IMGs, U.S. medical graduates provide same level of care

The quality of care provided by international medical graduates is the same as U.S. medical school graduates, according to a new study.

Researchers analyzed patient outcomes of 6,113 practicing Pennsylvania physicians who graduated from foreign and U.S. medicals school after 1958. They found no difference in mortality among patients hospitalized for congestive heart failure or acute myocardial infarction from 2003 to 2006, according to the study in the August issue of Health Affairs.

"We are really fortunate in the U.S. in that we have the top graduates from around the world coming for residency training here," said John J. Norcini, PhD, lead study author and president and chief executive officer of the Philadelphia-based Foundation for Advancement of International Medical Education and Research, a nonprofit that promotes excellence in international medical education.

There were distinctions when researchers compared other factors. The study found that patients of IMGs had longer hospital stays than those of U.S. medical graduates. More in-hospital patient deaths were attributed to IMGs who were U.S. citizens versus those who were not.

Patients of physicians with specialty board certification had lower mortality rates and shorter lengths of stay. Overall, mortality rates and length of stays increased with the number of years since a physician's medical school graduation, the study said (link).

The study's central findings seem correct, said Harlan Krumholz, MD,professor of medicine and director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation. But he questions how well the data demonstrate the quality of care provided by individual physicians.

"You can't just make an assumption about a physician based on the country where they trained," he said.

Care typically is provided by a team of physicians, making it difficult to attribute patient outcomes to individual physicians, he said. Also, the two groups studied are so large that each has a wide range of physicians of varying quality.

"I applaud their attempt, but I'm not sure that at the end of the day it helps us very much," Dr. Krumholz said.

IMGs make up nearly a quarter of U.S. physicians. Reports of physician shortages make the level of care provided by these doctors significant, Norcini said.

U.S. medical schools are expanding to produce more doctors to fill the need, but the number of residency training positions funded by Medicare remains capped. Without training opportunities for the growing number of graduates, it will become increasingly difficult for IMGs to find residency training slots in the United States, experts say.

"IMGs will probably come to the U.S. in smaller numbers if that cap remains," Norcini said.