yes, that is indeed the reality. I've worked on a few interdepartmental research projects for 2 years - neurosurg, plastics, ortho, and ER with some crosses into primary care, depending on the patient's profile... from that experience I know which fields I do and don't want to devote myself to. My goal isn't to be a physician, it's to be a surgeon.. were I to match into a primary care residency I know I wouldn't be happy - not because they're somehow "lesser" by any means - they're definitely not - but they're not the right fit for me personally, vis a vis temperament/interests/types of problems.
There is the option of staying in the EU... however there's a personal consideration here - I have a significant other for whom I care deeply so I couldn't ask her to move for me as she has her own career. I wasn't more diligent when I was younger about medicine, and now the cards are almost entirely stacked against me it seem, no?