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.