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When the Doctor Doesn't Look Like You
Tips the Season... for the Flu

Fall is in full swing and that means influenza (flu) season is here, too. The flu is caused by viruses that infect your nose, throat and lungs. It's easily spread from person to person, so be sure to follow these tips to protect yourself and your family:

  • Wash your hands frequently
  • Keep your home and office clean and disinfected
  • Get a flu vaccination
  • Know when to stay home from work or school

Want more details? Keep reading to learn more about how to avoid the flu this season.

M.D.s and D.O.s Moving toward a Single,
Unified Accreditation System for Graduate Medical Education

CHICAGO, October 24, 2012 - The Accreditation Council for Graduate Medical Education (ACGME), the American Osteopathic Association (AOA) and the American Association of Colleges of Osteopathic Medicine (AACOM) have entered into an agreement to pursue a single, unified accreditation system for graduate medical education programs in the United States beginning in July 2015. Over the coming months, the three organizations will work toward defining a process, format and timetable for ACGME to accredit all osteopathic graduate medical education programs currently accredited by AOA. AOA and AACOM would then become organizational members of ACGME.

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When the Doctor Doesn't Look Like You (continued)

Nonetheless, this surgeon soon became a favorite of ours. He was brilliant in the operating room, gentle at the patients’ bedside and, as I quickly learned, highly effective in the classroom. What continued to vex me, however, was not the peculiarity of his teaching style; it was his inability to attract patients. While other, less-skilled senior doctors had waiting rooms that were overflowing, his was not.

“If I were sick,” I said to my fellow resident that night, “I know which surgeon I would ask for.”

“But you can understand why some patients and referring doctors don’t go to him,” she replied matter-of-factly. “Other guys wear Brooks Brothers, have recognizable last names and carry a degree from the ‘right’ medical school. But when a potential patient or referring doctor sees our guy, all they might notice is a foreigner with an accent and a strange name who graduated from a medical school in some developing country.”

Our professor had been born abroad and immigrated to the United States after medical school. But despite clinical accomplishments and professional accolades in this country, I knew, like my fellow resident, that there were patients and physicians whose initial impulse was to dismiss him or any other doctor with an accent or an international degree.

For more than 50 years, international medical school graduates like my former professor have filled the gaps in the physician work force in the United States. Currently, they make up fully one-quarter of all practicing physicians, and although a majority are foreign-born, approximately 20 percent are American citizens who have chosen to go abroad, most notably to the Caribbean, for medical school.

Regardless of whether they are United States citizens, all international graduates must go through an arduous regulatory process before practicing in this country, a process that includes verification of medical school diplomas and transcripts, residency training in American hospitals and the same national three-part licensing exams and specialty tests that their medical school counterparts in this country take. Many go on to choose specialties or work in the rural and disadvantaged geographic locations that their American counterparts shun. International graduates, for example, now account for nearly 30 percent of all primary care doctors, a specialty that has had increasing difficulties attracting American medical students.

Though these doctors have filled an important national health care need for over half a century, doubts regarding the quality of care they provide have continued to plague them. Health care experts interested in this issue have been stymied over the years by inadequate methodologies for evaluating the effectiveness of large groups of physicians and so have chosen instead to focus on exam scores, an admittedly crude proxy for quality of care.

But even that data has proven confusing. Studies initially revealed that international graduates tended to score lower, while more recent research shows that they routinely outperform their peers on training exams in areas like internal medicine.

Now researchers from the Foundation for Advancement of International Medical Education and Research in Philadelphia have published the first study incorporating new research methods for evaluating the performance of large groups of physicians. And it turns out that contrary to certain individuals’ worst fears, accent or nationality did not affect patient outcomes. Rather, the main factor was being board-certified: completing a full residency at an accredited training program, passing written and, depending on the specialty, oral examinations, and having proof of experience with a defined set of clinical problems and technical procedures.

The researchers examined the records of more than 240,000 patients who were hospitalized for either congestive heart failure or heart attack and examined how their outcomes correlated with their doctors’ education and background. They found no differences in mortality rates between those patients cared for by graduates of international or American medical schools. But on closer review, they found that two factors did contribute significantly to differences in patient outcomes.

Dividing the international medical graduates into those who were foreign-born and those who were American citizens who chose to study abroad, the researchers discovered that patients of foreign-born primary care physicians fared significantly better than patients of American primary care doctors who received their medical degrees either here or abroad. John J. Norcini, lead author of the study and president of the foundation, postulates that the differences may stem from the fact that as primary care has become less attractive for graduates of American medical schools, it has also become less competitive. “The foreign international medical graduates are some of the smartest kids from around the world,” he said. “When they come over, they tend to fill in where the U.S. medical school graduates don’t necessarily go.”

Dr. Norcini and his co-investigators also found that patient mortality rates were related to the doctor’s board certification and time since medical school graduation, regardless of his or her background. Those physicians in the study who were board-certified had substantially lower death rates among their patients. And the greater the number of years since medical school graduation, the more likely that doctor was to have a patient with heart attack or congestive heart failure die in the hospital.

“If you put these two pieces of data together,” Dr. Norcini said, “they make a strong argument for board certification and the maintenance of certification programs currently being put in place to improve the periodic reassessment of board-certified doctors.”

While the results of this study will help Dr. Norcini and other medical educators further refine the regulatory process for physicians from international and domestic medical schools, Dr. Norcini points out that there is a “huge heterogeneity in all these groups” and cautions doctors and patients against making broad generalizations about any physician group. Instead, when searching for the best doctors, he recommends focusing not on a doctor’s medical school or country of origin but rather on board certification.

“My hope is that we begin to rely more on objective markers like board certification as a statement of quality rather than where someone went to medical school,” Dr. Norcini said. “One can always ask a doctor if he or she is board-certified and involved in maintaining that certification. It’s a straightforward quality marker, and it’s a question that’s easy to ask.”

He added, “And as a patient, I find that reassuring.”

Reference:When the Doctor Doesn't Look Like You    (Post by: PAULINE W. CHEN, M.D.)
Tips the Season... for the Flu (continued)

Wash Your Hands

Proper hand washing can prevent the spread of colds, flu and other common illnesses. The Centers for Disease Control (CDC) suggests using this technique when washing your hands: Wet your hands with clean running water and apply soap. Rub your hands together to make a lather and continue rubbing hands for 20 seconds. Rinse well under running water.

Stay healthy this season by washing your hands in these instances:

  • After sneezing or coughing
  • After handling pets
  • Before eating or touching food
  • After using the bathroom/toilet
  • When they are filmy, sticky or visibly dirty

Disinfect Your Home and Office

It's important to keep your home and workplace clean and disinfected to avoid spreading germs. Cleaning with soap and water removes dirt and most germs, but disinfecting actually kills germs.

Use antibacterial wipes to kill germs from commonly used spaces in your home or office. Examples include countertops, faucet handles, doorknobs, desktops, phones, computer screens and keyboards.

Get a Flu Vaccine

Everyone six months and older should get a flu vaccine. It's especially important for certain people to get the vaccine, including:

  • People with certain medical conditions, like asthma, diabetes and chronic lung disease.
  • Pregnant women.
  • People ages 65 and older.
  • People who live with or care for those at high risk of developing serious complications, such as caregivers of people with certain medical conditions, including asthma, diabetes and chronic lung disease.

Even if you've received a flu vaccine in the past, you should get one each year. That's because flu viruses are always changing and it's possible that a new flu strain will appear each year. By getting a vaccination each year, you are getting the best protection.

Know When to Stay Home

If you have symptoms of the flu, stay home from school or work until you are fever-free (without the help of fever-reducing medicine) for at least 24 hours.

M.D.s and D.O.s Moving toward a Single,
Unified Accreditation System for Graduate Medical Education (continued)

"This is a watershed moment for medical training in the U.S," noted Thomas Nasca, M.D., M.A.C.P., chief executive officer of ACGME. "This would provide physicians in the United States with a uniform path of preparation for practice. This approach would ensure that the evaluation and accountability for the competency of resident physicians are consistent across all programs," he added.

Graduate medical education is the period of clinical education in a specialty that follows graduation from medical school, and prepares physicians for independent practice. Currently, ACGME accredits over 9,000 programs in graduate medical education with about 116,000 resident physicians, including over 8,900 osteopathic physicians (D.O.s). The AOA accredits more than 1,000 osteopathic graduate medical education programs with about 6,900 resident physicians, all D.O.s. The transition to a unified system would be seamless so that residents in or entering current AOA accredited residency programs will be eligible to complete residency and/or fellowship training in ACGME accredited residency and fellowship programs.

Among the topics of discussion for the three organizations will be:

  • Modification of ACGME accreditation standards to accept AOA specialty board certification as meeting ACGME eligibility requirements for program directors and faculty;
  • Programs in graduate medical education currently accredited solely by AOA to be recognized by ACGME as accredited by ACGME; and
  • Participation by AOA and AACOM in accreditation of programs in graduate medical education to be solely through their membership and participation in ACGME.

"Americans deserve a health care system where continuously improving the quality of care and the health of our patients is the driving force," stressed AOA President Ray E. Stowers, D.O. "A unified accreditation system creates an opportunity to set universal standards for demonstrating competency with a focus on positive outcomes and the ability to share information on best practices."

Stephen C. Shannon, D.O., M.P.H., President of AACOM, adds that "AACOM is undertaking this historic initiative because we believe that a unified accreditation system will improve the quality and efficiency of graduate medical education."


The Accreditation Council for Graduate Medical Education (ACGME) is a nonprofit organization responsible for the accreditation of over 9,000 programs in graduate medical education and about 700 institutions that sponsor these programs in the United States. Its accredited residency programs educate over 116,000 resident physicians in 135 specialties and subspecialties. Its member organizations are the American Board of Medical Specialties, the American Hospital Association, the American Medical Association, the Association of American Medical Colleges, and the Council of Medical Specialty Societies. The ACGME's mission is to improve health care by assessing and advancing the quality of resident physicians' education through exemplary accreditation.

The American Osteopathic Association (AOA) is the largest professional membership organization for osteopathic physicians (D.O.s), representing more than 100,000 D.O.s and osteopathic medical students. Headquartered in Chicago, the AOA serves as the primary certifying body for D.O.s; is the accrediting agency for osteopathic medical schools; and has federal authority to accredit hospitals and other health care facilities.

The American Association of Colleges of Osteopathic Medicine (AACOM) serves as a unifying voice for osteopathic medical education. It represents the 21,000 osteopathic medical students as well as the administration and faculty of the 29 osteopathic medical schools in the United States. Guided by its Board of Deans and various other member councils and committees, AACOM promotes excellence in osteopathic medical education, in research and in service, and fosters innovation and quality among osteopathic medical schools to improve the health of the American public.