This. I think I've even posted about this here before. This has been my wife's experience too (surgeon). She trained with highly regarded academic surgeons that set the treatment recommendations and standards for her field. Then during her job search she went to a center with, well, surgeons not at all academic and she had a life changing moment because she realized their operations and outcomes (utilization, efficiency etc.) are far far better. At the academic centers you are recognized based on your research and publications, not on your surgical skills. These academic surgeons with relatively little experience are setting the standards for how the operation should be done and what the treatments should be. This is not at all recognized in her field unfortunately and is quite literally harming patients every day because of substandard treatment standards.