Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and Western Australia
Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and Western Australia
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DOI：
10.5694/mja12.10632
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发表时间：
2012-10-15
影响因子：
11.4
通讯作者：
Studdert, David M.
中科院分区：
文献类型：
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作者：
Elkin, Katie;Spittal, Matthew J.;Studdert, David M.
目的：为了确定国际医学毕业生（IMG）是否有更多的投诉对他们的医疗委员会和经验更多的不利纪律调查结果比澳大利亚培训的医生。设计和设置：维多利亚和西澳大利亚州分别在7.5年和5.25年期间向医疗委员会提出的所有针对医生的投诉的数据，提取并与同一时期在这些州注册的所有医生的信息相关联。数据涉及2010年2月之前在西澳大利亚州和2010年6月之前在维多利亚州解决的投诉，即各自的提取日期。我们测试了IMG状态和投诉的发生率之间的关联，使用多变量logistic regression.Main结果measures：投诉和不良纪律调查结果的发生率。结果：在39155名医生注册在维多利亚和西澳大利亚州在研究期间，5323投诉3191名医生。37%的注册医生是国际医疗集团。与非IMG相比，IMG的投诉几率更高（比值比[OR]，1.24; 95%CI，1.13-1.36; P < 0.001），不良纪律检查结果的几率也是如此（OR，1.41; 95%CI，1.07-1.85; P = 0.01）。然而，将IMG按其资格所在国进行分类显示出很大的差异：在尼日利亚获得资格的医生（OR，4.02; 95% CI，2.38-6.77），埃及（OR，2.32; 95% CI，1.77-3.03），波兰（OR，2.28; 95% CI，1.43-3.61），俄罗斯（OR，2.21; 95% CI，1.14-4.26），巴基斯坦（OR，1.80; 95% CI，1.09-2.98），菲律宾（OR，1.80; 95% CI，1.08-3.00）和印度（OR，1.61; 95%CI，1.33-1.95）吸引投诉的几率更高，但来自其他13个国家的IMG与澳大利亚培训的医生的几率没有显着差异。结论：总体而言，IMG比澳大利亚培训的医生更有可能吸引医疗委员会的投诉和不利的纪律调查结果，但风险因培训国家而异。更好地了解这种异质性，可以为更注重证据的登记和监督规则办法提供信息。
Objective: To determine whether international medical graduates (IMGs) have more complaints made against them to medical boards and experience more adverse disciplinary findings than Australian-trained doctors.Design and setting: Data on all complaints made against doctors to medical boards in Victoria and Western Australia over 7.5 years and 5.25 years, respectively, were extracted and linked with information on all doctors registered in those states over the same time periods. The data pertained to complaints resolved before February 2010 in Western Australia and June 2010 in Victoria, the dates of the respective extractions. We tested for associations between IMG status and the incidence of complaints using multivariable logistic regression.Main outcome measures: Incidences of complaints and adverse disciplinary findings.Results: Among 39155 doctors registered in Victoria and Western Australia in the study period, 5323 complaints were made against 3191 doctors. Thirty-seven per cent of registered doctors were IMGs. The odds of complaints were higher against IMGs than non-IMGs (odds ratio [OR], 1.24; 95% CI, 1.13-1.36; P < 0.001), as were the odds of adverse disciplinary findings (OR, 1.41; 95% CI, 1.07-1.85; P = 0.01). However, disaggregation of IMGs into their countries of qualification showed wide variation: doctors who qualified in Nigeria (OR, 4.02; 95% CI, 2.38-6.77), Egypt (OR, 2.32; 95% CI, 1.77-3.03), Poland (OR, 2.28; 95% CI, 1.43-3.61), Russia (OR, 2.21; 95% CI, 1.14-4.26), Pakistan (OR, 1.80; 95% CI, 1.09-2.98), the Philippines (OR, 1.80; 95% CI, 1.08-3.00) and India (OR, 1.61; 95% CI, 1.33-1.95) had higher odds of attracting complaints, but IMGs from the 13 other countries examined had odds that were not significantly different from Australian-trained doctors.Conclusions: Overall, IMGs are more likely than Australian-trained doctors to attract complaints to medical boards and adverse disciplinary findings, but the risks differ markedly by country of training. Better understanding of such heterogeneity could inform a more evidence-based approach to registration and oversight rules.