Foreign doctors and hospital quality: Evidence from the English NHS

Abstract

This paper examines the relationship between hospital quality and the share of foreign doctors in the English NHS. Baseline findings suggest that heart attack mortality is higher in hospitals with greater shares of foreign doctors practising relevant specialties. Robustness tests and heterogeneity analyses indicate that this association is specific to Acute Myocardial Infraction (AMI) treatment and is driven by hospitals that are smaller, of lower-quality, and ill-equipped to provide optimal care. When explicitly considering for treatment type, AMI mortality does not vary with the share of foreign AMI specialists in hospitals capable to access certain treatment technologies within 150 min. Overall, the results suggest that higher AMI mortality is not caused by foreign-trained AMI doctors but instead reflects structural challenges and resource-driven hiring patterns in constrained hospitals, which tend to rely more heavily on foreign doctors to mitigate worse outcomes. Further research is needed to better understand the allocation of foreign doctors to underperforming hospitals and its implications for healthcare delivery.