Study Compares Quality of Care Under U.S.- and Foreign-Trained Doctors

An observational study published in BMJ suggests that older patients who were hospitalized and treated by doctors who graduated from non-U.S. medical schools had lower 30-day mortality rates than those treated by U.S. medical school graduates.

Yusuke Tsugawa, MD, MPH, PhD, from the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health in Boston, Massachusetts, and authors analyzed more than 1.2 million hospital admissions of Medicare patients ≥65 years of age (mean age = 80 years) between 2011 and 2014. Patients were seen by a total of 44,227 internists; 44.3 percent (n=19,589) graduated from non-U.S. medical schools.

Patients treated by foreign-trained physicians had decreased 30-day mortality (the study’s primary outcome), compared to those treated by U.S.-trained physicians (11.2% vs. 11.6%; odds ratio = 0.95; 95% CI 0.93-0.96; p<0.001). However, patients had slightly higher costs of care per admission when treated by foreign-trained doctors ($1,145 vs. $1,098; 95% CI 39-55; p<0.001). Readmission rates did not differ.

The authors offered several potential reasons for the observed lower mortality outcomes, including:

  • Most foreign graduates complete two residencies – one in the country where they received their degree and one in the United States.
  • Foreign-trained doctors often face prejudice, possibly making them more cautious and more likely to ask for consultations to avoid mistakes.

The authors noted that although 30-day mortality and readmission rates are widely accepted measures of quality for hospital care, they are not comprehensive, thus limiting the study’s outcomes.

Source: Tsugawa Y, Jena AB, Orav EJ, Jha AK. Quality of care delivered by general internists in US hospitals who graduated from foreign versus US medical schools: observational study. BMJ. 2017 February 2. [Epub ahead of print]