Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and Western Australia
In reply: Nguyen and Nguyen question our finding that international medical graduates (IMGs) are at higher risk of attracting complaints than Australian-trained doctors (ATDs),1 based on recalculations using the descriptive statistics we reported. They infer, from the fact that IMGs accounted for 37% of doctors and 30% of total complaints, that IMGs were at lower risk of complaints.
Comparisons of simple proportions as above mislead for a couple of reasons. First, doctors were observed for different periods of time — accounted for by conducting the analysis at the doctor-year level. Nguyen and Nguyen’s reanalysis rests on the incorrect assumption that duration of follow-up was comparable between the two groups. On average, observation periods for IMGs were significantly shorter than those for Australian-trained doctors. Secondly, comparisons of simple percentages do not account for confounders — characteristics that differ systematically between IMGs and Australian-trained doctors and are also associated with the probability of complaints. We adjusted for several of these characteristics with multivariate analysis. Nguyen and Nguyen’s calculations do not take them into account.