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U. S. medical graduates versus foreign medical graduates. Are there performance differences in practice?

This study has attempted to determine the relationship between physicians' medical education and their performances (technical quality and utilization of medical care resources) in offices and hospitals. The sample consisted of 506 physicians of Hawaii, involving 18 specialty categories. The study finds little evidence of the influence of the type of medical schools on physicians' technical quality and utilization of medical resources in practice. The mean differences between the categories of medical schools were not statistically significant (except for the quality when specialists practiced within their own areas of specialization). There is no evidence that all categories of U.S. medical graduates provided a higher quality care and better utilization than all categories of foreign medical graduates. There was no consistent pattern of performances within the categories of U.S. medical schools and of foreign medical schools in these dimensions of performances.

Clinical Competence

United States foreign medical graduates in Connecticut: how they compare with foreign medical graduates.

This study contrasts the graduate training and subsequent careers of a cohort of United States-born foreign medical graduates (USFMGs) and foreign medical graduates (FMGs) who were in training positions in Connecticut in 1964 and who were located in 1971. The data suggest that although USFMGs were foreign-educated, they had certain advantages--both cultural and administrative--in hospital training positions which helped them to pursue different career alternatives than FMGs. However, the data further suggest that they retained characteristics of their foreign training which continued to differentiate them from United States medical graduates (USMGs).

Age Factors

American foreign medical graduates. Performance after a year of supervised clinical clerkships (fifth pathway).

The performance during graduate medical education of Americans who have studied medicine abroad and who have taken a year of intense and closely supervised clinical clerkships (fifth pathway program) was assessed. Only 14% of such house officers were given inadequate or below-average ratings in overall clinical performance by residency program directors. Ninety percent or more received average, good, very good, or excellent evaluations in their ability to take medical histories and perform physical examinations, in their response to instruction, in behavior and interpersonal relationships, and in appearance and emotional stability. Seventy percent were said to be as good as or better than house staff in general. Carefully selected and properly motivated Americans who have studied medicine in a foreign country can become good physicians following a well-organized, comprehensive closely supervised year of clinical clerkship education.

Asia

Foreign medical graduates and Maryland Medicaid.

To determine whether foreign medical graduates provide a disproportionate share of medical care to the poor, Medicaid vendors in Maryland were compared with all licensed physicians in the State. Foreign medical graduates constitute 22 per cent of all physicians in Maryland but 36 per cent of the Medicaid vendors. In addition, of all the vendors for fiscal 1974, 94 per cent who were licensed in 1972 or 1973 were foreign medical graduates. This disproportional representation in the Medicaid program is concentrated in the specialties of general surgery, internal medicine and general practice. Thirty-two per cent of all foreign medical graduates in Maryland are board-certified physicians, but only 22 per cent of those who are Medicaid vendors are board certified. For United States medical graduates, 48 per cent of all physicians are board certified, but this figure increases to 52 per cent for the Medicaid vendors. Finally, representation of foreign medical graduates among Medicaid vendors tends to be highest in areas with the highest physician-to-population ratios and with the highest percentages of total Medicaid payments.

Certification

Foreign medical graduates and the issue of substantial disruption of medical services.

Provisions of the 1976 Health Professions Educational Assistance Act may result in a substantial disruption of medical services provided by foreign medical graduates in United States residency training programs. Estimates of the effect of the Act indicate that between one third and two thirds of foreign graduates receiving visas annually will not qualify for admission, under the new provisions. Results of a recent study show, furthermore, that foreign medical graduates constitute a majority of the residents in 23 per cent of the hospitals with residency programs. Transition to a decreased dependence on foreign graduates may be facilitated through the waiver of two provisions relating to exchange visitors. Projected numbers of United States medical graduates and citizens receiving medical education abroad will not be enough to fill the gap created by the ultimate reduction in alien physicians. United States residency programs will have to develop alternative sources of residents to continue operating at current levels.

Delivery of Health Care

Predicting success in psychiatric training for foreign medical graduates: II. Patterns in course.

Faculty ratings of 22 foreign medical graduates ('FMGs'), all of whom entered psychiatric residency training at the University of Missouri-Columbia from 1966 through 1973, were compared with those of a similar group of North American medical graduates ('AMGs'). An on-going evaluation programme provided data for a variety of parameters ranging from 'theoretical knowledge' to 'clinical skills'. Results indicated that in most of performance the median FMG started at a level substantially lower than that of the median AMG and very slowly caught up. When achievement criteria were utilized it became apparent that, at least by the third year of training, 'superior' FMGs could equal or surpass the median performance of 'superior' AMGs, whereas 'marginal' residents, whether foreign or native-born, seldom attained even competence in most major spheres of functioning. Implications of these findings and those in related studies are discussed.

Clinical Competence

Licensure of foreign medical graduates: an historical perspective.

Today, one out of five practicing physicians in the U.S. is a graduate of a foreign medical school. The sixfold growth in their number over the past two decades results from national policy; but the place and conditions of practice have been controlled by state governments. The several states have used their jurisdiction over licensure in ways that have often been unfair and irrational. Recent trends toward uniform standards, however, may lead to more equitable assurance of professional competence, and to interstate mobility related to local and national needs.

Certification

Foreign medical graduate performance--a review.

Numerous factors have adversely influenced appraisals of the competence of foreign medical graduates. The statistical design of some comparative studies has been weak. Language and cultural backgrounds of foreign graduates have varied. Foreign physicians who have complete school at various times in the past have been graded according to a test designed to be taken during the fourth year of American medical schools. Licensing examinations and grading have varied from state to state. To reach reliable conclusions, matched samples of adequate size must be studied under controlled conditions.

Clinical Competence

Foreign medical graduates in rural primary care: the case of western New York State.

To determine whether foreign medical graduates (FMGs) provide a disproportionate and increasing share of primary care in some rural areas, changes in physician distribution in a rural section of upstate New York over a 20-year period (1953-1973) were evaluated by country of medical education and type of practice. A contiguous urban area was examined for comparison. In 1953, FMGs accounted for a higher proportion of primary care physicians in rural areas (11%) than in urban practice (6%) (p less than 0.01). By 1973, this distribution had increased to 26% rural and 14% urban (p less than 0.001). During the two decades, the number of U.S. medical graduates in primary care declined by 15% in the rural areas but increased by 13% in the urban center. The number of primary care FMGs in this same period increased 88% in the rural area. With a 10% decline in (rural) FMGs trained in developed countries, this net increase in FMGs was accounted for by physicians from developing countries. Primary care physicians trained in the U.S. or in developed countries increased more in the urban center, while physicians from developing countries increased more in rural (53%) than urban (47%) practices. Finally, by 1973, rural primary care physicians were more likely than urban primary care physicians to be from developing countries (p less than 0.001).

Developing Countries

The foreign medical graduate and public policy: a discussion of the issues and options.

This paper analyzes four basic reasons for curtailing the number of foreign medical graduates (FMGs) entering the United States: the loss to less-developed countries, the possible lower quality of medical care delivered by FMGs, the inability of all U.S. citizens who desire to receive a medical education to do so, and the fear of a possible surplus of physicians in the U.S. For each of these concerns, alternatives are presented and analyzed according to how well they would achieve their objectives. Based on the options proposed for reducing the number of FMGs, the conclusion is reached that the primary concern at present is an oversupply of U.S. physicians.

Developing Countries