AMA Takes On Medical Tourism

American Medical Association Outlines New Guidelines As Medical Tourism Grows

When the American Medical Association whispers, doctors and patients listen. That’s why the 171-year-old organization dedicated to improving the practice of medicine has issued new guidelines on medical tourism.
Two years ago, estimates from various sources show that anywhere from 1.5 million to 11 million Americans left the United States to seek treatment or have surgery in a foreign land. At that time, medical tourism was valued at $50 billion, according to VISA, with annual growth expected for the next decade.
The main reasons people leave the United States for treatment or procedures appear consistent:

  • Financial. According to, a day in the hospital in the United States costs $5,220; one day in a hospital in Spain costs $424. Likewise, an MRI here can cost upwards of $1,100, while only $215 in Australia. Lower costs and perceived high standards are luring people to travel for treatment.
  • To get drugs, procedures, or surgeries not approved in the U.S. Many individuals travel outside our borders to receive services that may not be or are not yet approved by the Federal Drug Administration.
  • To get the treatment they need faster.

On June 11, the AMA approved ethical guidelines “to help physicians understand their fundamental responsibilities when interacting with patients who seek or have received medical care outside the U.S.,” the AMA said in a statement.
It noted issues that Dr. Tutu Cheng, a plastic surgeon at the Heart of Florida Physician Group, discussed in a recent interview, such as caring for patients when they return and gaining access to medical records.
“I have come across patients in my training during general surgery and plastic surgery who have gone out of the country for various procedures. Subsequently, we have ended up trying to help them after they return,” Dr. Cheng says. “Now, in my own practice, I’ve seen patients and heard stories of patients who have suffered  complications from procedures they had done abroad.
“This is a huge concern within the field of plastic surgery,” she says. “I know this crosses over to other practices, as well, especially bariatric. The concern is that the standards are not upheld in other countries, both within physician practices, training, and the facilities in which they operate.”
The AMA agrees, saying that quality and safety issues abroad may not be set as high as they are in the United States, especially when patients are undergoing procedures not approved here. In addition, they may not have the privacy protections Americans have under HIPAA laws.
Its new guidelines urge physicians to:

  • Understand what medical tourism is so they can help their patients make the best decisions possible.
  • Explain the risks involved with seeking treatment outside the United States, especially when dealing with non-FDA approved drugs and procedures.
  • If a patient has sought a physician’s advice, let patients know whether you will continue to see that patient after they return.
  • If a patient left the country without seeking a physician’s advice,  “Respond compassionately to requests for follow-up care from returning patients … and carefully consider the implications before declining to provide (non-emergency) follow-up care,” the AMA said.

Cheng says she thinks the AMA released the guidelines to remind doctors that “medical tourism is very active.”
“It’s a reminder for us to be sympathetic to patients,” Cheng says. “Having said that, patients should be aware that it’s difficult for physicians to pick up care following another person’s doing.”
She  cautions patients about leaving the country for treatment.  If someone decides to pursue that route, she says she would advise them to “do adequate research concerning the training the surgeon may have had, to make sure they are a surgeon even, and to be informed of the regulations that that particular country has or doesn’t have.”
Patients who do seek treatment elsewhere should be aware of some of the warning signs that could indicate problems immediately after surgery. “Post-op complications include redness at the site, opening of the wound, drainage, warmth, fever, or tenderness. Those are signs something is wrong.”
Cheng says she wants to caution the public that surgery isn’t something that ends after a day or two.
“People need to think of it as a full recovery process, which often is not completed within a country,” she says. “A true recovery process can take six months to one year, and that’s conservative. So many procedures require long-term recovery — even years — of follow-up care to make sure they don’t have any future complications. They should be monitored by their physician or surgeon.”
Cheng says she relies on her training when dealing with patients, especially those seeking follow-up care. “Just because we can do something doesn’t  mean we necessarily should,” she says. “We have to be cautious accepting patients so we can provide adequate care.”
But patients also must do their homework and make informed decisions, she says.
“We need to get the message out there that patients may be enticed by the cost of the procedure, which is why they are going to other facilities, institutions, or countries,” Cheng says, but “their health should be important enough to have it done where the rules, regulations, and long-term risks are more understood.”
“Their health is important and we take that seriously.”

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