About one-quarter of all physicians practicing in the U.S. graduated from an international medical school, and a study in Health Affairs suggests that patients receive the same quality of care whether their doctors were trained here or abroad—but further analysis shows better outcomes if the foreign-trained doctor was not a U.S. citizen at the time they entered medical school.
Foreign-trained docs just as safe: study
John Norcini, president and CEO of the Foundation for Advancement of International Medical Education and Research in Philadelphia, and colleagues examined the records for 244,153 hospitalizations of patients with congestive heart failure or acute heart attack at 184 Pennsylvania hospitals. These patients were seen by 6,113 cardiologists, family physicians and internists between Jan. 1, 2003, and Dec. 31, 2006, with 4,616 (75.5%) of those doctors trained in U.S. schools and the other 1,497 trained at 391 medical school in 79 countries. Of the foreign trained physicians, 1,123 (75%) were not U.S. citizens when they entered medical school, the report said, while 374 were U.S. citizens studying abroad.
The percentage of in-hospital deaths for congestive heart failure was 3.4% for domestically trained doctors and 3.1% for internationally trained physicians. For foreign-trained doctors who were not U.S. citizens during medical school, the rate death was 3%; for U.S. citizens who trained abroad, it was 3.5%. For heart attack patients, the in-hospital death rate was 13.1% for domestically trained doctors, and 12.7% for those trained abroad. For non-U.S. citizens trained abroad the rate was 12.2%; for U.S. citizens trained at foreign schools, it was 14.4%.
In noting the statistics for U.S. citizens trained at foreign medical schools, the study concluded that it “suggests the importance of further research to clarify whether their performance is a result of their medical education experiences or their ability.”
“Despite a rigorous U.S. certification process for international graduates, the quality of care provided by doctors educated abroad has been an ongoing concern,” Noricini said in a news release. “It is reassuring to know that patients of these doctors receive the same quality of care that they would receive from a physician trained in the United States. … These findings bring attention to foreign-trained doctors and the valuable role they have played in responding to the nation's physician shortage.”
(For more discussion of the role foreign-trained doctors have in overcoming the U.S. primary care shortage, please see the July 26 Modern Healthcare article “Foreign Concepts” and listen to the podcast interview with Gerard Anderson of the Johns Hopkins Bloomberg School of Public Health.)
The data used in the study were collected from the Pennsylvania Health Care Cost Containment Council and taken from all hospitals in the state except for Veterans Affairs institutions, skilled-nursing facilities and state psychiatric hospitals. Data was limited to cases involving attending physicians who graduated after 1958, and researchers said heart attack and congestive heart failure patients were chosen because those are common conditions and often used as markers of quality of care. Also, the study said that the preponderance of care for these conditions is provided by cardiologists, family physicians and internists, and these specialties account for 44% of all international medical graduates in active practice.
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.