How good are foreign doctors?The British Medical Journal perhaps has an answer to this question. In a press release few months back, it reported that the US patients treated by foreign physicians have less mortality rate when compared to those treated by US trained doctors. It is also to be noted that these foreign doctors are caring for a higher number of patients with chronic conditions.
Getting treated by a physician from different ethnic background speaking different language may not be appealing to US patients and a graduate degree from a developing country does not raise additional respect either.
The reality is different:
Taking into consideration, the US medical workforce, you come across with few amazing facts.
- Since more than 50 years, international medical school graduates have considerably filled up the demand-supply gap in the US physician workforce.
- Currently, foreign medical school graduates contribute ¼ th of the practicing physicians in the US.
- A deeper analysis reveals, immigrant physicians constitute 50.7% in geriatric medicine, 47.2% as kidney specialists, 43.6% as cardiologists and 41% as critical care specialists. [www.forbes.com]
- Today, medical school graduates from abroad nearly account for 30% primary medical care physician workforce which has been increasingly shunned by the US medical graduates.
The Study and its findings:
The comprehensive study included 1.2 million medi-care patients aged 65 and above who took hospital admission for medical treatment in 2011-14. They were treated by 44,000 internists who were either US medical graduates or from abroad medical school.
Medical graduates from eight countries India, Pakistan, Philippines, Syria, Nigeria, Mexico, Egypt and China were included in this study as these constitute the main immigrant physician workforce in the US. The patients treated by foreign internists suffered slightly more from chronic ailments.
- The primary outcome considered the 30 day mortality of patients. Patients treated by international medical grads showed a lower risk of mortality of 11.2% against 11.6% for patients treated by US medical grads. This implies for every 250 patients looked after by US medical grads, one life could be saved if the standard of quality care remains equivalent to those graduated from foreign medical schools.
- There was no difference in the readmission rates of patients treated by US medical graduates and foreign school grads.
- The cost of care per patient admission was found to be slightly higher with the patients treated by international medical grads but on further analysis that difference also did not seem to exist.[http://www.bmj.com]
The treatment approach may cause this difference:
It has always been a rigorous selection procedure for foreign medical graduates to obtain the rights of practicing in the US that demands to pass3 exams and complete several years of accredited residency in this country. In spite of this, concerns are raised over the standard of care provided by the foreign graduates.
- Foreign medical students are most likely to practice in rural and underserved regions where hospital resources are lower and the patient population with severe illness may be higher.
- These graduates are likely to be younger working in non-teaching hospitals, clinics and even in hospitals without intensive care units.
- The patients seen by foreign graduates are less likely to be white, well-off or have private health insurance.
- These patients are also likely to suffer from one or more chronic ailments like diabetes, congestive heart failure or chronic obstructive pulmonary disease.
The difference in quality care may stem from the physicians’ involvement in Primary Health Care and board certification:
An earlier report published in 2010 from the foundation for Advancement of International Medical Education and Research in Philadelphia also stated the board certification fulfilling the entire academic and experience requirement mattered most in patient outcome and not the nationality of the physicians. [http://www.nytimes.com]
In the same report, researchers also discovered that patients treated by foreign qualified Primary care physicians fared better than those receiving treatment from the US qualified primary care physicians.
According to the lead author of the study, Dr. John J Norcini, the US qualified physicians are shunning the primary care which is being rapidly filled up by the foreign medical graduates. In providing patient care, these guys ultimately turn out to be the smartest lot.
Dr. Norcini is also of the view that board certification and time elapsed since graduation are two crucial factors affecting the mortality rates of patients. As the time elapsedsince graduation increases for a doctor, patients under his/her care are likely to have higher chances of death from heart attack or congestive heart failure. He strongly emphasizes on the maintenance of board certification through periodic assessments by board-certified doctors.
Considering the selection procedure and working policies in the US, there is no denial of the fact that international medical graduates are accustomed in handling more serious challenges apart from completing two residencies (one in home country and the other in the US). Perhaps, this may have contributed to improvement of their patient care standards as observed in the latest study.
Most importantly, these findings are broad generalizations comprising people of varied personalities hailing from different cultural and academic background. Just a mere formulaic conception overlooking the individual as an entirety does not always lead to accurate conclusions. It definitely does not imply that a US physician trained in the US would not deliver the required standard of quality care and an immigrant would always perform above the standard.