The training of each doctor takes a lot of resources, especially specific numbers of cases necessary for each of the specialists who do surgery of any kind. If a surgeon does not do a procedure on a regular basis they lose skill in it and the less practice a doctor has had in a field, the worse their outcomes. So if you get 10 whipples in a year in an area and you have too many surgeons or hospitals taking less than 1 per year, without one getting more than a number of cases a year, all of them will be bad and your mortality will be high.