I was rather impressed with the nurse practitioner at a CVS Instant Clinic a couple of months back. I could have tried to get an appointment with my primary care when I got home. But when I actually saw her a few weeks later for a scheduled appointment, she basically shrugged and said she'd have done exactly the same thing the nurse practitioner did. (Keep taking Tussin and there's a prescription for an inhaler at the pharmacy counter.)

Pre-COVID (and the test I took was negative for what little that was worth), it would have been eh you have a virus. Which ended up basically the diagnosis.

Why would you think this is sarcasm? The availability of capable surgeons is already limited; when looking geographically, they are extremely limited.

You would have surgical assistants and nurses on the ground, but the actual expertise for surgery shouldn't be location dependent.