Foreign doctors and hospital quality: Evidence from the English NHS

• AMI mortality is higher in hospitals with a greater share of foreign doctors • This result comes from hospitals of lower quality and limited treatment capacity • The share of foreign doctors shows limited within-hospital variation • Timely treatment reduces AMI mortality and mitigates differences in hospital quality • Further research is needed to understand the allocation of foreign doctors 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 minutes. 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.