Best Medical Training in the World?

Best Medical Training in the World?
US-Trained Docs Kill
4 Patients/1000 More Than
Foreign-Trained Docs in US Hospitals

Foreign Trained Doctors Have Better Outcomes than US Trained Docs in US Hospitals 

By: I M Wiser*

Most patients and doctors assume that US trained doctors provide superior care compared to foreign trained physicians.  A new study published March 9, 2017 in the prestigious British Medical Journal** online documents that the opposite is true: foreign-trained internists save 1 life for every 250 patients they treat compared to their US-trained colleagues treating patients in similar hospital settings.

The study looked at deaths and  treatment costs  of 1,215,490 patients admitted to the hospital under the care of 44,227 general internists between 2011 and 2014. Patients treated by international graduates had lower mortality (adjusted mortality, 11.2% v 11.6%; adjusted odds ratio, 0.95; 95% confidence interval [CI], 0.93 – 0.96; P < .001). US trained graduates lost 1 patient in 250 compared to their foreign trained colleagues.  The cost for the patients of foreign trained graduates was slightly higher (which makes sense considering that patients who have expired cease to incur treatment costs).

Some foreign trained graduates have completed more than one residency but their patients tend to be poorer, sicker and have more diseases or conditions at the same time, making their relative survival and only slightly marginally higher medical costs all the more remarkable.

Is it possible that the difference lies in a different attitude to illness and personal choice, also known as Informed Consent, so that doctors less fanatically committed to the paternalistic and pervasive  Practice Guideline robotic medicine taught, endorsed and rewarded by US medical training, actually confer a   significant survival advantage to their otherwise more ill, more challenged and less advantaged patients? 

Further study is necessary, but perhaps a more collaborative approach, giving people the opportunity to make their own medical choices, use their own alternatives and involve their own personal and cultural wisdom might be the missing factor, lethal to 4 additional patients per thousand, or, in the size of the study population here, about 1,215 people who did not have to die preventable and postponable deaths.

US medical training, and US medical patients, would do well to heed the message of this study and look for ways to maximize the differences in practice and perspective between more dangerous, less effective US medical graduates and foreign-trained ones. 


** Quality of care delivered by general internists in US hospitals who graduated from foreign versus US medical schools: observational study, Yusuke Tsugawa, research associate, Anupam B Jena, Ruth L Newhouse associate professor, and faculty research fellow, E John Orav, associate professor, Ashish K Jha, K T Ki professor of international health, and director, BMJ 2017; 356 doi: (Published 03 February 2017) Cite this as: BMJ 2017;356:j273 


* IM Wiser is the pseudonym of am internationally-known US trained physician who sees, and is duly distressed by, the nearly total lack of adherence to the absolute right of Informed Consent by US and Globalist Medicine.


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