Dive Brief:
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Medicare patients admitted to the hospital were slightly less likely to die within 30 days if they were treated by an international medical graduate (IMGs) than by a physician trained in the United States, according to research published by The BMJ.
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Average cost of care was slightly higher when patients were treated by IMGs than by physicians who trained in the United States, but there were no significant variations in other performance measures, like readmissions, considered by researchers.
- The results suggest that standards for selecting IMGs for practice in the United States are higher than for physicians trained in the United States.
Dive Insight:
After adjusting for differences in patient condition and physician characteristics, 30-day mortality rates were 11.2% among patients treated by IMGs and 11.6% among patients treated by physicians who trained in the United States. Researchers considered Medicare data for more than 1.2 million hospitals covering more than 44,000 internists to reach their conclusions.
While a higher bar is set for IMGs to practice in the U.S., the selection process improves quality of care. Lowering the bar to allow more IMGs to practice in the country could have the adverse effect of lowering the quality of care.
Additionally, with IMGs accounting for around a quarter of the physician workforce, attempts to limit immigration could have implications for quality of care, as MedPage Today reported. President Donald Trump's recent executive order limiting immigration from seven countries could have an adverse affect.
Many studies have looked into variations in outcomes depending on patient population. However, it seems that it is becoming more common for researchers to examine how differences in physician characteristics affect outcomes. For instance, some research suggests that female doctors are generally more encouraging and reassuring, more likely to engage in shared decision-making with patients, and likely to spend more time with patients, as Dr. Pauline Chen wrote for The New York Times.
There are some tools that healthcare organizations can deploy to make care more standardized. For instance, John Hopkins Hospital discovered an apparent gender bias when it looked into blood clot prevention treatment. Close to one-half of female trauma patients did not receive appropriate treatment compared with 31% of men. Implementing a simple checklist allowed the hospital to eliminate preventable blood clots in all patients.