You got into medical San Francisco 49ers faithful forever signatures shirt school, not so easy. You professors kept an eye on you to make sure you were relatively normal, and you passed everything. There were a lot more eyes on you later, during various rotations. Then you had to get into a lenghty orthopedic residency, where a lot of experts in what makes a good orthopedic surgeon looked closely at your skills. Your skill and commitment were evaluated every day by senior doctors, and you learned by doing, under close observation. For a lot of years. Then, if you could impress some program somewhere that you were really skilled and very good, after all that observation by experts, you might get a slot in prestigious hand surgery fellowship.
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A couple of more years of San Francisco 49ers faithful forever signatures shirt honing your skills under observation and evaluation. You’re into your thirties by now. That’s why there’s a fairly narrow range of skill for trained hand surgery specialists. That’s why, assuming no surprise impairments, your chances of getting a fine, skilled hand specialist are pretty high, whereever you go in the places such people work. Now take a psychotherapist. Nowadays free-standing for-profit programs, including online programs (!) turn out counselors and even psychologists in huge numbers. There are supervised practica and internships, but you are not supervised in person for individual therapy. You only get supervised on what you say about your work. (I always wanted interns to be my co-therapist in group sessions. That way I could learn a lot about their talents and their developing skills.