Physician Citizenship Tied to Mortality Rates

It's a common perception that physicians trained by foreign medical schools aren't as skilled as doctors trained by U.S. medical schools. But that's a false assumption, according to a report published in Tuesday's edition of the journal Health Affairs.

The quality of a physician's skill seems to depend more on whether the doctor educated abroad was an American citizen or a foreign one at the time he or she entered medical school, said the author, John J. Norcini, president and CEO of the Foundation for Advancement of International Medical Education and Research.

Doctors who were both foreign citizens and foreign medical school graduates had lower patient death rates than doctors who were U.S. citizens and foreign medical school graduates.

One in four physicians now practicing in the U.S. received medical education abroad.

Norcini and colleagues looked at in-hospital death records of 244,153 patients hospitalized at 184 Pennsylvania hospitals between 2003 and 2006. Here, more precisely, is how the review broke down, based on severity-adjusted death rates for patients with either congestive heart failure or who had suffered an acute myocardial infarction:

• Doctors who were foreign citizens at the time they entered a foreign medical school had a "significantly lower" mortality rate (5%).
• Doctors who were U.S. citizens at the time they entered a U.S. medical school had a higher mortality rate, (5.5%).
• Doctors who were U.S. citizens at the time they entered a foreign medical school had the highest rate, (5.8%).