Expatriate health care workers in Saudi Arabia: Exploring workforce integration, advantages, and challenges in a globalized health care system.

BACKGROUND: Effective expatriate management has become crucial in the health care sector, driven by the growing number of globally mobile professionals. The Saudi Ministry of Health data shows that 53% of the health care workforce in Saudi Arabia is comprised of expatriates, with expatriate health care workers constituting up to 90% of the workforce in some Gulf Cooperation Council (GCC) countries. In addition, technological advancements such as telemedicine, artificial intelligence, and electronic health records are transforming health care delivery, presenting both opportunities and challenges for expatriate health care workers. Despite these trends, there is a lack of research in examining expatriate outcomes for health systems. PURPOSE: The purpose of this paper is to examine the advantages and challenges of employing expatriates in Saudi Arabia's health care industry. METHODOLOGY/APPROACH: This study employs a mixed-methods approach. Qualitative data were collected from the top management team (TMT) overseeing health care expatriates (N=32), and thematic analysis was used to analyze the data. The findings of this study were triangulated with the secondary data collected from the Ministry of Health and the Saudi Health Council. FINDINGS: The findings reveal five primary advantages-international clinical experience, health care professionalism, ethical patient care, adaptability to local environments, and workforce diversity-and four main challenges: high expatriate labor costs, Saudization policies, operational risks related to knowledge transfer, and language barriers in patient communication. CONCLUSION: There are more advantages of employing expatriates than challenges, leading to a novel framework. Findings were triangulated with secondary quantitative data, which confirmed the same. This study fills a gap in the expatriate workforce literature by providing empirical insights from the underexplored context of the Middle East, particularly Saudi Arabia. It extends Caligiuri's performance dimension theory by integrating performance outcomes and contextual challenges specific to health care expatriates in Saudi Arabia. The study also offers actionable recommendations to overcome operational challenges, such as expatriates' reluctance to share knowledge and challenges associated with the Saudization policy, with the ongoing need for skilled expatriates. It also contributes to the human resource management and health care/aged care management literature. PRACTICAL IMPLICATIONS: The study recommends fostering public-private collaborations and partnerships between health care institutions and global universities to address skill gaps and ensure workforce sustainability in Saudi Arabia's health care sector.