ArticleJournal of general internal medicine2026
End-of-Life Care Processes and Outcomes for Older Adults Treated by International Medical Graduates vs. US Medical Graduates.
Article in Journal of general internal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
importanceInternational medical graduates (IMGs-physicians who graduated from a medical school outside the US) hold a significant role in the US healthcare system. Research suggests that clinicians' attitudes towards end-of-life (EOL) care may vary across countries.
objectiveTo compare EOL care processes and outcomes for older adults treated by IMGs vs. US medical graduates (USMGs).
designCross-sectional study.
participantsA 20% random sample of Medicare fee-for-service beneficiaries aged 66 years or older who died in 2016-2019. MAIN MEASURES: Seven EOL care-related measures: (i) palliative care counseling or hospice enrollment in the last 180 days of life; (ii) emergency department visits, (iii) hospital admissions, (iv) intensive care unit admissions, (v) use of mechanical ventilation or cardiopulmonary resuscitation, or (vi) feeding tube placement in the last 30 days of life; and (vii) death in an acute care hospital. We adjusted for beneficiary- and physician-level confounders; P-values were adjusted using the Bonferroni-Holm method for multiple comparisons.
resultsAmong 391,425 beneficiaries, 117,754 (30.1%) were attributed to IMGs and 273,671 (69.9%) to USMGs. We found no evidence that six of the seven measured EOL care processes and outcomes differ between IMGs and USMGs. Beneficiaries treated by IMGs were slightly less likely to have emergency department visits in the last 30 days of life (57.1% vs. 57.6%; adjusted difference, -0.5 pp; 95% CI, -0.9 to -0.2; P = 0.04) compared with those treated by USMGs. Subgroup analyses by beneficiaries with cancer or chronic heart failure showed no evidence that EOL care processes and outcomes differ by physician's country of medical school after adjustment for multiple comparisons.
conclusionsEOL care processes and outcomes were similar for older adults treated by IMG and USMG physicians, despite potential differences in medical training during medical school.
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