Study points to gap in US medical education

By Pat Wechsler
Bloomberg News / August 8, 2010

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NEW YORK — Patients of doctors who went to medical school outside the country and weren’t American citizens had a 9 percent lower death rate on average than those whose doctors trained at home, a study showed.

The report, published in the August issue of Health Affairs, tracked the performance of primary-care doctors, internists, and cardiologists in 244,153 hospitalizations involving congestive heart failure or heart attacks. Economics may help explain the gap in patient outcomes, said John Norcini, co-author of the study.

Internal medicine and primary care have failed to attract the best students in the United States because of lower pay relative to other specialties, he said.

“Primary care may not be getting the best and the brightest from US medical schools,’’ said Norcini, chief executive officer of the Foundation for Advancement of International Medical Education and Research, a Philadelphia nonprofit. “Foreign students see primary care as a gap that they can fill and a way to practice medicine here.’’

Primary-care doctors, including internists and family practice physicians, earn on average from $175,000 to $200,000 annually, while orthopedic surgeons make $519,000; radiologists $417,000; and anesthesiologists $331,000, according to a survey released in June by the national physician search firm Merritt Hawkins, based in Irving, Texas.

Medical schools don’t produce enough graduates to supply all the postgraduate training slots available, and the void has been filled by graduates from institutions in other countries, Norcini said.

These international-schooled doctors make up a quarter of practicing physicians in the country, and are especially important in the area of primary care, he said.

The authors of the Health Affairs study said their results, based on data from 2003 to 2006 in Pennsylvania, mark a shift from the early 1990s when research showed international medical graduates underperforming US-trained doctors on licensing exams, specialty board certifications, and other metrics.

Not all international medical school graduates had good results.

US citizens who attended medical schools abroad underperformed graduates of US medical schools and citizens from other countries who went to school outside the United States. Internationally trained foreign doctors had a 16 percent lower mortality rate among their patients than Americans schooled overseas, according to the article.

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