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Foreign-Born Doctors Give Equal Care in U.S.By DENISE GRADY
Published: August 3, 2010

Patients treated by foreign-born doctors who trained in other countries fare just as well as people treated by doctors educated in the United States, a new study has found.

But the results are not as good when the doctor is an American who went to medical school overseas and then returns to practice, the researchers determined. In that situation, patients with heart disease have longer hospital stays and slightly higher death rates.

Graduates of foreign medical schools now make up a quarter of all the practicing doctors in the United States. In order to qualify here, they have to pass a series of rigorous exams and complete residency training. About one-fifth of the foreign-trained doctors in the United States are Americans who studied abroad, often at medical schools in the Caribbean. Most foreign-born doctors in the United States come from India or Pakistan and initially studied medicine in those countries.

The study is being published Tuesday in the August issue of the journal Health Affairs. The first author is John J. Norcini, president of the Foundation for Advancement of International Medical Education and Research, in Philadelphia.

The authors of the study offered two possible reasons the Americans who went to foreign medical schools might not perform as well as doctors trained in the United States, or as well as foreign-born doctors. One is that many of the Americans who study medicine elsewhere do so because their grades and test scores were too low to get into medical school in the United States — so they may be less capable in the first place. Another possibility is that some of the overseas medical schools Americans attend may not be up to par.

There is a doctor shortage in the United States, and foreign doctors have stepped into the breach, particularly in specialties like internal medicine and family practice, which many American students have turned away from in favor of more lucrative specialties like cardiology. In response to the doctor shortage, medical schools in the United States have begun to expand their class sizes, and some new schools have opened. But the number of residency spots is not increasing, so new American graduates may start squeezing out the foreign-born doctors when it comes time to start residencies.

The authors say their findings offer a cautionary note: if schools in the United States lower their standards to fill new spots and begin admitting the kind of American applicants who have been going overseas to study, they may start turning out less competent doctors.

Dr. Norcini said there had been concern about the competence of foreign-trained doctors, based in part on reports in the 1990s of lower test scores and performance ratings. But his study noted that “by the mid-1990s, international medical graduates were outperforming U.S. graduates” on tests in internal medicine.

The researchers set out to evaluate doctors by assessing the health of their patients. They analyzed records from 244,153 hospitalizations in Pennsylvania from 2003-06. All the patients had congestive heart failure or had suffered heart attacks, conditions that are considered a good gauge of the quality of medical care.

The patients were treated by 6,113 doctors. As in the rest of the country, about three-quarters of them were born and trained in the United States. The rest had trained in other countries, and most were foreign-born; about 400 were Americans who had trained overseas.

The patients of foreign-born international graduates had the lowest death rate, 5 percent, and the patients of American doctors trained overseas had the highest death rate, 5.8 percent. Patients of the American born-and-trained doctors fell in the middle, with 5.5 percent