Doctors Educated Outside U.S. have 9% percent lower death rate

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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 heart attacks. It found that doctors educated outside the U.S. have 9% percent lower death rate.

U.S. Doctors and Primary Care

“Primary care may not be getting the best and the brightest from U.S. medical schools,” said Dr. John 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.”

"We're extraordinarily blessed that people from around the world want to come here and practice," said Norcini. "And we really do get the cream of the crop from other countries."

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The largest group of foreign-born doctors who come to the U.S. are from India and Pakistan. They often fill gaps in practice areas that fewer American doctors pursue, such as primary care, where pay rates are lower than for specialty medical practices.

“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 raise.”

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.

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.

“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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