Foreign Medical Schools: Education Should Improve Monitoring of Schools That Participate in the Federal Student Loan Program. Report to Congressional Committees. GAO-10-412
Author: Scott, George A.
Date: 2010-06-00
Type: Numerical/Quantitative Data
Subjects: Medical Education,Medical Schools,Foreign Medical Graduates,Student Loan Programs,Licensing Examinations (Professions),Academic Achievement,Inspection,Outcomes of Education,Foreign Nationals,Graduates,Negligence,Focus Groups

Each year, the federal government makes a significant financial investment in the education and training of the U.S. physician workforce. A quarter of that physician workforce is composed of international medical graduates (IMG) and they include both U.S. citizens and foreign nationals. Little is known about IMGs with respect to how much they borrow overall, or the outcome of their medical studies, leading some policy makers to question the federal return on investment in IMGs. Therefore, Congress mandated that GAO study the performance of IMGs educated at these schools and other aspects of a foreign medical education, including the potential effect of the new 75 percent pass rate requirement on school participation in the federal loan. This report examines the following questions: (1) What amount of federal student aid loan dollars has been awarded to U.S. students attending foreign medical schools? (2) What do the data show about the pass rates of international medical graduates on license examinations? (3) To what extent does Education monitor foreign medical schools' compliance with the pass rate required to participate in the federal student loan program? (4) What is known about schools' performance with regard to the institutional pass rate requirement? (5) What is known about where international medical graduates have obtained residencies in the United States and the types of medicine they practice? (6) What is known about discipline and malpractice involving foreign educated physicians? In summary, the GAO found the following: (1) From 1998 to 2008, U.S. students enrolled at foreign medical schools borrowed $1.5 billion in FFEL loans to attend free-standing medical schools. Although this amount represents less than 1 percent of all federal student loans borrowed during this period, borrowing has grown significantly, in part because of increases in tuition, student enrollments, and the availability of additional loan funds for graduate and professional students. (2) IMGs, as a group, have consistently passed their medical licensing exam at lower rates over the past decade than their U.S.-educated peers, but have narrowed this performance gap for most of the exam steps. (3) Education has not been able to fully enforce the institutional pass rate requirement needed for continued federal student loan eligibility. The three private organizations that administer each step of the exam have declined to release student scores on grounds that the data are proprietary in nature and should not be used for marketing purposes. As a result, Education reviews pass rates only when a school applies for the program, when it periodically seeks recertification, or when there is a change in ownership. (4) A GAO analysis of 2008 pass rate data of institutions located in countries that participate in the federal loan program indicates that while a majority of foreign medical schools in these countries met the current 60 percent student pass rate requirement, very few--11 percent--would likely meet the newly required 75 percent pass rate. (5) IMGs have entered into residency programs in all states, though they are concentrated in the eastern United States, and a larger proportion tend to practice in primary care than do U.S.-educated graduates. Nationwide, in academic year 2008-2009 there were 109,482 medical residents, over 30,000 of whom were IMGs (about 27 percent). Overall, few significant differences exist between all IMGs and U.S.-educated physicians with regard to either disciplinary actions that would revoke or suspend their licenses or with regard to malpractice payments--and rates of disciplinary actions are low for physicians as a whole.  Appended are: (1) Briefing Slides; (2) Objectives, Scope, and Methodology; (3) Comparison of Average Cost of Attendance at U.S. and Selected Foreign Medical Schools; (4) Performance on Licensing Exam by Number of Attempts on Each Exam Step, and by Nationality of IMG; (5) International Medical Graduates and Residencies; (6) Summary of Responses by Focus Group Participants at the Five Foreign Medical Schools We Visited; (7) Comments from the U.S. Department of Education; and (8) GAO Contact and Staff Acknowledgments. (Contains 3 tables, 4 figures, 14 footnotes, and a bibliography.)