Originally Posted by Gerald
It cannot be all because of malpractice insurance in the US can it.
Of course not! Anyhow, I expect there's a bell curve representing medical competence--not sure if it skews higher in major metropolitan areas. If it does, my guess is that severely incompetent doctors don't last as long when interfacing with more of their brethren as they do in urban hospitals/practice groups. Presumably the curve skews higher for research skills at major hospitals, but that's not identical to clinical skills.
Whether the "average" foreign doctor is equivalent to their American counterpart, I don't know, but I bet plenty of them are better than the average American doctor. My husband was impressed with the doctor he saw in Delhi (who came to our hotel room), and I was impressed with the pharmacists I saw in France and Italy. I have no problem seeking medical care abroad.