That isn't a factor of the artificial scarcity however, that's a factor of the teaching standards.
In Australia we have a very limited number of surgical training positions each year. We could do plenty more, but we don't... more or less because surgeons are snobs who want people to go through the same hoops they went through.
I think the two approaches are not that far apart. High teaching standards require an elite and dedicated student body and will weed out all that don't conform. An aggressive entry barrier for a limited number of seats will push applicants to compete with each other and select for largely the same thing, only earlier and at a lower cost for the students and the educational system.
I've experienced both systems "easy to enter, next to impossible to finish" vs "highly selective, smooth sailing after that", I can't say there is a definitive superior solution.
In Australia we have a very limited number of surgical training positions each year. We could do plenty more, but we don't... more or less because surgeons are snobs who want people to go through the same hoops they went through.