Thicker Accent = Better Odds? by Pat Conrad MD

The agenda doctors at Harvard are at it again. Last year we covered how women made better doctors than men. That same bunch now has data to show that foreign (or do we say international?) “Doctors Who Trained Abroad Are Better at Their Jobs, Study Says.”

This curious TIME-Health headline is from a study done by a study from Dr. Yusuke Tsugawa, at the department of health policy and management at the Harvard T.H. Chan School of Public Health. Why would anyone do such a seemingly asinine study? Dr. T. thinks it unfair that, “Some patients are concerned about the quality of care from foreign-medical graduates,” and so sought to examine the validity of their concerns.

Some highlights:

  • The primary outcome was 30-day mortality of patients. Foreign docs scored 11.2% mortality while the homegrowns scored 11.6%, a 0.4 percentage point difference. This computes to an additional life saved for every 250 patients treated by US medical graduates “if the quality of care were equivalent between the international graduates and US graduates.” The secondary outcomes were readmission rates and amount spent per admission, and the differences between the astute internationalists and the slovenly Americans were negligible.
  • The guest healers tended to see more chronic conditions, and tended to treat more non-white, lower income, Medicaid, multi-comorbid conditions. “Our data showed that, if any, the international graduates appear to treat patients with higher rates of chronic disease and lower socioeconomic status than do the US graduates.” I wonder it that’s because the U.S. docs are adapting to the current economics that punish them for seeing the sicker and poorer.

“Foreign-trained doctors are also more likely to serve rural and under-staffed parts of the country, ‘places not many U.S. medical graduates want to go and practice,’”, Dr. T said. .And as I brilliantly noted a few days back, I get why someone from a country where AK-47’s are more common than toilet paper would find this a relatively attractive setting, even when a hospital administrator is paying $50 a day to man a Medicaid clinic.

I thought this an interesting assumption: “As international graduates might be more or less likely to work as intensivists in intensive care units, we excluded hospitals with a medical intensive care unit.” It reads like Dr. T. kind of wanted it both ways here, you know, to make the data fit the narrative.

And this: “We excluded international graduates who graduated from medical schools in Central America and the Caribbean, because three quarters of US citizen international medical students graduate from medical schools in these countries.” But the TIME headline said “Doctors Trained Abroad…,” not “Doctors Born Abroad.” So TIME and the study were really more interested in physicians that looked and/or sounded different than American natives. Of course any U.S. citizen who said he only wanted a doctor who looked and/or sounded American would be a horrible racist and should be thrown off a tall building, or forced to go on “Dr. Phil.”

But later in the study they say, “We could not distinguish between foreign born international medical graduates and US citizens who travel abroad for medical training.” So doesn’t that make an American who trains abroad but NOT in the Caribbean the best possible doc to get?

  • “We examined whether patient outcomes varied by countries where international medical graduates were trained, after restricting to eight countries with the largest number of international medical graduates going to the US (India, Pakistan, Philippines, Syria, Nigeria, Mexico, Egypt, and China) to avoid unstable estimates.” And man, like we need any more estimated unstables from some of those zip codes.

I’m not ragging on foreign born and/or trained physicians, some of whom I personally know to be damn good physicians. The real question is why these public health school agenda researchers would really do such a study. I submit that they want larger government health systems, and the need for more research grants to show why they are needed. They stress the need for foreign docs to fill residency slots and to work in underserved or undesirable areas, and Voila!, here is data to show that the visa holders actually give better care. I can only assume that they have not yet found that they follow core measures and meet quality goals as well as the celebrated women in the previous study, or they would have made that a linked positive. And it is unsurprising that in these days of national turmoil over immigration policy, Harvard researchers would land safely, reliably, on the side of their natural ideological comfort and that of their donors.

Which makes the study’s last line sort of funny: “Funding: This study received no support from any organization.” And a department full of tenured researchers found a way to simultaneously please their benefactors and polish their one-world leftist bona fides while trying to grab headlines for their compassion, all on their spare time. Sure they did.

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  1 comment for “Thicker Accent = Better Odds? by Pat Conrad MD

  1. Mike
    February 22, 2017 at 2:24 pm

    One of the reasons so many foreign trained /born physicians are practicing in rural areas is because that’s the only place they can go be employed with their J-1 and HB 1 visas. And, of course, if your in some backwoods county anywhere in rural America you will see lots of comorbidities and high numbers of Medicaid and uninsured. These docs are typically employees of not-for-profit hospitals who must see Medicare, Medicaid and uninsured as an element of their employment agreements.

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