Problem is that in medical school, and nursing school, once you get in- there is an enormous reluctance to kick anyone out, even if they really aren't up to the job. With the current (US) nursing shortage, as well as the shortage of GPs (Low compensation, high malpractice costs) there is no incentive to expel any students not up to the job, or to expect excellence. So if you go to the biggest hospitals, the best run clinics, you will get the good ones. Otherwise, you get the ones that should never have made it through the program. Once saw a urological surgeon freak out in surgery when his patient had an arrest.