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The scarcity of MDs who want to work for minimal pay under crappy working conditions? A big part. Does the top med student out of our best medical school want to spend her career working in a clinic where they shuffle through patients every five minutes?
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That's just the thing -- to get into pretty much any med school, you need excellent grades and a pretty good MCAT score. If you were a mediocre student who scored well on the MCAT? You *might* get into DO school.
The fierce competition for a limited amount of admissions slots should (and this is not based on fact, observation, or anything but conjecture) breed the sort of M.D. who will expect to have an elite job with elite compensation whether they graduate from John Hopkins or anywhere else. Can anyone name a med school which has 'easy' entrance requirements or one which will admit students on a probationary basis?
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I don't think so. We want our healthcare providers to be the best educated, best trained, most experienced professionals with access to all the best equipment, tests, and medications.
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Why should medicine have to have only the "best"? How determinative are undergraduate grades and MCAT scores as to how good someone will perform in a family practice environment? We don't need every single person in the profession to be elite.
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We expect premium care from our health care providers, and we're going to have to pay them well and provide them with autonomy if we want a premium healthcare system.
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Sometimes, mediocre will suffice.