Complicated question, speaking from the U.S. There are huge disparities in pay depending on specialties, and some specialties earn frankly far too much approaching $750,000 - $1,000,000 annual salary in some markets (think orthopaedic surgeons, neurosurgeons, interventional rediologists). The chance at obscenely high compensation convinces students to accrue huge amounts of debt and take on enormous personal risk. Meanwhile, few actually make it into these specialties and many end up in specialties with much lower compensation such as family and internal medicine. It's become a very high stakes system where the participants make huge sacrifices and take on enormous risk for enormous gain