By Lisa Rapaport

(Reuters Health) - U.S. patients may have lower mortality rates if their doctors were trained at foreign medical schools rather than at American universities, a recent study suggests.

Researchers examined data for more than 1.2 million hospitalizations handled by general internists at U.S. hospitals, and found patients were slightly less likely to die within 30 days after admission if their doctor went to medical school in another country.



"Although we are uncertain exactly why foreign-trained doctors have slightly better outcomes, the U.S. currently sets a very high bar for foreign medical graduates to practice medicine in the U.S.," said lead study author Dr. Yusuke Tsugawa, a policy and management researcher at the Harvard T.H. Chan School of Public Health in Boston.

"Therefore, the doctors who choose to leave their home country and manage to pass all certification exams may be very capable and motivated individuals," Tsugawa said by email.

The absolute difference was small, with mortality rates of 11.2 percent for foreign-trained doctors versus 11.6 percent for U.S. medical school graduates.

After accounting for other factors that could contribute to patients’ outcomes, the mortality rate was 5 percent lower for foreign medical graduations. But that's large enough to impact tens of thousands of patients nationwide.

International medical graduates make up a quarter of the physician workforce in the U.S., the U.K., Canada and Australia, researchers note in the BMJ. In the U.S., doctors trained elsewhere treat a far greater proportion of patients in many rural and underserved communities, previous studies have shown.

The research team points out that in order to get a license to practice medicine in the U.S., foreign medical school graduates must pass two examinations that test medical knowledge and one examination that assesses clinical skills, and they must also complete several years of accredited residency training in the U.S.

For the current study, Tsugawa and colleagues examined data on patients 65 and older covered by Medicare who were treated by 44,227 general internists between 2011 and 2014.

Overall, 19,589 of the doctors, or 44 percent, were international medical school graduates. The foreign graduates tended to be slightly younger and were more likely to work in non-teaching hospitals, for-profit hospitals and hospitals without intensive care units.

In general, compared with patients treated by U.S. graduates, those seen by international graduates were less likely to be white, affluent or covered by private insurance. Patients seen by international doctors were also more likely to have multiple chronic health problems like congestive heart failure, diabetes and chronic obstructive pulmonary disease.

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