In the United States, death rates are lower in patients treated by doctors who graduated from medical schools abroad than those hailing from institutions in America.

International medical graduates account for 25 percent of doctors in the United States, UK, Australia, and Canada, and are required to pass necessary examinations to be allowed to practice medicine in the United States and UK. 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 abroad and those who received training in U.S. medical schools.

International Vs. U.S.-Trained Doctors

Using nationally representative data, Ashish Jha and colleagues compared patient outcomes in cases handled by general internists from medical schools abroad and in the United States, analyzing data from more than 1.2 million beneficiaries under Medicare aged at least 65 years old. The patients were admitted between 2011 and 2014 with a medical condition treated by more than 44,000 general internists from international or U.S. medical schools. Those who received care from non-U.S. graduates reported slightly more chronic conditions.

To gauge results, primary outcomes were defined as 30-day patient mortality rates, while secondary outcomes pertain to 30-day readmission rates as well as care costs. Based on their findings, the researchers saw that patients who received care from a general internist who graduated from a medical school abroad had a lower risk of mortality at 11.2 percent compared with the 11.6 percent that was associated with U.S.-trained doctors.

Readmission rates were the same for the non-U.S. and U.S. graduates although the former had a higher cost of care for every admission at $1,145 versus $1,098 for the latter.

Study Implications

To put the results into perspective, the researchers said that for every 250 patients receiving care under a U.S. graduate internist, one life could be saved if both groups of doctors offered the same level of care.

The researchers also carried out further analysis to assess results but their findings did not affect the study's overall results. They did come up with a possible explanation why doctors who trained abroad are offering better care: the selection process international medical graduates undergo to be allowed to practice in the country is designed to identify better physicians.

No firm conclusions on cause and effect, however, can be drawn from the study because it is observational in nature. Still, the researchers point out that the results of their work are means of reassurance that the approach currently in place to license medical graduates from abroad to practice in the United States is rigorous enough to ensure high-quality care.

Female Vs. Male Doctors

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

About a third of all doctors in the United States are female.

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