New Study Rebuffs Physician Training Misperceptions


A new study comparing physicians who were trained in the U.S. with those trained in medical schools abroad should offer reassurance to patients, families, and professional peers who hold biases against foreign-born or foreign-trained physicians, the lead author says.

John Norcini, PhD, CEO of the Foundation for Advancement of International Medical Education and Research, and colleagues studied 244,000 hospitalized Pennsylvania patients with congestive heart failure and acute myocardial infarction. They found that mortality rates were slightly lower for physicians who were trained abroad and were not U.S. citizens when they entered medical school. The study showed higher rates for U.S. citizens who went overseas for their medical training.

The Norcini study (Health Affairs. 2010;29:1461-1468) focused on family medicine, internal medicine, and cardiology physicians, but it did not identify hospitalists. One-quarter of all physicians practicing in the U.S. are foreign-trained; however, a greater proportion are found in primary care and internal medicine. For hospitalists, the foreign-trained percentage might be even higher, 40% according to Philip Miller of the physician recruiting firm Merritt Hawkins.

One thing that can be said about international medical graduates is that they are a “crucial and growing part of the hospital medicine workforce, and we welcome them,” says Winthrop Whitcomb, MD, MHM, former SHM president and medical director of healthcare quality at Baystate Medical Center in Springfield, Mass. “I find, having worked with physicians trained all over the world, that for the best ones, it’s what they do every day, not where they came from. Are they consistent, careful, compassionate and committed to improving day by day?”

The challenge for hospitalist groups, he adds is to clearly state expectations for physicians, hold them accountable, make sure they understand the group’s goals and standards, and offer the tools they need to improve. An example could be access to English as a Second Language instruction to enhance communication.

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