I agree with you, totally, RU. The neurosurgeon/gynecologist scenario was a bit of hyperbole. I realize that on a local level it would be unlikely that the neurosurgeon would get privileges to do the hysterectomy, because it would be unusual if he kept doing that procedure after he trained in neurosurgery. He couldn't continue to show competence in that area.
I guess my point was that Medicare doesn't care about the provider's training. Basically, reimbursement is the same for whoever submits the correct and documented charges.