to understand the expectations of the job and the country and decide if it was a good fit before uprooting my children from school and my husband from his work. I researched the schools for my children, places to live, what it means to be an American ex-pat, and my obligation to the USA.

Be adventurous. In Qatar, you are about six hours away from any country in Europe, three hours away from any country in the Middle East and the GCC. There are many opportunities to see the world “on a weekend” and broaden your horizons outside of the workplace. We are close to family in Lebanon, so to see family even for a couple of days is achievable. Hamad International Airport (Doha’s airport) is an adventure in and of itself!

I have made lasting friendships with people from all over the world. My children have grown culturally and have a global view of the world. Many people have asked me, “How long do you plan to stay in Qatar?” My response is always, “As long as I am welcome, I feel that I am making a difference, and the work I do is valued, I will be here a long time.”

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