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Notes -
Quick Google search suggests that there's something like half a million gallbladder removals per year in the USA. I'll leave it as a simple exercise for the reader to estimate how many residents per year could be trained to do gallbladder surgeries at such a rare.
You'd have to do this exercise for every type of surgery that a competent surgeon should know. Gallbladder is one of the most common (hence, one of the first to come off the top of my head), but you still need your local surgeon to be able to do the less known things as well. If I'm betting my life on a baseball player hitting a home run off a knuckleball pitcher, I want him to have at least gone up against a lot of knuckleballs in his life instead of a guy who's mostly only hit against fastball and curveballs and is going to be out there winging it for the first time.
Isn't that what specialists are for, though? If you need a guy who knows what to do with a knuckleball, you go to that guy, who specialized in it. But if you're dealing with fastballs and curveballs, then your local guy is good enough.
There's a death of generalists in medicine underlying a lot of this, in part because everyone wants the guy who's good with knuckleballs. But not everyone is going to face a knuckleball, and you don't need to go to the specialist otherwise.
I think the problem here is that you often don't know what you're dealing with until you're already knee deep.
If we're keeping with the baseball analogy, the specialist is the guy you call when you already know you're up against the absolute best knuckleballers. The generalists are still out there dealing with most pitchers, who aren't the best at it but do mix in knuckleballs among fasts and curves. I guess the analogy I should have used is:
"If I'm betting my life on a baseball team, I want most of their batters to have at least gone up against a lot of knuckleballs in their life instead of a bunch of guys who've mostly only hit against fasts/curves and are going to be out there winging it for the first time if it turns out the opponent team has many solid knuckleball pitchers." (Sorry if this is bad baseball, I don't actually follow baseball)
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