Doctors who train outside U.S. have lower death rate

Doctors who went to medical school outside the country and weren't American citizens had a 9 percent lower patient death rate on average than doctors who trained at home, a study showed.

The report, published yesterday 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 U.S. students because of lower pay, relative to other specialties, he said.

"Primary care may not be getting the best and the brightest from U.S. medical schools," said Norcini, chief executive of the Foundation for Advancement of International Medical Education and Research, a Philadelphia- based 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.

U.S. 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 United States, 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 U.S.-trained doctors on licensing examinations, specialty board certifications and other metrics.

"I am somewhat surprised by the results of the study," said John Prescott, chief academic officer of the American Association of Medical Colleges in Washington. "But the paper was well-written and the authors went out of their way to address any issues people might raise."The study also found that doctors who have been certified by a medical specialty board - typically after completing postgraduate training - have lower mortality rates than those who haven't been, regardless of nationality, Norcini said.

The further a doctor gets from medical training the worse their patients fare as well, making an argument for the need for continuing education and post-certification testing, he said.