United States doctors trained overseas have slightly better patient outcomes

"Although we are uncertain exactly why foreign-trained doctors have slightly better outcomes, the USA now sets a very high bar for foreign medical graduates to practice medicine in the USA", said lead study author Dr. Yusuke Tsugawa, a policy and management researcher at the Harvard T.H. Chan School of Public Health in Boston.

Researchers examined data for more than 1.2 million hospitalizations handled by general internists at USA 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 worldwide graduates are required to pass examinations to practice medicine in the United Kingdom and USA, concerns have been raised about the quality of care provided by these graduates. Many of those foreign-born doctors - particularly primary care physicians, such as internists - work in rural areas or with underserved populations in metropolitan areas.

After adjusting for factors that could have affected the results - including patient characteristics, physician characteristics and hospital fixed effects - they found that patients cared for by worldwide graduates had a lower risk of mortality (11.2 per cent versus 11.6 per cent) than patients cared for by U.S. graduates across a broad range of clinical conditions.

In another study, researchers discovered that female doctors are associated with lower mortality and readmission rates where elderly patients are involved.

In addition, landing a medical residency in the United States is much more hard for non-U.S. graduates.

For the study, the Harvard researchers analyzed more than 1.2 million hospital admissions of Medicare patients aged 65 and older (average age: 80 years) who were admitted to a hospital for a medical condition from 2011 through 2014.

Worldwide medical graduates make up a quarter of the physician workforce in the US, UK, Canada and Australia. Patients seen by global doctors were also more likely to have multiple chronic health problems like congestive heart failure, diabetes and chronic obstructive pulmonary disease.

Researchers set out to determine whether patient outcomes differ between general internists who graduated from a medical school outside the USA and those who graduated from a USA medical school.

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.

Yet no study has investigated differences in patient outcomes between worldwide medical graduates and United States medical graduates using nationally representative data.

For the study, researchers analyzed the data of more than 1.2 million Medicare patients aged 65 and older who were admitted to hospitals between 2011 and 2014 and treated by both U.S. medical graduates and by doctors from other countries. If medical graduates from other countries do not practice in America, it may have a significant impact on the US health care system. They did come up with a possible explanation why doctors who trained overseas are offering better care: the selection process global medical graduates undergo to be allowed to practice in the country is created to identify better physicians.

"Our findings indicate that current standards of selecting worldwide medical graduates for practice in the USA are functioning well for at least one important dimension: inpatient outcomes", they add.



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