The context is Americans getting healthcare, so Americans would be choosing from people in America.

I would also point to the unnecessarily arduous and lengthy process of becoming a doctor in the US as one of the US system’s problems.

If I’m going to be asked to sacrifice all of my 20s and maybe early 30s and worked on 24 hour shifts during the prime of my life, I am also going to be making sure I get paid a ton for it. Otherwise, I would choose a different career.

I know a lot of doctors that advise their kids to not pursue medicine even if they want to do it, simply because the cost benefit is not worth it anymore (if you have other options).

They’re probably comparable, but one advantage, no doubt due to our high costs, is that US hospitals tend to have a ton of resources and the latest equipment. This does make a difference if you have a condition that benefits from cutting edge treatments.

I recently had a family member get surgery for a life threatening condition where a cutting edge treatment greatly reduces complications. The equipment only exists in a small number of hospitals on the planet and their normal hospital, which wasn’t even a particularly fancy US hospital, had one. It's probably not an issue for small and rich countries though. Probably more-so for medium income countries.