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Dennis T. Ko, MD; Peter C. Austin, PhD; Benjamin T. B. Chan, MD, MPA; Jack V. Tu, MD, PhD

Arch Intern Med. 2005;165:458-463.

Background  International medical graduates (IMGs) make up a substantial proportion of the physician workforce and play an important role in the care of patients with acute myocardial infarction (AMI). There are concerns that IMGs may provide inferior medical care compared with locally trained medical graduates, but that has not been established.

Methods  We performed a retrospective cohort study of linked administrative databases containing health care claims of physicians’ service payments, hospital discharge abstracts, and patients’ vital status. We included 127 275 AMI patients admitted between April 1, 1992, and March 31, 2000, to acute care hospitals in Ontario. We then compared the risk-adjusted mortality rates and adjusted use of secondary prevention medications and cardiac invasive procedures in patients treated by IMGs vs Canadian medical graduates.

Results  Of the 127 275 admitted AMI patients, 28 061 (22.0%) were treated by IMGs and 99 214 (78.0%) by Canadian medical graduates. The risk-adjusted mortality rates of IMG- and Canadian medical graduate–treated patients were not significantly different at 30 days (13.3% vs 13.4%, P = .57) and at 1 year (21.8% vs 21.9%, P = .63). Furthermore, AMI patients treated by both groups had similar adjusted likelihood of receiving secondary prevention medications at 90 days and cardiac invasive procedures at 1 year.

Conclusions  The use of secondary prevention medications and cardiac procedures and the mortality of AMI patients were similar, regardless of the origin of medical education of the admitting physician. This information places the care provided by IMGs into perspective and supports the ability of well-selected IMGs in caring for AMI patients.

Author Affiliations: Division of Cardiology and Schulich Heart Centre (Dr Ko), Institute for Clinical Evaluative Sciences (Drs Ko, Austin, Chan, and Tu), and Division of General Internal Medicine and Clinical Epidemiology and Health Care Research Program (Dr Tu), Sunnybrook and Women’s College Health Sciences Centre; and Departments of Public Health Sciences (Drs Austin, Chan, and Tu), Family and Community Medicine (Dr Chan), Health Policy, Management and Evaluation (Drs Chan and Tu), and Medicine (Dr Tu), Faculty of Medicine, University of Toronto; Toronto, Ontario.

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