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If I understand correctly, the big problem with training doctors is they need to see a certain number of patients (say 10,000 for neatness) before they have seen 90% of the full gamut of what they might experience while practicing on their own.
This takes time and there's a saturation effect. You can make it take shorter time by forcing medical students to work for 80 hours a week, but you can't (or at least shouldn't) make more patients for trainees to see. In a given city, there will only be 100,000 people who need to see a doctor (in that specialty) that year, and so if you have a four year residency, each resident needs to see 2,500 patients a year, and only 40 people can be in residency a year in that city.
The confusing thing is how it ever worked. Was there a huge pathway from "war medic to ER doc" that we're missing now?
I don't think number of patients seen is a very robust metric, even if it's not useless. You also need to keep in mind that multiple med students or doctors in training can review the same person, even if they aren't handling the actual treatment. It's quite common for us to be to be asked to come up with a treatment plan in parallel, compare it to what our seniors did, and then have a discussion on the pros and cons of various approaches.
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It isn't quite as universal as all that, procedural skills and procedural specialties for sure need that, for medical specialties you can usually do a decent enough job with adequate extended length education and case simulation.
However the specific problem you are talking about kinda stems from improvements - as surgical technology and medical management improves you don't need to do certain kinds of things as often. This is great! But some things you simply cannot be allowed to do alone for the first time without decades of experience pecking at the margins to improve skills in aggregate.
This means that the number of surgical specialists needs to be restricted by supply of ill patients, and furthermore by supply of academic centers that can actually train them.
If you gave the SE federal funding for 2,000 extra general surgeons they just ....couldn't do a good job. The NE might be able to figure it out.
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