Healthcare and Trump’s travel ban: data proves success of physicians developed abroad

Research indicates slightly better outcomes for US patients treated by physicians trained outside US and many come from countries affected by Trump order

American patients treated by internationally trained physicians have slightly better outcomes than those treated by their American-educated equivalents, a new survey has determined, as Donald Trumps ban on traveling from seven Muslim-majority countries is expected to stop some immigrant physicians from coming to the United States.

But that is not because American medical schools are falling short, the authors of the report in the British Medical Journal said.

Were not saying medical school in the US is not doing a good job, its only about selection, said Yusuke Tsugawa, a research associate at Harvard Universitys TH Chan School of Public Health and lead author of the study. Self-selection, to be more specific.

They are highly motivated, Tsugawa said of physicians trained outside the US. They are not random physicians from their different countries, they are the best doctors.

Trumps executive order banned people from entering the US from seven countries Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen for 120 days following the order. The order also stopped the Syrian refugee resettlement program indefinitely.

Researchers looked at 1.2 m hospital admissions of patients on Medicare, the American public health insurance program for the elderly, who were treated by more than 44,000 physicians. The rate at which patients died or were readmitted was used to measure patient outcomes.

Despite the studys findings that internationally educated doctors were slightly more likely to treat a sicker population people with more chronic diseases, as well as more likely to be from racial minorities and more likely to be low-income outcomes were slightly better than among their American-educated peers. That held when comparing physicians in the same hospitals. Patients treated by both international and US graduates were about the same age on average, approximately 80 years old.

Our findings indicate that current standards of selecting international medical alumnus for practise in the US are functioning well for at the least one important dimension: inpatient outcomes, researchers wrote.

By the numbers, researchers found that when patients were treated by internationally trained doctors, they died at a rate of 11.2%, versus 11.6% for US-educated physicians, in comparisons of doctors working in the same hospitals.

Readmissions proved the same trend. Patients returned to the hospital within 30 days at a rate of 15.4% for internationally educated physicians, and 15.5% for US educated doctors, when comparing doctors in the same hospital.

Tsugawa said he and his colleagues undertook the study because other research proved there was a bias against foreign medical graduates, both from colleagues and patients, so they are thinking quality of care might be worse than US medical graduates.

Given that 25% of the doctors in the US or in the UK as well are foreign medical graduates, we want to make sure they are providingquality medical care, he said. Tsugawa said he expected to focus on the race of doctors in his next analyse.

To do the residency program in the US, the bar is genuinely high; only 50% of the candidates can get the slot in the residency program, said Tsugawa. There are multiple styles they are highly selected, and highly motivated, and that is the reason they have better outcomes.

Those who come to the US are the brightest and the best, he said.

About one quarter of physicians working in the US were trained abroad, multiple studies depict. But many workforce experts believe that even if the immigration status of hundreds werent suddenly in question, there still would not be enough physicians coming to the US to make up famines faced by ageing and rural Americans.

For example, the largely rural Alaska already needs an additional 60 doctors per year, the Atlantic reports. And a 2015 New England Journal of Medicine article argued that programs that brought 8,000 physicians to the US per year would fall far short of the primary care needs of the countrys ageing population.

Research from 2013 goes to show that 299 physicians from Iran, Iraq, Libya, Sudan, or Syria applied to train in the US as residents that year, with an acceptance rate of only 40%, a New England Journal of Medicine article reported.

Syria is also one of the top the export of physicians to the US in another program that places physicians in high-need rural and inner-city regions, the J-1 visa program. In 2014, 165 Syrian doctors moved to the US under the program, according to the same article. If the ban continues beyond 120 days the number of doctors and therefore patients affected could escalate very quickly.

Physicians with J-1 waivers are filling clinical jobs in areas of need, the NEJM authors wrote. An executive order that has not taken into account the widespread ramifications may lead to further shortages of physicians in areas that are already in dire want.

Read more: www.theguardian.com

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