title: Quality of care of international and Canadian medical graduates in acute myocardial infarction.
abstract: 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.
authors.affiliation: Division of Cardiology and Schulich Heart Centre, Sunnybrook and Women's College Health Sciences Centre, Ontario, Canada.
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Ko
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.forename: Benjamin T B
authors.initials: BT
authors.lastname: Chan
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000592:standards / Q000706:statistics & numerical data; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D006328:Cardiac Catheterization / Q000592:standards / Q000706:statistics & numerical data; D002309:Cardiology / Q000193:education / Q000592:standards*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D005550:Foreign Medical Graduates / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D009864:Ontario; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011787:Quality of Health Care; D012189:Retrospective Studies; D020379:Risk Adjustment / Q000706:statistics & numerical data; D016019:Survival Analysis; D015996:Survival Rate
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors