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.

Part of the problem is the US education system seems to not be turning out enough people with quality educations, even when there isn't a shortage of of credentialed people. For instance, there are plenty of lawyers. Most of them don't make much money and leave the industry quickly. Yet it is difficult to find a highly qualified lawyer to handle difficult issues.

With medical professionals, there is simply a huge shortage. Same with researchers, engineers, etc.

My company hires H1B visas not because they are cheaper, but because we can't get anyone here to do the job at reasonable rates. Reasonable being new graduate hires start out at CPI adjusted rates to near top end in silicon valley.

"My company hires H1B visas not because they are cheaper, but because we can't get anyone here to do the job at reasonable rates."

Sounds like "H1B visa holders are cheaper" to me. High quality engineers should be commanding on the order of $250k. In the absence of H1B visa holders lowering wages, that's what high quality engineers would command as an average salary; same as a good doctor or lawyer.

The main reason doctors and lawyers cost that much: you can't H1B them. Lawyer skills are too specific to a locality and subsection of the trade; for whatever reason, law school doesn't actually help with this -experience, networking (particularly for criminal law) and apprenticeship is how it ends up working. LLD is just a hoop that needs to be jumped through to get such apprenticeships. The AMA is the most effective labor union in America, keeping out highly skilled doctors from abroad by denying their skills validity.

Layer's pretty much world wide, have some form of 'local certification' in the form of 'Passing the bar', or equivalent local requirement. Its not that the skills are specific to a locality, its that in order be allowed to practice law in a jurisdiction you must complete the local requirement.

"not because they are cheaper, but because we can't get anyone here to do the job at reasonable rates."

Um... that is the definition of cheaper. In your own justification sentence. H1B must (should) be paid at your prevalent rate -- and this may not be what you consider a "reasonable" rate.