August 9, 2010
According to a new study by John Norcini, president and CEO of the Foundation for Advancement of International Medical Education and Research in Philadelphia, patients of non-U.S. citizen international medical school graduates had significantly lower mortality rates than doctors who trained in the U.S. Patients of U.S. citizens who graduated from an international medical school and returned to the U.S. to practice had the highest risk of dying.
HealthDay reported that Norcini's study analyzed nearly 250,000 patients hospitalized in Pennsylvania in 2003-2006. All patients had congestive heart failure or had suffered a heart attack. The study included more than 6,100 doctors--approximately 4,600 were U.S. medical school graduates and 1,500 were international graduates.
The study found that patients of foreign-born doctors who graduated from an international medical school "had a 9 percent lower death rate than the patients of U.S. citizens trained at U.S schools". The largest difference was between U.S. citizens who earned their degrees from an international school and Non-U.S. citizen international graduates. In this case, patients of non-U.S. citizen international graduates had a 16 percent decrease in mortality.
The authors of the study speculated two possible reasons for the gap in performance: Americans who studied abroad may have done so because their grades and test scores were not high enough for U.S. medical schools or some overseas medical schools are not up to par with U.S. medical school standards, reported The New York Times. According to HealthDay, foreign-born doctors who trained overseas and want to practice medicine in the United States have to go through a rigorous screening and training process. They must pass all the same exams and meet the same requirements as medical students who got their degrees in the U.S. Doctors trained abroad must also complete their residency at a U.S. hospital. Furthermore, graduates of medical schools in other countries may receive a more rigorous education. "Most of those who come from foreign countries have already learned so much and seen so much from their practical experience," stated Ajeet Singhvi, president of the American Association of Physicians of Indian Origin.
Bloomberg added that economics may also be a reason. "Primary care may not be getting the best and the brightest from U.S. medical schools. Foreign students see primary care as a gap that they can fill and a way to practice medicine here," said Norcini. Bloomberg pointed out that because primary care doctors earn on average from $175,000 to $200,000 annually, American students have opted for more lucrative specialties. Orthopedic surgeons and radiologists, for example, can earn $519,000 and $417,000 respectively.
Bloomberg reported that board certification helped alleviate the gap in performance. According to the study, doctors who have been certified by a medical specialty board have lower mortality rates than doctors without certification, regardless of nationality. Continuing education also mattered as patient mortality rates increased with the number of years since medical training. "People don't need to pay much attention to whether their doctor is a graduate of an international school but they should pay more attention to whether or not the doctor has been board certified," argued Norcini.
Compiled by Heidi M. Agustin
"Doctors Educated Outside U.S. Outperform Home-Grown Physicians," bloomberg.com, August 3, 2010, Pat Wechsler
"Evaluating The Quality Of Care Provided By Graduates Of International Medical Schools," healthaffairs.org, August 2010, John J. Norcini et al.
"Foreign-Born Doctors Give Equal Care in U.S.," NYTimes.com, August 3, 2010, Denise Grady
"Foreign-Trained Doctors As Good As U.S.-Trained Counterparts," healthday.com, August 3, 2010, Jennifer Goodwin