I worked for 8 years at a software company working with reformers in the medical system trying to fix how the active learner and "resident" system works. It was pretty disturbing to learn how things work at a typical learning hospital. Especially frightening was discovering that "evidence based medicine" is (was?) still a relatively fringe idea that there was large resistance to. The system sucks. I live in Canada where the learning system is a bit better, but we have a significant brain drain problem where Canadians attend a relatively affordable medical program here and then move to the states to earn the big bucks in the private medical system.