Patients treated by immigrant docs in US have lower death rate

Boston: Patient death rate in the US is lower for immigrant doctors from countries such India and Pakistan, as compared to trained medical graduates from American medical schools, according to a new study that comes amidst the immigrant controversy triggered by President Donald Trump.

The researchers, including those from Harvard Medical School in the US, examined whether patient outcomes varied by countries where international medical graduates were trained.

They were restricted to eight countries with the largest number of international medical graduates going to the US - India, Pakistan, Philippines, Syria, Nigeria, Mexico, Egypt, and China - to avoid unstable estimates.

In the US, international graduates are largely from India, the Philippines and Pakistan - not including US citizens who have gone abroad for medical education and returned to the US to practice.

The researchers said that current standards of selecting international medical graduates for practice in the US "appear sufficiently rigorous to ensure high quality care."

International medical graduates make up a quarter of the physician workforce in the US, UK, Canada and Australia.

Although international graduates are required to pass examinations to practice medicine in the UK and US, concerns have been raised about the quality of care provided by these graduates.

Yet no study has investigated differences in patient outcomes between international medical graduates and US medical graduates using nationally representative data.

Researchers set out to determine whether patient outcomes differ between general internists who graduated from a medical school outside the US and those who graduated from a US medical school.

They analysed a national sample of data for over 1.2 million Medicare beneficiaries aged 65 years or older admitted to hospital with a medical condition in 2011-14 and treated by over 44,000 international or US medical graduates who were general internists.

Compared with patients treated by US graduates, patients treated by international graduates had slightly more chronic conditions.

After adjusting for factors that could have affected the results - including patient characteristics, physician characteristics and hospital fixed effects - they found that patients cared for by international graduates had a lower risk of mortality (11.2 per cent versus 11.6 per cent) than patients cared for by US graduates across a broad range of clinical conditions.

The researchers said that for every 250 patients treated by US medical graduates, one patient's life would be saved if the quality of care were equivalent between the international graduates and US graduates.

Re-admission rates did not differ between the two types of graduates, whereas a cost of care per admission was slightly higher for international medical graduates.