One of the more controversial aspects of the migration of doctors is whether international medical graduates offer the same quality of care as doctors who train and practise in destination countries. This debate is fuelled by the increasing dependence on doctors who were trained abroad—a quarter of practising doctors in the United States attended medical school in another country, and recent policy changes in the United Kingdom have led to a greater reliance on doctors who were trained abroad in the NHS. Across countries, the “fitness to practise” process or its equivalent, which investigates and adjudicates on concerns about the fitness of individual doctors to practise medicine, is widely held as the great quality arbiter, protecting patients from unfit doctors. In the linked study (doi:10.1136/bmj.d1817), Humphrey and colleagues assess whether country of medical qualification is associated with high impact decisions (the most severe forms of censure) at different stages of this process after allowing for other characteristics of doctors and inquiries.1

The process of licensure for doctors migrating to developed countries is rigorous. For instance, in the US the Educational Commission for Foreign Medical Graduates (ECFMG) …