Integrating the Private Sector into Surgical Residency Training: Insights from Dr. Sulaiman Al Habib Medical Group, Saudi Arabia

Medical education and surgical training are essential for developing competent healthcare professionals. Globally, residency training has traditionally concentrated in public hospitals and academic centers. However, recognition of the private sector's role in expanding training opportunities has emerged, particularly in countries facing rising medical graduates and evolving health reforms.

This mixed-methods institutional case study draws on quantitative, institutional, and national datasets alongside qualitative materials from interviews, focus groups, and document analysis. Dr. Sulaiman Al Habib Medical Group (HMG) hosts an extensive postgraduate education platform, delivering Saudi Commission for Health Specialties (SCFHS)-accredited residency and fellowship programs across multiple specialties. This report examines private sector impact on surgical residency training in Kingdom of Saudi Arabia (KSA), covering program availability, accreditation, policy dynamics, challenges, and opportunities.

Healthcare system structure

Saudi Arabia's healthcare comprises public and private providers. The Ministry of Health (MOH) operates 244 hospitals with 33,277 beds, accounting for 60% of healthcare services. Military hospitals, university teaching hospitals, and specialty centers like King Faisal Specialist Hospital provide advanced care, forming an extensive safety net including rural areas [1].

Private hospitals account for 41% of total hospitals and one-third of bed capacity. Operating on fee-for-service models, major groups include HMG, Saudi German Hospitals, Al Mouwasat, and Dallah Health, with modern facilities in Riyadh, Jeddah, and Dammam. The private sector accounts for approximately 37% of outpatient visits nationwide, thereby enhancing trainees' clinical exposure to diverse patient populations [2].

Programs in private sector

Residency training primarily occurred in government hospitals due to accreditation requirements and the presence of high-acuity cases. Recent SCFHS amendments broadened the standards to include qualified private hospitals, increasing the number of accredited positions while maintaining oversight. Initial assessments identified gaps; a 2009 survey showed only 6% of residents believed effective monitoring existed (Table 1).

Table 1.

Private-sector hospitals with Saudi Commission for Health Specialties accredited residency programs.

Institution	Location	Programs	Highlights
International Medical Center (IMC)	Jeddah	Internal Medicine; General Surgery; Pediatrics; OB/GYN; Orthopedics; Anesthesiology; ENT; Urology; Radiology; Pathology; Emergency Medicine; Family Medicine	Early SCFHS-accredited private training adopter; broad multi-specialty exposure with structured academic governance
Johns Hopkins Aramco Healthcare (JHAH)	Dhahran	Family Medicine; Anesthesiology; Emergency Medicine; Pathology; Pharmacy	Standardized curricula with strong quality assurance and academic oversight in internationally affiliated system
Dr. Sulaiman Al Habib Medical Group (HMG)	Multiple cities	Internal Medicine; Pediatrics; General Surgery; OB/GYN; Orthopedic Surgery; Anesthesiology; Emergency Medicine; Critical Care; Dental Specialties	SCFHS-accredited programs from 2014; phased expansion with centralized academic oversight through HMG Academy

SCFHS: Saudi Commission for Health Specialties, HMG: Dr. Sulaiman Al Habib Medical Group, JHAH: Johns Hopkins Aramco Healthcare, IMC: International Medical Center, OB/GYN: obstetrician-gynecologist, ENT: ear, nose and throat.

Over the past decade, SCFHS has adopted competency- and outcome-based frameworks that utilize simulation laboratories. Circa 2018–2019, simulation-based training and formal clinical skills assessments were incorporated, improving surgical skill acquisition [3]. The contemporary system emphasizes quality, patient safety, and the production of competent consultants.

Private institutions offer streamlined administration, competitive salaries, and superior facilities attracting skilled surgeons. Key drivers include: i) universal health coverage evolution: government regulation through Council of cooperative health insurance (CCHI) increased private care demand. Incorporating private practice exposure provides residents comprehensive understanding of diverse healthcare delivery models. ii) and healthcare professional shortage: only 17% of KSA's healthcare workers are nationals, with 2.3-year average tenure [4]. The National Transformation Program aims to raise resident physicians from 2,200 to 4,000, expanding private hospital roles, supporting Vision 2030's health goals [5].

Quality of training: private versu public

Training quality in private hospitals faces scrutiny regarding case volume and clinical exposure. Public hospitals handle higher patient influxes, complex procedures, and trauma cases, offering comprehensive experience. Private hospitals focus on elective procedures, potentially restricting advanced case exposure.

However, private hospitals provide high-quality training through infrastructure investment, state-of-the-art facilities, and low trainee-to-consultant ratios. Evidence shows structured curricula and committed faculty achieve comparable outcomes. The SCFHS enforces standardized curricula and periodic reviews, ensuring educational parity across service models.

Challenges in private hospital training

i) Limited case variety: Surgical training requires hands-on experience. Private hospitals handle narrower case ranges, focusing on electives while complex trauma cases remain in government centers. A substantial proportion of surgery residents report dissatisfaction with case-load diversity. Surgical competence is primarily achieved through repeated performance of core procedures under structured supervision. High-volume elective surgeries in private hospitals offer consistent skill-building opportunities. Modern competency-based education focuses on outcomes and objective assessments, demonstrating that private training can match public standards. Selected private institutions, including HMG, have achieved international accreditation, provide specialized services (cardiac, oncology, women's health), and partners with over 21 universities. ii) Fee-for-service model influence: This model ties income to services, potentially creating teaching tensions. Patient satisfaction emphasis makes opinions crucial. Patients often prefer senior consultants and may hesitate to involve trainees, leading to more observation than hands-on practice. iii) Supervision and mentorship: Private hospitals typically lack teaching cultures, making mentorship challenging with scarce senior educators and smaller programs. Faculty fellowship initiatives, such as HMG Academy and the George Washington University, enhance mentorship. The HMG maintains partnerships with Guy's and St Thomas' National Health Service Foundation Trust, University Hospitals Birmingham, and Prince Mohammed Bin Salman College, with a focus on training and leadership development.

Expansion opportunities

i) Geographic distribution: Public programs concentrate in major cities (Riyadh, Jeddah, Dammam). Private providers operate in secondary cities and towns. Encouraging residency programs can decentralize training. The HMG's expansion to Tabuk, Kharj, and Jubail enables regional training hubs under SCFHS oversight. ii) Reducing expatriate reliance: Training more Saudi specialists addresses Saudization goals. Currently, only 3,000 of 33,800 private sector doctors are Saudi (8% Saudization) [5]. The HMG achieved 36.7% Saudization by November 2024. Private groups expanding training create pipelines of locally trained consultants, fulfilling regulatory requirements and ensuring cultural alignment. Every additional training position represents an investment in future Saudi doctors–critical for healthcare sustainability. The HMG Academy sponsors doctors for fellowships abroad; upon return, they contribute advanced expertise.

In conclusion, KSA's private healthcare sector is increasingly enhancing residency training, providing structured opportunities that complement public systems. This collaboration is crucial for Vision 2030 workforce goals. Leveraging private sector medical education enables training more surgeons and improving healthcare delivery without overburdening public hospitals.

Disclosure statement

Artificial intelligence tools were used solely for language editing, structural refinement, and clarity of presentation. No AI tools were used for data collection, data analysis, result interpretation, or for generating original research data or images. The author takes full responsibility for the integrity, accuracy, and originality of the work. No part of this work has been previously presented at any conference or published in abstract form.

Acknowledgement

The author would like to acknowledge Scribbr for the English language editing.

Disclosure

The author declare no conflicts of interest. This study did not receive any financial support or funding from pharmaceutical or medical device companies.