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This is America
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I think it's mainly because there is a limitation of the amount of students who can start the education. Every year the government holds entry exams and only the best 1600 can start the studies. Somewhere in their studies they have to choose their specialisation (heart, children, oncology,...) And as far as I know only a small part of them is interested to become a 'housedoctor' ( the type of doctor we have to visit when we have something like a flu)