Researchers examined data for more than 1.2 million hospitalizations
handled by general internists at U.S. hospitals and found patients
were slightly less likely to die within 30 days after admission if
their doctor went to medical school in another country.
"Although we are uncertain exactly why foreign-trained doctors have
slightly better outcomes, the U.S. currently sets a very high bar
for foreign medical graduates to practice medicine in the U.S.,"
said lead study author Dr. Yusuke Tsugawa, a policy and management
researcher at the Harvard T.H. Chan School of Public Health in
Boston.
"Therefore, the doctors who choose to leave their home country and
manage to pass all certification exams may be very capable and
motivated individuals," Tsugawa said by email.
The absolute difference was small, with mortality rates of 11.2
percent for foreign-trained doctors versus 11.6 percent for U.S.
medical school graduates.
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After accounting for other factors that could contribute to
patients’ outcomes, the mortality rate was 5 percent lower for
foreign medical graduations. But that's large enough to impact tens
of thousands of patients nationwide.
International medical graduates make up a quarter of the physician
workforce in the U.S., the UK, Canada and Australia, researchers
note in the BMJ. In the U.S., doctors trained elsewhere treat a far
greater proportion of patients in many rural and underserved
communities, previous studies have shown.
The research team points out that in order to get a license to
practice medicine in the U.S., foreign medical school graduates must
pass two examinations that test medical knowledge and one
examination that assesses clinical skills, and they must also
complete several years of accredited residency training in the U.S.
For the current study, Tsugawa and colleagues examined data on
patients 65 and older covered by Medicare who were treated by 44,227
general internists between 2011 and 2014.
Overall, 19,589 of the doctors, or 44 percent, were international
medical school graduates. The foreign graduates tended to be
slightly younger and were more likely to work in non-teaching
hospitals, for-profit hospitals and hospitals without intensive care
units.
In general, compared with patients treated by U.S. graduates, those
seen by international graduates were less likely to be white,
affluent or covered by private insurance. Patients seen by
international doctors were also more likely to have multiple chronic
health problems like congestive heart failure, diabetes and chronic
obstructive pulmonary disease.
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When researchers looked at conditions that commonly bring patients
to the hospital, they found international graduates had
significantly lower mortality rates for pneumonia and congestive
heart failure.
The non-U.S. doctors had lower mortality rates for most other
conditions, too, but the difference wasn't big enough to rule out
the possibility that it was due to chance.
There wasn't a meaningful difference in readmission rates, or the
proportion of patients who returned to the hospital again within 30
days of being sent home.
The study isn't an experiment designed to prove whether doctors
educated in the U.S. or other countries provide better care or help
patients live longer, the authors note. Researchers also couldn't
distinguish between foreign-born international medical school
graduates and U.S. citizens who left the country to train overseas.
It's also possible that patients treated by foreign-trained doctors
were different from people seen by U.S. medical school graduates in
some ways that weren't detected in the study, said Dr. Vineet Arora,
a researcher at the University of Chicago who wasn't involved in the
study.
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"I find the mortality difference hard to explain by educational or
cultural differences alone given the varied educational experiences
and cultural backgrounds of international medical graduates," Arora
added by email. "We do know that international doctors who gain
entry into the US are often at the top of their class - so it’s
certainly possible that this could explain the findings."
SOURCE: http://bit.ly/2kBno94 BMJ, online February 3, 2017.
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