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Patients Treated by Foreign Doctors Are Less Likely to Die

A study of 1.2 million hospital admissions suggests that international MDs are the safest ones there are.
Image: Michael Coyne/Getty

There may be documented bias against doctors trained in foreign countries, but a new study published in the BMJ shows that hospital patients are actually safer in their hands than they are in those of US-trained doctors.

The study, led by Yusuke Tsugawa, a research associate at Harvard's Chan School of Public Health, concludes that patients are less likely to die in hospitals when cared for by foreign-trained doctors. Using a national sample from 2011 to 2014, researchers analyzed data from more than 1.2 million hospital admissions, and more than 44,000 doctors.


Their results show that when looking at 30-day mortality (that is, how likely a patient is to die within 30 days of admission to a hospital), patients cared for by internationally-trained doctors had a mortality rate of 11.1 percent, compared to the 11.7 percent of those trained in the United States.

That may not sound like a whole lot, but in practical terms what it means, per the study, is this: "For every 250 patients treated by US medical graduates, one patient's life would be saved if the quality of care were equivalent between the international graduates and US graduates."

As the United States healthcare system has grown, it has required more internationally trained healthcare practitioners. According to the study authors, international medical graduates make up a quarter of physicians in the US, primarily from India, the Philippines, and Pakistan. There is no current standardized accreditation in the US for foreign medical schools. On account of this, they write, there is public concern with the ability of foreign-trained doctors to perform at the same level as domestic doctors.

"America has a history of attracting the best and brightest from around the world and that appears to be true in medicine as well," senior author Ashish Jha, a professor of health policy and director of the Harvard Global Health Institute, said in a press release. "We hope that we are able to maintain that openness because the biggest beneficiaries of these doctors coming to the US have been the American people."

"The [Trump] ban has impact on both the quantity and quality of the US health system," Tsugawa tells Tonic. "One in four doctors in the US are international medical graduates, and therefore, the ban has a major impact on the US health workforce and whether American people can get good access to care."

While the authors note that they cannot speculate why they got these results, they do affirm that the study "should reassure policymakers and the public that our current approach to licensing international medical graduates in the US is sufficiently rigorous to ensure high-quality care."