Apologies to hospitalists. Many do amazing things, work hard etc. My point is that the acute need for patients now and as long as I can remember in America is doctors who will see outpatients 5 days of the week. And yet the taxpayer has been paying for residency programs that are hospitalist factories. So in the last 30 years “ progress “ is creating a whole separate class of doctors that see inpatients only. In order to make way for the hospitalists, the prior group that was doing this work (your family practice doctor) had to be displaced (at times forcibly). The non profit hospital then turns around and complains about the rising cost of care and sends you a $10,000 bill for your one night stay. And at the end of the day, the end result is a pipeline built for Aga Khan University students to come to America and make a top 1% American income with zero medical debt. This is in the context of 2/3 American applicants being rejected from medical school. Cherry on top is affirmative action policies that make the bar for white / Asian U.S. citizens to get into medical school very high. So circling back to where this all started : do I think there are lots of qualified American citizens that could do the job trainees at these small programs are doing? 100% yes. The current state of affairs is a policy choice that works against American citizens, not for American citizens. And American tax payer dollars fund all of it.