Volume 198 - Issue 5
Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and Western Australia
Author: Carlos Zubaran
Med J Aust 2013; 198 (5): 256-257. || doi: 10.5694/mja12.11809
Published online: 18 March 2013
Published online: 18 March 2013
To the Editor: Elkin and colleagues acknowledged that “most [international studies] have found no association” between acquiring a medical degree overseas and being the subject of a complaint; however, their principal findings - which differ from these other studies - require care in interpretation.
In the study by Elkin et al, the “clinical specialty was missing” for 75% of registered doctors. Yet, certain medical specialties are ...
To the Editor: Elkin and colleagues acknowledged that “most [international studies] have found no association” between acquiring a medical degree overseas and being the subject of a complaint;1 however, their principal findings — which differ from these other studies — require care in interpretation.
In the study by Elkin et al, the “clinical specialty was missing” for 75% of registered doctors. Yet, certain medical specialties are associated with a higher risk of attracting complaints. In one US study, surgeons attracted significantly more lawsuits than non-surgeons.2 Therefore, a disproportionate number of complaints involving international medical graduates (IMGs) could have been owing to working in, for instance, surgical specialties.
Further, neither “race” nor ethnicity was examined. In an analysis of 14 314 doctors in the United States, non-white professionals were at significantly greater risk of being disciplined than their white counterparts.3 Similar findings for the United Kingdom have been published.4 The authors of the British study referred to “possible inequalities and unfairness”, including racism, in official procedures involving doctors from ethnic minorities and IMGs. A recent parliamentary inquiry into the registration processes in Australia noted that while “IMGs generally have very strong community support, they do not always receive the same level of support from the institutions and agencies that accredit and register them”.5
Elkin et al analysed data from only two Australian states. The authors of a study conducted in California not only revealed that certain personal characteristics and medical specialties were associated with increased disciplinary action, but also cautioned that those findings could not be extrapolated to the entire country.6
Competing interests
No relevant disclosures.
References
- Elkin K, Spittal MJ, Studdert DM. Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and Western Australia. Med J Aust 2012; 197: 448-452. 0_CHDDADCD
- Hickson GB, Federspiel CF, Pichert JW, et al. Patient complaints and malpractice risk. JAMA 2002; 287: 2951-2957. 0_i1142869
- Khaliq AA, Dimassi H, Huang CY, et al. Disciplinary action against physicians: who is likely to get disciplined? Am J Med 2005; 118: 773-777. 0_i1142871
- Humphrey C, Hickman S, Gulliford MC. Place of medical qualification and outcomes of UK General Medical Council “fitness to practise” process: cohort study. BMJ 2011; 342: d1817. 0_i1142873
- House of Representatives Standing Committee on Health and Ageing. Lost in the labyrinth: report on the inquiry into registration processes and support for overseas trained doctors. Canberra: Parliament of the Commonwealth of Australia, 2012. http://www.aph.gov.au/Parliamentary_Business/Committees/House_ of_Representatives_Committees?url=haa/overseasdoctors/report.htm (accessed Feb 2013).
- Kohatsu ND, Gould D, Ross LK, et al. Characteristics associated with physician discipline: a case-control study. Arch Intern Med 2004; 164: 653-658. 0_i1142877