Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and Western Australia

To the Editor: In a recent article,1 Elkin and colleagues concluded that, compared with Australian-trained doctors (ATDs), international medical graduates (IMGs) posed a greater risk of attracting complaints to medical boards. However, we think the conclusion is not supported by the data, and might have been compromised by the analytical methods used.

Box 1 of the research article1 shows that IMGs accounted for 37% of the total number of doctors, but were involved in 30% of complaints, suggesting that the risk of complaints among IMGs was lower than among ATDs. Indeed, in a reanalysis of the data, we found that the rate of complaints against IMGs was 25% lower (P < 0.001) than that for ATDs (Box).

The logistic regression used by the authors is suboptimal for count and rate data, which are likely to follow the Poisson distribution. We reanalysed the data using a Poisson regression model assuming similar durations of practice and found that the rate of complaints was highly dependent on the language background of IMGs (Box). For instance, compared with the complaint rate against ATDs, the complaint rate among IMGs whose countries list English as an official language was significantly lower (34%; P < 0.001), but was not lower among IMGs from non-English speaking countries (P = 0.098). Furthermore, among IMGs whose language requirements may have been waived by the medical board, the rate of complaints was substantially lower than among ATDs (46%; P < 0.001).

In summary, our reanalysis of the data suggests that compared with ATDs, IMGs had a lower rate of complaints against them.