Press Release

Embargoed Until Contact

August 03, 2010
12:01 AM EST

Jemma Weymouth
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Sue Ducat
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From Health Affairs


New Study Finds Foreign-Trained Doctors Provide Same Quality of Care as Doctors Educated in U.S.

Study Also Finds That U.S.-Born Physicians Who Trained Overseas Had Higher Patient Death Rates Than Foreign-Born Doctors Who Trained Abroad And Practice in the U.S.


Bethesda, MD - Some in the U.S. medical community have questioned the competence of physicians trained abroad. But a new study, to be released on August 3 in Health Affairs' August issue, indicates that the quality of care provided by these physicians is no different from that provided by physicians trained at U.S. medical schools. In fact, the study--based on data from Pennsylvania, and the first to compare patient outcomes of care by both groups of physicians--found no significant difference in the death rates of patients treated by international medical school graduates versus those treated by graduates of U.S. medical schools.

The study, however, raises important questions about U.S. citizens who seek training abroad. This group accounts for approximately one-fifth of all foreign-trained doctors certified to practice in the United States. The study found that the patients of U.S.-born doctors who graduate from non-U.S. medical schools had higher rates of in-hospital deaths than the patients of foreign-born international medical graduates.

One-quarter of all doctors practicing in the United States are educated abroad. Since international medical graduates are clearly filling many gaps in care, the findings are encouraging, the study authors (John. J. Norcini and colleagues), say.


"Despite a rigorous U.S. certification process for international graduates, the quality of care provided by doctors educated abroad has been an ongoing concern," said John J. Norcini, president and chief executive officer of the Foundation for Advancement of International Medical Education and Research (FAIMER) and lead author of the study. "It is reassuring to know that patients of these doctors receive the same quality of care that they would receive from a physician trained in the United States."


U.S. citizens seeking a medical education but not admitted to a U.S. medical school frequently pursue medical education abroad. As U.S. medical schools expand in response to a perceived need for more physicians, they must remain vigilant in their selection procedures to ensure that this pool of potential candidates for admission does not dilute the quality of U.S. graduates, say the authors.


The study analyzed 244,153 hospitalizations of patients with congestive heart failure or acute heart attack in Pennsylvania who were treated by either a U.S.-trained or foreign-trained doctor who specialized in family medicine, internal medicine, or cardiology. The composition of the 6,113 doctors in the study closely mirrors national figures, with graduates of U.S. medical schools accounting for approximately 75 percent of the study group and graduates of international schools 25 percent. Of the 1,497 international graduates in the study, 1,123 were not U.S. citizens when they entered medical school.

Among the three groups (U.S. nationals trained in the United States, U.S. nationals trained abroad, and foreign nationals trained abroad), patients of foreign-born international medical graduates had the lowest death rates, while those of U.S.-citizen international graduates had the highest. In addition to patient death rates, the study looked at length-of-stay as a measure of quality of care. It found that patients of U.S. graduates had the shortest lengths-of-stay and the patients of U.S.-citizen international graduates had the longest. The variance in length-of-stay between U.S. medical graduates and foreign-born international medical graduates was relatively small, indicating little practical difference between the two.


"These findings bring attention to foreign-trained doctors and the valuable role they have played in responding to the nation's physician shortage," said Norcini. "U.S. medical schools are doing their part by expanding for the first time in thirty years, but the number of graduate training programs has not increased proportionately. If this continues, the current physician shortages will persist and the numbers of foreign-trained doctors will likely decrease significantly."


In findings relevant to the general population of physicians in the United States, the study also found that:

• Specialty board certification was associated with lower mortality and shorter stays.


• Physician performance declined over time, with mortality rates and length-of-stays increasing with the number of years since graduation from medical school.


"Ongoing training programs and periodic reassessment of doctors' knowledge and skills can help maintain the level of physician competence needed to deliver high quality health care," said Norcini. "This is important for all doctors, regardless of whether they went to school in this county or any other."

To access a full table of contents from this issue, visit:

About Health Affairs

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears each month in print, with additional Web First papers published weekly at The full text of each Health Affairs Web First paper is available free of charge to all Web-site visitors for a two-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund.