International medical graduates and their patient outcomes

Did you know that international medical graduates account for 30% of primary care doctors in the United States?

And with American medical graduates continuing to shy away from the field, that number will undoubtedly go up.

But that’s not necessarily a bad thing.

Recent news stories, like Pauline Chen’s New York Times column, have focused on a landmark study comparing patient outcomes of doctors educated in the United States versus those receiving training abroad:

And it turns out that contrary to certain individuals’ worst fears, accent or nationality did not affect patient outcomes. Rather, the main factor was being board-certified: completing a full residency at an accredited training program, passing written and, depending on the specialty, oral examinations, and having proof of experience with a defined set of clinical problems and technical procedures.

Of course, the data was coming from a group named the Foundation for Advancement of International Medical Education and Research, who may or may not have a vested interest in the outcome.

In any case, it makes sense that board certification, not where the doctor trained, was the most influential factor.

Also interesting is the hypothesis explaining why foreign-trained doctors may have better patient outcomes than their American peers.  According to the lead author of the study,

the differences may stem from the fact that as primary care has become less attractive for graduates of American medical schools, it has also become less competitive. “The foreign international medical graduates are some of the smartest kids from around the world,” he said. “When they come over, they tend to fill in where the U.S. medical school graduates don’t necessarily go.”

Patients may be interested in where a doctor trained.  But, like hospital rankings in national publications, this too may be overrated.

They should primarily be looking at whether their physician is board certified, or not.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of, also on FacebookTwitterGoogle+, and LinkedIn.

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