Foreign Medical Graduates and Their Effects on the Quality of Medical Care in the United States

by Kathleen N. Williams, Robert H. Brook

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The literature on quality of care delivered by foreign medical graduates (FMGs) substantiated the existence of differences between U.S. medical graduates (USMGs) and FMGs, especially in terms of structural (proxy) characteristics — e.g., achievement of standard professional credentials or the quality of undergraduate and graduate training. Data from two studies using process criteria to evaluate quality of care, however, do not consistently support the notion that FMGs deliver lower level medical care than USMGs. Four policy-related recommendations were advanced: (1) the heterogeneity of the FMG physician pool must be taken into account in policy formulation; (2) peer review activities must be administered impartially for fully qualified FMGs and USMGs; (3) higher priority should be given to improvement of the medical care capabilities of the less able provider; and (4) quality of care studies (in both hospital and office practice settings) should be implemented so as to compare FMGs with USMGs, not with ideal standards.

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