There has been a flurry of coverage on international medical education, lately. These pieces have painted an interesting picture of the sometimes under-noticed benefits to patients and hospitals as well as the pragmatic and necessary contributions to public health. We thought we’d weigh in on these and offer some of our own perspective.
First, let’s look at the benefits of international medical education. This recent piece in Time Magazine notes that, among physicians that are IMGs (international medical graduates), death rates are lower, readmission rates are equal, and provided a slightly higher cost-of-care. This one is tricky to parse, but in both hospital and ambulatory settings, a marginal increase in cost-of-care per physician is considered to be an investment in quality and an indication of more attentive patient interaction that reduces costs and leads to substantially better outcomes.
Think of it as you, the physician, astutely investing a small amount of a hospital’s money into your work with a patient and ultimately increasing a metric called the CMI (case mix index), which reduces the overall cost of care for your patient, the hospital, and the community at large.
The impact here shouldn’t be missed: it means, from a hospital perspective, that internationally trained physicians are not only helping to reduce the physician shortage, they are, marginally speaking, and from a financial perspective, actually worth more than their US trained counterparts. While this impact is measurable, it is admittedly subtle. However, when you recognize that 25% of all physicians in the United States practice internal medicine, and of that group, a full 36% were IMGs. In real numbers, that’s approximately 82,000 IMGs filling the desperately needed role of primary care physicians. The mortality decreases noted above work out to 1 in 250 patients surviving when they otherwise wouldn’t thanks to the attentiveness of international graduates. When you multiply that by the number of physicians and the size of an annual patient load, the lives saved by that marginal gain thanks to internationally trained physicians is truly remarkable.
While we cannot speak for other schools, this attentiveness to the patient and diligent care comes from two specific factors for Trinity students. First and foremost, their own dedication. We’ve heard from a number of our alumni spotlights that in their experience, Caribbean students just sometimes seem to want it “more” than their US and Canadian-trained counterparts in clinicals and residencies because they feel they have something to prove. Because many Caribbean students took the route they did after finding rejection in the US and Canadian systems and didn’t give up, they tend to bring that same tenacity onward throughout their careers.
The second factor, which cannot be undersung, is the early clinical experience offered at Trinity. Our students spend time in our affiliated teaching hospital from the first week of their basic sciences, observing and interacting with patients at a 230 bed teaching hospital that’s tasked with serving the major medical needs of St. Vincent. The diversity of cases provides a variety of diseases and disorders that are incredibly uncommon back home. Moreover, the students are immersed early on with doctors that emphasize the importance of preventative medicine (as well as acute care). This puts our students in a comfort zone that leaves them feeling more than prepared to return home for their rotations, we like to think that confidence carries through throughout their career.
All of this culminates in one of the primary goals of Trinity: addressing the physician shortage. As noted, 25% of physicians in the US are from international medical schools. US schools graduated 19,000 students in 2016. That’s a near shortfall of 5,000 physicians to reach a number that only gets us to the point of being in a state of doctor-drought.
The shortage itself is forecast to only grow. Current US medical school admission proccesses can’t adapt to keep up with overall population growth and the steady increase of the average age (and care-needs) of the US as the baby boomers enter their seventies.
To that end, it is always worth restating: IMGs use the same texts as their US counterparts. They take the same exams and meet the same licensing standards. In fact, while in the past it wasn’t always the case, these days, international schools like Trinity meet incredibly rigorous evaluation by national and international evaluations before receiving accreditation and certification. While we like to think we’re providing a terrific academic experience for our students, as well as offering opportunity for qualified applicants that are going overlooked by the US system, the high standards to which we are held, and hold ourselves, can’t be ignored.
Becoming a doctor is a long, intense process of study that reveals to each student their ability to absorb, process, and apply knowledge, often under pressure. We’re proud of each of our students, but more than anything, we’re so glad that the data is bearing out what we’ve known all along: that international medical graduates, particularly our own, are not just good doctors, they’re making a real difference.
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