This forces plaintiff's attorneys to seek experts from other communities, often far away from the location of the trial. There are a limited number of doctors willing to testify, even from distant locations. The hourly fees can be prohibitive. The doctor you sue, on the other hand, typically has an unlimited number of colleagues in the community, making it easier to provide a defense, even when the negligence is relatively clear. Insurance companies are often willing to fight to the very end on these claims.
Settlements occur, if at all, right before trial, or during trial.
Only the most serious instances of malpractice causing the most serious injuries result in viable malpractice litigation. It is a perverse situation that you can't pursue a claim unless you are severely injured. Unfortunately, however, it doesn't make sense to spend thousands and thousands of dollars if you can't expect to recover significantly more. Unfortunately, until the medical profession and the insurance industry provide appropriate policing, such will be the case. Your inquiries are always welcome.