Like most things, quality will out. And you are certainly right on the mal-practice...keeps costs down. So does the income tax set up. They don't pay a lot of thet either.
Here, the good MDs graduate, do a year's internship in public health hospitals all around the country. Then the most fortunate ones will go into Residencies, again all over the world, and the less wealthy or those with lesser grades, will go into the Public Health Ministry's Residency Programs. Here in Santiago we hat the University Regional Hospital, and it has many Residencies, from surgery to transplant, and , for the fortunate, Argentina Brazil, Mexico and Spain are favored because of the language. Those with US Residence will certainly try for a Residency in the States. Stateside MDs have to take the Boards, like any other med school grad, and compete on mostly that basis. Lots of Dominicans have "married" US citizens in order to get residency and therefore qualify for these programs-both medical and dental.
Once the Residency is over, the MD establishes his office in a reputable clinic (costing easily over $1 million pesos for an office space in a decent clinic, besides any equipment he may or may not need, it is quite an investment) while at the same time offering his services on the staff of the local hospital, where the salary is really dismal. He/She now has a "specialty" and is beyond the General Practicioner status. At this time, they might be as young as 27 or 28 years old...
HB