February 6, 2017

US patients of foreign-educated physicians have better survival rates, study suggests

Daily Briefing

    Patients treated by foreign-educated physicians are slightly less likely to die within 30 days of hospital admission than those treated by doctors who studied in the United States, according to a study published Friday in BMJ.

    The findings come shortly after President Trump signed an executive order that blocks many individuals from seven countries from entering the United States, including some physicians and researchers. A federal court has blocked the order, which some physicians have challenged in court. However, the order has created uncertainty for hospitals, as well as hundreds of medical residency applicants from the affected countries.

    Doctors sue Trump administration over travel ban

    According to a BMJ spokesperson, the timing of the study was a coincidence. The spokesperson said research for the study started last year and the study was scheduled to be published before Trump issued the executive order.

    Study details

    For the study, researchers examined hospital admissions among more than 1.2 million Medicare beneficiaries ages 65 and older between 2011 and 2014. They compared survival rates among beneficiaries who were patients of about 44,200 internal medicine physicians.

    The patients' average age was 80, and the most common causes of death among the patients included:

    • Chronic obstructive pulmonary disease;
    • Congestive heart failure;
    • Pneumonia; and
    • Sepsis.

    Findings

    The researchers found that about 44 percent of general internists in the United States were international graduates. They tended to be younger and work in medium-sized, non-teaching hospitals without intensive care units.

    According to the researchers, patients of foreign-educated doctors had slightly better 30-day survival rates. The study found that such patients had an 11.2 percent chance of dying within 30 days of admission, compared with an 11.6 percent chance among patients treated by U.S.-educated physicians. The researchers found similar mortality rates even after adjusting for patients' ages, the complexity of patients' conditions, and the hospitals where the doctors worked.

    Discussion

    The study did not address why patients of foreign-educated physicians might fare better. However, study co-author Ashish Jha of the Harvard T.H. Chan School of Public Health suggested it might be because the United States attracts the highest-quality physicians from other countries.

    Study co-author Yusuke Tsugawa, who graduated from a medical school in Japan, said another reason for the disparity could be that U.S. hospital residencies often have more rigorous requirements for non-U.S. graduates.

    The researchers also said most foreign-educated physicians go through two residencies, one where they studied and one in the United States. Such "intensive and prolonged training" could make them better doctors, the researchers wrote.

    Despite the findings, Rachel Reid, an associate physician policy researcher at RAND Corporation, said individuals should not use the study's results to inform their choice of physician, noting that physician quality can vary.

    Andrew Ryan, an associate professor at the University of Michigan, said multiple factors can affect patients' survival rates. He added, "Attributing mortality to a single physician who cared for a patient during a hospitalization is a major challenge."

    Michael Lavine—professor of statistics at the University of Massachusetts, Amherst—expressed a similar concern, saying, "We don't know whether the results will generalize" (Evans, Wall Street Journal, 2/2; Begley, STAT News, 2/2; Tsugawa et al., BMJ, 2/3; O'Brien, Star-Ledger, 2/2; Silva/Hanrahan, NBC News, 2/6).

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    The changing physician workforce

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