Physician Citizenship Tied to Mortality Rates

"Part of the performance difference may be due to variability in the quality of the medical schools that U.S.-citizen international graduates attend," Norcini wrote in the journal article. "But to some degree, it may also reflect their ability. It will be important to monitor this possibility, since the pool of U.S. applicants to international schools is a potential source of students for U.S. medical schools as they expand."

Norcini concludes that foreign-trained doctors play a valuable role in filling significant provider shortage gaps throughout the country.  However, while medical school spots may be expanding, residency programs are not increasing at the same rate. 

"If this continues, the current physician shortages will persist and the numbers of foreign trained doctors will likely decrease significantly" because they won't find a residency spot for their training.  Instead, those spots will be taken up with American-educated medical students who will likely have priority.

The authors acknowledged that the study has several important limitations.  It looked at only two conditions and one clinical setting—the hospital not the office practice—and in only one state.  And it did not compare and contrast education at various U.S. or international medical schools.

It also could not guarantee that the physician of record may not have been the only physician to care for the patient.