Learned to scale? It is quite intentional. The medical boards are controlled by the doctors themselves. They decide how many residents to train for their specialty each year. The usual figure is about under ~300students/yr for the most sought-after (and "undersupplied") specialties. That keeps wages up. This is not like programming where you get a gamut of skillsets and 120,000 extra immigrants hopping into the pipeline each year. There is no supply/demand equation here other than what is allowed by specialty medical boards themselves.
But they still have the concept of one very highly skilled and expensive doctor in front of every patient. It is a form of craft industry. It hasn't moved on to the industrial area, where you only need very skilled workers to create and prototype, but that scale well by not putting these expensive workers in front of every customer. Even banks have done that.
I am not saying it is easy, and perhaps the technology doesn't allow it yet, but undoubtfully this is a next step in the medical profession.
