If you look across countries, you realize that a lot of the sacrifices are part of the pipeline, but not necessarily key to good outcomes. Just like the grueling hours at certain residencies.

It's like claiming that one needs to cram hours upon hours of leetcode practice to be a quality software developer. It might be necessary for some companies to hire you, but that's to meet a filter that is less and less predictive over time, not an actual performance requirement.

And there's certain constraints related to patient's safety which have an impact (i.e. less handovers, longer shifts)

Education system was set up in XIX century. It's not clear how much of it is necessary in XXI century.

Back in the day religious books were copied by scribes educated in a monastic tradition. Now printers can print them in a completely godless manner but the result isn't any worse.