The Characteristics of International Medical Graduates Who Have Been Disciplined by Professional Regulatory Colleges in Canada: A Retrospective Cohort Study.
This study evaluated the proportion and characteristics of international medical graduates (IMGs) who have been disciplined by professional regulatory colleges in Canada in comparison with disciplined North American medical graduates (NAMGs).



The authors compiled a database of the nature of professional misconduct and penalties incurred by disciplined physicians from January 2000 to May 2015 using public records. They compared discipline data for IMGs versus those for NAMGs, and calculated risk ratios (RRs) and 95% confidence intervals (CIs) for select outcomes.



There were 794 physicians disciplined; 922 disciplinary cases during the 15-year study period. IMGs composed an average of 23.4% (standard deviation = 1.1%) of the total physician population and represented one-third of disciplined physicians and discipline cases. The overall disciplinary rate for all Canadian physicians was 8.52 cases per 10,000 physician years (95% CI [7.77, 9.31]). This rate per group was higher for IMGs than for NAMGs (12.91 [95% CI (11.50, 14.43)] vs. 8.16 [95% CI (7.53, 8.82)] cases per 10,000 physician years, P < .01, and RR 1.58 (95% CI [1.38, 1.82]). IMGs were disciplined at significantly higher rates than NAMGs if they were trained in South Africa (RR 1.73 [95% CI (1.14, 2.51), P < .01), Egypt (RR 3.59 [95% CI (2.18, 5.52)], P < .01), or India (RR 1.66 [95% CI (1.01, 2.55)], P = .03).



IMGs are disciplined at a higher rate than NAMGs. Future initiatives should be focused to delineate the exact cause of this observation.
A. Alam is staff anesthesiologist and transfusion medicine specialist, Department of Anesthesia, Sunnybrook Health Sciences Centre and Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada. J.J. Matelski is a biostatistician, Division of General Internal Medicine, Toronto General Hospital, Toronto, Ontario, Canada. H.R. Goldberg is a medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. J.J. Liu is a general medical internist, Division of General Internal Medicine, University Health Network and Department of Medicine, University of Toronto, Ontario, Canada. J. Klemensberg is a medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. C.M. Bell is a general medical internist, Division of Internal Medicine, Mt. Sinai Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Asim
A
Alam
John J
JJ
Matelski
Hanna R
HR
Goldberg
Jessica J
JJ
Liu
Jason
J
Klemensberg
Chaim M
CM
Bell
D000328:Adult; D002170:Canada; D015331:Cohort Studies; D005260:Female; D005550:Foreign Medical Graduates / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America; D016017:Odds Ratio; D010820:Physicians / Q000706:statistics & numerical data*; D028743:Professional Misconduct / Q000706:statistics & numerical data*; D012189:Retrospective Studies