Study: US Medicare patients treated by foreign-educated physicians more likely to survive

Medicare patients admitted to U.S. hospitals had lower mortality when cared for by foreign-educated physicians than by graduates of U.S. medical schools, according to a study published Thursday in the journal BMJ.

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For the study, Harvard University researchers examined data for Medicare fee-for-service beneficiaries admitted to the hospital with a medical condition between 2011 and 2014 and treated by international or U.S. medical graduates who were general internists. They looked at more than 1.2 million hospital admissions treated by 44,227 general internists.

After adjusting for patient and physician characteristics and hospital fixed effects, they found patients treated by foreign-educated physicians had lower mortality (11.2 percent) compared to patients treated by U.S. medical school graduates (11.6 percent).

"We found no evidence that patient outcomes for graduates who had trained outside of the U.S. were worse than for graduates from a U.S. medical school. If any, patients treated by the international graduates had lower 30-day mortality than those treated by the U.S. graduates. These differences persisted across a broad range of clinical conditions, and even among hospitalists, where patient selection might be less of a concern," the study's authors wrote.

Researchers said patients treated by foreign-educated physicians also had slightly higher costs of care per admission ($1,145) compared to patients treated by U.S. medical school graduates ($1,098). According to the study, readmission rates remained similar between foreign-educated physicians and U.S. medical school graduates.

Researchers noted several explanations for why foreign-educated physicians might have better patient outcomes than U.S. medical school graduates, including the fact that the approach for allowing foreign-educated physicians to practice in the U.S. may select for, on average, better physicians.

"Indeed, the match rate for U.S. residency programs is substantially lower for international medical graduates (49.4 percent) than for U.S. medical graduates (94 percent for graduates of U.S. allopathic medical schools), and therefore, it is possible that international graduates who are successful in the U.S. matching process might represent some of the best physicians in their country of origin," they wrote.



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