"The Canadian healthcare setting
is seeing lots of foreign-trained doctors," notes cardiologist
Dr Dennis Ko in a telephone interview. And it's a good
thing too given our physician shortage. Yet cynics question
if these foreign-trained doctors are the equal of their
home grown colleagues when it comes to quality of care.
As Canada grows desperate for physicians, a new study
takes a closer look at this pressing question. Are these
concerns valid or purely conjecture borne out of prejudice
and preconceived notions?
Conventional wisdom has it that
our immigrant population is filled with doctors languishing
as they wait to be admitted to residency programs. The
gatekeepers maintain that it takes time to be sure that
foreign-trained doctors really have the skills they
need. Dr Ko's University of Toronto study proves that
international medical graduates (IMG) who make it through
Canadian qualification requirements are just
as capable as their Canadian-trained colleagues.
BATTLING
BIAS
Regarding the study published in the February 28 edition
of the Archives of Internal Medicine, lead author
Dr Ko said that it was written in part to "counter the
biases from some medical authorities and policy makers
that foreign medical graduates may be unable to deliver
the same quality of care" as their North American counterparts.
His study compared the quality
of care given to heart attack patients by IMGs to that
provided by their Canadian-trained colleagues. Dr Ko
and his colleagues made use of an Ontario database that
keeps track of every patient admitted to hospital with
a heart attack. They analyzed data on 127,275 acute
myocardial infarction (AMI) patients admitted to acute
care hospitals over an eight-year period. The analysis
considered risk-adjusted mortality rates, use of secondary
prevention medications and invasive cardiac procedures
administered by IMGs and Canadian medical grads (CMGs).
The authors "found no difference
in the prescribed therapies and the mortality rates
of AMI patients admitted to Ontario hospitals treated
by IMGs and CMGs." The risk adjusted mortality rates
were 13.3% vs 13.4% at 30 days and 21.8% vs 21.9% after
one year. Patients treated by both groups received secondary
prevention medications at 90 days and invasive cardiac
procedures at similar rates at the one-year mark.
PERFORMANCE
UP to PAR
"These were extremely similar rates of medication use,
procedures and outcomes," notes Dr Ko, adding that these
results were "reassuring and great news for patients."
He pointed out that "IMGs have to go through medical
residency programs. They have to pass fellowship exams
as family physicians or in other specialties in order
to gain the right to practise independently." He's convinced
that IMGs are well-trained. Unfortunately, they're expected
to jump through hoops to prove it to the qualifying
authorities.
Interestingly, all of the
study authors were trained in North America. "[I] had
no preconceived notions about the issue, so I was not
surprised by the findings," claims Dr Ko but he readily
admits that he and his colleagues were looking at outcomes
in "only one disease — only one area of medicine."
Nevertheless, this study strikes a deafening blow for
IMGs in their battle against the unfounded prejudices
they're faced with when they come to this great nation
— let's hope the medical authorities and policy
makers sit up and pay attention.
Arch Intern Med Feb 28, 2005;165:458-63
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