It sounds like there's a paradoxical situation in American medicine where the standards are unreasonably high for white male doctors but unreasonably low for everyone else. So rather than having people whose aptitudes are a good match for the role of MD, you have some docs whose talents would be put to better use in R&D, while others are glorified nurses - if that.

Plus it doesn't really matter how smart you are if you're sleep-deprived, as sleep deprivation impairs you as bad as alcohol. As with alcohol tolerance some people can handle sleep deprivation better than others, but the shortage of docs means that the ones we have are overworked and not able to properly focus their cognitive abilities, even if they're otherwise highly competent.

I really don't think the problem of sleep deprivation among medical professionals can be understated, just imagine every doctor you meet having to chug a whole bottle of wine before treating you. And med schools should have something akin to Hell Week early on (obv not anywhere near as physically strenuous ofc) to test your ability to operate under bad conditions.