Wednesday, 19 September, 2018

Foreign-Educated Doctors Provide Better Care Than Their US Counterparts

Melissa Porter | 07 February, 2017, 04:07

However, concerns have been raised regarding the quality of care they provide even though no study has been carried out to investigate differences in patient outcomes between doctors trained overseas and those who received training in US medical schools. 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 the USA, doctors trained elsewhere treat a far greater proportion of patients in many rural and underserved communities, previous studies have shown.

Researchers examined data for more than 1.2 million hospitalizations handled by general internists at US 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.

Yet no study has investigated differences in patient outcomes between global medical graduates and U.S. medical graduates using nationally representative data. Interestingly, the patients of the foreign-trained internists were more likely to be non-white, to be on Medicaid and to have a lower median household income than the patients treated by the US -trained internists.

Those patients were treated by 44,227 general internists, of whom about 44 percent were trained outside the U.S. The eight countries with the largest number of global medical graduates were India, Pakistan, Philippines, Syria, Nigeria, Mexico, Egypt and China.

They analysed a national sample of data for over 1.2 million Medicare beneficiaries aged 65 years or older admitted to hospital with a medical condition in 2011-14 and treated by over 44,000 worldwide or United States medical graduates who were general internists. The most common causes of death were sepsis, pneumonia, congestive heart failure and chronic obstructive pulmonary disease. "That is, I think, unfair without looking exactly at whether their performance is as good as the US medical graduates".

In general, compared with patients treated by USA graduates, those seen by global graduates were less likely to be white, affluent or covered by private insurance.

The study isn't an experiment created to prove whether doctors educated in the USA or other countries provide better care or help patients live longer, the authors note.

The researchers, including those from Harvard Medical School in the United States, examined whether patient outcomes varied by countries where global medical graduates were trained.

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 USA medical graduates and by doctors from other countries.

"Our findings indicate that current standards of selecting worldwide medical graduates for practice in the U.S. are functioning well for at least one important dimension: inpatient outcomes", they add. They reported that elderly patients treated by female doctors regardless of medical condition were 4 percent less likely to succumb to death prematurely and 5 percent less likely to be readmitted to the hospital 30 days after their initial discharge.

Although the study wasn't created to prove a cause-and-effect relationship, the findings "should reassure policymakers and the public that our current approach to licensing worldwide medical graduates in the U.S.is sufficiently rigorous to ensure high-quality care", Tsugawa's team concluded.