Foreign medical graduates and their impact on the quality of medical care in the United States.

The literature on the level of quality of care delivered by foreign medical graduates (FMGs) has been reviewed in order to derive policy recommendations concerning their use in the United States. This review revealed a paucity in information on direct measures of the level of quality of care provided by FMGs. Differences between U.S. medical graduates (USMGs) and FMGs, especially with regard to the less than fully licensed FMGs and those FMGs at the start of graduate training, were found on examining proxy measures of quality, such as achievement of standard professional credentials or the quality of clinical training. Given this lack of evidence as to differences in performance between FMGs and USMGs, it is difficult to formulate recommendations, but four are advanced. These include (1) acknowledgment of the crucial significance of their heterogeneity, especially in regard to the quality of care provided, (2) assurance of the principle that peer-review activities are administered even-handedly to FMGs and USMGs alike, (3) improvement of the medical care capabilities of the less able provider, and (4) performance of quality of care studies, in both hospital and office practice settings, which compare FMGs with USMGs, not to ideal standards.