Why U.S. patients treated by international medical graduates are less likely to die

If your doctor was trained overseas instead of in the United States, you are less likely to die in their care.

This surprising finding came from a recent study published in the BMJ by Harvard University’s Yusuke Tsugawa, and Dr. Tsugawa came onto Figure 1 on the day of publication to discuss the results as part of a new partnership between the medical publisher and Figure 1.
The study showed that patients aged 65 and older cared for by international medical graduates after hospital admission have a lower risk of mortality than patients cared for by U.S. graduates across a broad range of clinical conditions. In his live Q&A, Dr. Tsugawa addressed everything from how the study was designed to the implications for immigration policy. The full Q&A is available on Figure 1. Below are some highlights.

But first, why?

The first thing every healthcare professional wanted to know was why. Does this reflect a shortcoming in the U.S. education system or simply a tough screening process? Dr. Tsugawa replied:

“We don’t think medical education in the U.S. is inferior. Instead, we think this is because of the selection. The U.S. (and other high-income countries) is setting a very high bar for foreign-trained doctors to come and practice medicine. Those who do are highly-motivated to begin with, and those who succeed in passing all the selection processes are the best and brightest.”

How does this relate to President Trump?

When a medical student quipped, “Show this to Donald Trump”, Dr. Tsugawa simply replied, “I hope he has an opportunity to read our article.” On immigration policy, Dr. Tsugawa expanded: “I think that the bottom-line is that American people are benefiting from having foreign-trained doctors come to the U.S. in terms of both quantity (1/4 doctors in the US are foreign medical graduates) and quality (foreign medical graduates deliver high-quality care).”

What about the brain drain?

One medical student asked, “Has anybody stopped to think what happens in the countries where these international medical graduates (IMGs) come from? The IMGs’ countries of origin are suffering from ‘brain drain’. Their countries invest in training brilliant physicians who wind up leaving to the U.S./U.K./Canada/Australia simply for a bigger paycheck.”

Dr. Tsugawa replied, “This is a difficult issue because individuals usually have a right to decide where to live, and whether the social benefit of keeping them locally outweighs their individual rights is [a] difficult question. Some ethicists argue that locally-relevant medical training may be able to mitigate this problem.”

Dr. Tsugawa was frank about the message of his research: “I hope this study would be helpful for eliminating implicit biases toward foreign medical graduates among patients and also among program directors, if there are any.”

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