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Comment by seanmcdirmid | Hacker News Reader

> A doctor trained in India is no less qualified than a doctor trained in the US.

In general?

http://blogs.worldbank.org/developmenttalk/shocking-facts-ab...

> It’s also pretty staggering that hiring qualified staff doesn’t appear to increase this probability. Das and colleagues suggest that part of the issue might be the variation in the quality of instruction in Indian medical training institutions. So there may be some institutions from which a qualification does make a difference. But given the paper’s results, the effect of such institutions must be rather small. The fact that providers working in better equipped facilities don’t have a higher probability of prescribing the right treatment is also alarming.

Obviously, heart surgery isn't rocket science, and our medical training is a bit overpriced, but is it so easy to compare two disjoint systems?

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That article doesn't actually compare India to the US. In fact, it says that "It’s also likely the results aren’t India-specific." It would be interesting to see the results of a similar study carried out in the US or UK, for example.

In any case, there is a difference between the general level of competency of doctors in a given country, and the level of competency available to wealthy foreigners travelling to the country for medical tourism.

It's not India-specific. This is definitely happening in Eastern European countries, too, and probably even some of the western ones (although a bit more) - just like with college tuitions.

There's something seriously wrong with both the healthcare system and the education system in US if the prices are 20x+ more than in any other country.

This is definitely happening in Eastern European countries, too, and probably even some of the western ones

Careful here. I live in London for several years now, and from my experience Eastern European doctors are much better qualified then Western European. I'm originally from Poland, and medical studies are really hard, and people spend whole 6 years cramming just to become an apprentice to the doctor (it's Bachelors and Masters degree combined). On the other hand in western countries you can do undergrad degree in anything and only then apply to med school.

If you do your bachelors in non-science field, you cannot get admitted without doing a post-baccalaureate, which can take 1-2 years additional. There are a lot of science requirements to even apply to medical school, that someone with a computer science degree, for instance, would not meet and would have to take those courses (i.e. biology, chemistry, biochemistry, organic chemistry etc.)

Well, to be fair, OP only said apply to medical school, not get in...

Same reason why many people in the Netherlands got their eyes lasered in Turkey. Both cheaper (including the flight) and better qualifications (if anything by experience).

This was a few years ago though, from what I've seen the costs for eye lasering here seem to be catching up a little.

Frankly I'm a bit surprised by all the people in this thread saying "well that's a huge price difference, but how do you know Indian doctors are as good as US doctors"--as good? On what basis is the default assumption that US doctors would be better and the Indian ones need to prove themselves? All I know of the US healthcare system is that it's ridiculously overpriced, but just like that $8 bowl of ramen (wat) someone mentioned upthread, doesn't mean it's better, it might even be worse.

Because everyone born in a capitalist society has been taught from day one that "the more expensive the better." Just as you would assume a $200k car is a really good one.

> On the other hand in western countries you can do undergrad degree in anything and only then apply to med school.

This isn't quite right. If you want access to anything but a fly-by-night medical school, they're wanting hard science and most likely a focus in biology.

For what it's worth, there's a huge range of private care in India. From expensive hospitals that cater primarily to the upper class to charlatans without a degree holed away in a slum.

The difference between these two ends is incredible. While I can imagine these results at the latter, I find them hard to believe at the former. I'm paywalled away from this for the next two weeks, so if you want the facts, that's where I'd look: what sort of private healthcare.

Edit: To illustrate, another commenter has a link to an news story that says mortality is lower after the Indian procedure - http://m.theaustralian.com.au/archive/business-old/the-henry...

I read about this clinic somewhere else, and there it was said this clinic actually outperforms western clinics in terms of complications, which seems to be achieved through staggering case numbers per doctor.

That makes sense: experience increases performance, which is why we have intensive residencies; there is a reason why until recently residents were working 80+ hours a week. Perhaps we should ship all our resident-ready medical students off to third world countries where the needs are great so they can become proficient very quickly. Perhaps our system has become too soft.

Our residents do work 80+ hour weeks. Until recently, it was 100+ hours.

It's still ~100 hours a week: 6 days at up to 16 hours = 96 hours/week.

There’s a cumulative “in-hospital” time cap of 80 hours/week (88 for neurosurgical residents). In practice, however, this means that (a) the cap is regularly broken or (b) residents end up doing preparatory study, reading papers, doing research, etc outside of the hospital to remain under the cap. They are still working more or less the same hours.

Also, the 16 hour/day rule is only for interns, IIRC. Resident shifts can go up to 30(?) hours.

Perhaps we should ship all our resident-ready medical students off to third world countries where the needs are great so they can become proficient very quickly. Perhaps our system has become too soft.

The problem is they would become proficient at treating the wrong things. Medical conditions vary greatly by geography. Polio is still alive in the third world, Russia is fighting drug resistant TB, and up thread there is a mention of a surgery performed at a 1000x rate in India compared to the US(Once a decade vs once a day). All the while what affects Americans would be glossed over because it doesn't infect the rest of the world at the same rates.

It's completely meaningless to compare mortality rates. It's also not clear that if a patient had a CABG in India, went home and dropped dead within 30 days, that this data would actually be captured rigorously.

Anyway, you're drawing the wrong conclusion - it's astounding how close the US mortality rate is to the Indian, which attests to how good the US system is at operating successfully on more complex, elderly patients. Of course, you could argue that the US has optimised the wrong thing, at great expense...

> Anyway, you're drawing the wrong conclusion - it's astounding how close the US mortality rate is to the Indian, which attests to how good the US system is at operating successfully on more complex, elderly patients. Of course, you could argue that the US has optimised the wrong thing, at great expense...

Is that connected to the extra funding that older people get?

What happens if we compare mortality in people under 65?

It's still going to be problematic. There is a hidden selection bias that you can't get around. Eg in India there are still a lot of people that can't afford the CABG no matter how much it costs. Are those people less or more likely to die after surgery than the people that do get operated on? The answer invariably would be yes.

Do centres that do more surgery have better outcomes? The answer to this is already a resounding yes. There isn't any doubt about that, it's been shown over and over again for multiple different surgeries within developed countries. Surgeons knows this, and so do health insurance companies. But of course this has to be asymptotic. Doing 1000000 CABGs doesn't make you 1000 times better than the surgeon that does 1000. So I doubt there is any real difference between the surgical skill in Shetty's centre and top institutions in the US. It's an untestable question in any case. The important point is that the care overall seems grossly non-inferior to the US, not that the US is inferior.

While the results of the studies are true in that study (that those fake patients were misdiagnosed), the assessment that why they were misdiagnosed is (may be?) not directly related to their competency.

As a Indian (who comes from relatively simple background), I don't need a study to tell me that general/govt. hospitals that provide PHC are overcrowded, lack necessary support staff, lack necessary equipment.

What the bloomberg article is talking about is, another class of hospitals and medical staff. Narayan Hridayala, Fortis etc employ pretty good doctors.

I doubt that, any general statement can be made about - "doctors trained in India are less qualified than US", because it depends on lot of factors.

EDIT: Added "may be?"

If their doctors are trained like the bulk of their it professionals -- those hired by the body shops, no thanks. At least from what I've seen, countries that make a business iut of pudging grad numbers hoping for expat acceptance, quality is inversely proportional to quantity.

Within the US, the cost of heart surgery is highly variable, but if I were to go international, i would go south/central America over India any dry.

Such a crass generalization. If you think the bulk of India's IT professionals are bad - then you should at least consider if such poor skills are "good enough" for a vast majority of IT work.

The Doctors and Engineers from the best institutes of India are comparable to the best in the world. You will regularly meet them in American or European hospitals anyways doing consulting. It's a poor comparison. Some of the hospitals in India are comparable to any top-class hospitals in the world. In the end, you will be visiting such a hospital in India, not small time ones.

thats quite a narrow minded comparison. Theres a significant difference between bodyshopping IT employees because western companies want to save money on IT and consider it commodity, & training surgeons. Having lived in both India and South America - I found the quality of healthcare in India significantly better. You need to think a bit before making comparisons! Besides - learn how to spell ;)

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