Foreign Medical Graduates and the Medical Underground

A written questionnaire was distributed by the Educational Council for Foreign Medical Graduates to 4035 foreign medical graduates taking the January, 1973, examination in centers in the United States. Forty-eight per cent of the 3935 respondents were working in the health field at the time of the examination. In general, married males on permanent visas who entered the United States before 1970 had the highest rate of employment in the health field. Those working in the health field had a lower passing rate on the examination than those not working (15 vs. 26 per cent). The questionnaire was followed by telephone interviews of a sample of 850 respondents designed to obtain more detailed information about job duties. Seventy-three per cent of the 513 who reported working in the health field were involved in direct patient care, and 64 per cent of these were employed in hospitals. Analyses of specific job duties revealed large numbers functioning independently and in unsupervised settings. The results suggest that serious problems exist in the control of the quality of care delivered in the American health-care system. (N Engl J Med 290:1408–1413, 1974)