American patients treated by internationally educated doctors have slightly better outcomes than those treated by their American-educated counterparts, a new study has found, as Donald Trump’s ban on travel from seven Muslim-majority countries is expected to stop some immigrant physicians from coming to the United States.
But that is not because American medical schools are falling short, the authors of the report in the British Medical Journal said.
“We’re not saying medical school in the US is not doing a good job, it’s only about selection,” said Yusuke Tsugawa, a research associate at Harvard University’s TH Chan School of Public Health and lead author of the study. Self-selection, to be more specific.
“They are highly motivated,” Tsugawa said of doctors educated outside the US. “They are not random doctors from their home country, they are the best doctors.”
Trump’s executive order banned people from entering the US from seven countries – Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen – for 120 days following the order. The order also stopped the Syrian refugee resettlement program indefinitely.
Researchers looked at 1.2m hospital admissions of patients on Medicare, the American public health insurance program for the elderly, who were treated by more than 44,000 physicians. The rate at which patients died or were readmitted was used to measure patient “outcomes”.
Despite the study’s findings that internationally educated doctors were slightly more likely to treat a sicker population – people with more chronic diseases, as well as more likely to be from racial minorities and more likely to be low-income – outcomes were slightly better than among their American-educated peers. That held when comparing doctors in the same hospitals. Patients treated by both international and US graduates were about the same age on average, approximately 80 years old.
“Our findings indicate that current standards of selecting international medical graduates for practice in the US are functioning well for at least one important dimension: inpatient outcomes,” researchers wrote.
By the numbers, researchers found that when patients were treated by internationally educated doctors, they died at a rate of 11.2%, versus 11.6% for US-educated physicians, in comparisons of doctors working in the same hospitals.
Readmissions showed the same trend. Patients returned to the hospital within 30 days at a rate of 15.4% for internationally educated doctors, and 15.5% for US educated doctors, when comparing doctors in the same hospital.
Tsugawa said he and his colleagues undertook the study because other research showed there “was a bias against foreign medical graduates, both from colleagues and patients, so they are thinking quality of care might be worse than US medical graduates.
“Given that 25% of the doctors in the US – or in the UK as well – are foreign medical graduates, we want to make sure they are providingquality medical care,” he said. Tsugawa said he expected to focus on the race of doctors in his next study.
“To do the residency program in the US, the bar is really high; only 50% of the candidates can get the slot in the residency program,” said Tsugawa. “There are multiple ways they are highly selected, and highly motivated, and that is the reason they have better outcomes.
“Those who come to the US are the brightest and the best,” he said.
About one quarter of physicians working in the US were educated abroad, multiple studies show. But many workforce experts believe that even if the immigration status of hundreds weren’t suddenly in question, there still would not be enough doctors coming to the US to make up shortages faced by ageing and rural Americans.
For example, the largely rural Alaska already needs an additional 60 doctors per year, the Atlantic reports. And a 2015 New England Journal of Medicine article argued that programs that brought 8,000 doctors to the US each year would fall far short of the primary care needs of the country’s ageing population.
Research from 2013 showed that 299 doctors from Iran, Iraq, Libya, Sudan, or Syria applied to train in the US as residents that year, with an acceptance rate of just 40%, a New England Journal of Medicine article reported.
Syria is also one of the top exporters of physicians to the US in another program that places doctors in high-need rural and inner-city areas, the J-1 visa program. In 2014, 165 Syrian doctors moved to the US under the program, according to the same article. If the ban continues beyond 120 days the number of doctors – and therefore patients – affected could escalate very quickly.
“Physicians with J-1 waivers are filling clinical jobs in areas of need,” the NEJM authors wrote. “An executive order that has not taken into account the widespread ramifications may lead to further shortages of physicians in areas that are already in dire need.”
Healthcare and Trump"s travel ban: data shows success of doctors trained abroad
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