Posted by Published in Bloomberg dot com from IP 18.104.22.168 on August 03, 2010 at 08:02:39:
International Doctors in U.S. Performing Better Than
By Pat Wechsler - Aug 3, 2010 12:01 AM EDT
U.S. patients of doctors who went to medical school
outside the country and weren’t American citizens had a
9 percent lower death rate on average than those whose
doctors trained at home, a study showed.
The report, published today in the August issue of
Health Affairs, tracked the performance of primary-care
doctors, internists and cardiologists in 244,153
hospitalizations involving congestive heart failure or
Economics may help explain the gap in patient outcomes,
said John Norcini, co-author of the study. Internal
medicine and primary care have failed to attract the
best U.S. students because of lower pay, relative to
other specialties, he said.
“Primary care may not be getting the best and the
brightest from U.S. medical schools,” said Norcini,
chief executive officer of the Foundation for
Advancement of International Medical Education and
Research, a Philadelphia- based nonprofit. “Foreign
students see primary care as a gap that they can fill
and a way to practice medicine here.”
Primary-care doctors, including internists and family
practice physicians, earn on average from $175,000 to
$200,000 annually, while orthopedic surgeons make
$519,000; radiologists, $417,000; and anesthesiologists
$331,000, according to a survey released in June by the
national physician search firm Merritt Hawkins, based
in Irving, Texas.
U.S. medical schools don’t produce enough graduates to
supply all the postgraduate training slots available,
and the void has been filled by graduates from
institutions in other countries, Norcini said. These
international-schooled doctors make up a quarter of
practicing physicians in the U.S., and are especially
important in the area of primary care, he said.
‘Cream of the Crop’
“We have been blessed with the cream of the crop” from
other countries, said Norcini. “The ones who make it
through to become doctors are highly desirable and
Before being eligible to apply for a post-graduate
residency slot in the U.S., graduates of non-U.S.
medical schools must go through a two-step process that
tests a graduate’s clinical knowledge and skills. Over
the past five years, more than 10,000 certificates have
been awarded annually by the Educational Commission for
Foreign Medical Graduates, the group that created
The authors of the Health Affairs study said their
results, based on data from 2003 to 2006 in
Pennsylvania, mark a shift from the early 1990s when
research showed international medical graduates
underperforming U.S.-trained doctors on licensing
examinations, specialty board certifications and other
“I am somewhat surprised by the results of the study,”
said John Prescott, chief academic officer of the
American Association of Medical Colleges in Washington.
“But the paper was well-written and the authors went
out of their way to address any issues people might
Not all international medical graduates had good
results. U.S. citizens who attended medical schools
abroad underperformed graduates of U.S. medical schools
and citizens from other countries who went to school
outside the U.S. Internationally trained foreign
doctors had a 16 percent lower mortality rate than
Americans schooled overseas, according to the Health
“Whenever you have a study like this, it says perhaps
we need to look a little more closely,” AAMC’s Prescott
Harlan Krumholz, a professor at Yale School of Medicine
and director of Yale-New Haven Hospital Center for
Outcomes Research and Evaluation, raised issues with
the methodology and conclusions of the study.
“In reality there is a team of doctors for every
patient and it is difficult to know the role that any
one individual played,” he said in an e-mail. He also
questioned why the article didn’t distinguish where the
international medical graduates went to school.
“This can only be considered an exploratory result,” he
Even though foreign medical graduates produced good
patient outcomes, according to this study, they may
find it harder to get a post-graduate residency as U.S.
medical schools have increased their class sizes while
the federal government has failed to raise the number
of training spots available. The number was capped in
1997 as a way to control spending on Medicare, the U.S.
health plan for the elderly and disabled. Medicare
helps fund post-graduate positions.
The study also found that doctors who have been
certified by a medical specialty board -- typically
after completing post- graduate training -- have lower
mortality rates than those who haven’t been, regardless
of nationality, Norcini said. The further a doctor gets
from medical training the worse their patients fare as
well, making an argument for the need for continuing
education and post-certification testing, he said.
“People don’t need to pay so 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,” Norcini said.
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