NYT article about foreign-trained doctors

[Phoenixi]

http://www.nytimes.com/2010/08/03/health/03doctors.html?ref=health

Any thoughts?

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[leorl]

Can't really say much until the actual article is produced. But obviously it is making sweeping generalizations and assumptions. Also, it seems to be looking at a small subset - US IMGs vs. FMGs in internal medicine (re: CHF). I'd have to look at the article and analyze its data.

 

[JonathanMD]

Ouch.

Just keep in mind that there is a huge difference in quality between medical schools in the Caribbean, the majority of them being of very poor quality. It's easy to lump them all together.

Other than that, if that's what the data says, it's hard to argue.

 

[Lokhtar]

The differences in mortality of patients cared for by all international graduates and U.S. graduates (adjusted odds ratio: 0.99; 95 percent confidence interval: 0.94 to 1.04) were not statistically significant, nor were the differences between U.S.-citizen international graduates and U.S. graduates (adjusted odds ratio: 1.07; 95 percent CI: 0.99 to 1.16). However, the patients of non-U.S.-citizen international graduates had significantly lower mortality than U.S. graduates (adjusted odds ratio: 0.91; 95 percent CI: 0.86 to 0.97). Likewise, their patients had significantly lower mortality than the patients of U.S.-citizen international graduates (adjusted odds ratio: 0.85; 95 percent CI: 0.78 to 0.93).

 

[lobelsteve]

The bias in the NYT article is striking, as is the bias in the conclusion/discussion of the article.

Here is the meat:

The differences in mortality of patients cared for by all international graduates and U.S. graduates (adjusted odds ratio: 0.99; 95 percent confidence interval: 0.94 to 1.04) were not statistically significant, nor were the differences between U.S.-citizen international graduates and U.S. graduates (adjusted odds ratio: 1.07; 95 percent CI: 0.99 to 1.16). However, the patients of non-U.S.-citizen international graduates had significantly lower mortality than U.S. graduates (adjusted odds ratio: 0.91; 95 percent CI: 0.86 to 0.97). Likewise, their patients had significantly lower mortality than the patients of U.S.-citizen international graduates (adjusted odds ratio: 0.85; 95 percent CI: 0.78 to 0.93).

Among the physician characteristics included in the analysis, the number of years since graduation was positively related to mortality, and the magnitude of the effect was substantial. Each additional year since graduation was associated with a 0.58 percent (95 percent CI: 0.34 percent to 0.81 percent) increase in the mortality of a physician’s patients. Specialty board certification was associated with a 5.62 percent (95 percent CI: –0.003 percent to –10.67 percent) decrease in mortality, and treatment by a self-reported cardiologist was associated with a 6.1 percent (95 percent CI: 0.005 percent to 12.04 percent) increase in mortality.

Length-Of-Stay: Adjusting for all other variables, the patients cared for by U.S.-citizen international graduates and non-U.S.-citizen international graduates had significantly longer stays than patients of U.S. graduates.27 For the average stay of 5.28 days, this would represent an increase of 0.21 days (95 percent CI: 0.11 to 0.37 days) for patients of U.S.-citizen international graduates and 0.16 days (95 percent CI: 0.11 to 0.26 days) for patients of non-U.S.-citizen international graduates.

Holding all other variables constant, increasing years since medical school graduation was significantly associated with longer stays, while treatment by a cardiologist or physician holding a specialty board certificate was significantly associated with shorter stays. An urban location was also significantly associated with shorter hospital stays, while hospital and physician numbers of patients did not reach levels of statistical significance.

 

[peppy]

I think the journalist is making a mistake in thinking that the problem and solution lies with medical school education. I do feel that there are some Carib schools who do their students a serious disservice by not giving them training on par with American medical students. However, I wouldn't expect that to be the make or break factor in if someone is a good clinician or not. I think residency has more to do with the kind of doctor you become than your med school does.
A person from a below average school who gets into an above average residency ("above average" in this sense being one that makes resident education a priority and doesn't just view them as cheap labor) would likely turn out to be a better clinician than someone who had a great med school but went to a malignant, workhorse style residency.

 

[DR TOOTH]

Would like to quote another article regarding thsi debate about US Vs non-US educated doctors - personally I would liek to focus on solutions rather than problems- media loves to make issues of nothing!

http://www.usatoday.com/news/health/2008-12-16-face-transplant_N.htm

I think the journalist is making a mistake in thinking that the problem and solution lies with medical school education. I do feel that there are some Carib schools who do their students a serious disservice by not giving them training on par with American medical students. However, I wouldn't expect that to be the make or break factor in if someone is a good clinician or not. I think residency has more to do with the kind of doctor you become than your med school does.
A person from a below average school who gets into an above average residency ("above average" in this sense being one that makes resident education a priority and doesn't just view them as cheap labor) would likely turn out to be a better clinician than someone who had a great med school but went to a malignant, workhorse style residency.