Today, I'm going to do a deep dive into some match data for Orthopedic Surgery, which is one of the more competitive specialties out there. Let's look at the data to see if this holds true and find out who you can set yourself up for success early on if this is something you’re interested in.
In general, Orthopedic Surgery is a surgical specialty. It's a five-year residency with a lot of subspecialties after that. I had Dr. Muppavurapu to talk about being a hand surgeon back in Episode 05 and he talked about the many other things you can do like joints, spine, hand, and so much more. Today we're going to talk generically about ortho residency matching as a medical student.
[02:55] Number of Programs, Spots, U.S. Seniors
NRMP is the MD application. (If you're reading this way in the future, words like ACGME and AOA won't really mean much because the MD and DO residency programs will have merged assuming all goes well as planned out for 2020.)
Looking at Table 1 for the NRMP Results and Data 2016 Main Residency Match, there are 163 programs in the country for orthopedic surgery. Just to give you an idea of the number of programs for other specialties, Anesthesiology had 119 PGY-1 spots and 77 PGY-2 spots, a total of 196 compared to 163 for Orthopedic Surgery. Neurosurgery had 105 programs, Emergency Medicine had 174 programs. This somehow gives you an idea of how many programs are out there for Orthopedic Surgery.
Another important number to look at here is the number of spots available. Orthopedic Surgery had 163 programs with 717 different spots available so that's average of 4.398 spot per program. Comparing to other programs, Emergency Medicine had only 11 more programs but more than double the number of spots offered.
Out of the 63 programs for Orthopedic Surgery, none of the programs went unfilled. Many residency programs here had 100% fill rate so it's not unusual but again, an important thing to keep in mind.
As you think about your specialty, how competitive is it for you to match into? How spots are going to be available? If you don't match for some reason, can you do the Supplemental Offer and Acceptance Program (SOAP)? Can you find an open program? For something competitive like Orthopedics, you probably won't be able to find one and it's going to be much, much harder for programs that typically go completely filled.
There were 717 available spots while there were 1,058 total applicants. 874 of those were U.S. Seniors. Note that the number of U.S. Seniors applying are even more than the spots offered. Out of the number of students that matched, 650 were U.S. Seniors. That means U.S. Seniors make up 90.6% of students that matched into orthopedic residency. U.S. Seniors here are allopathic U.S. Seniors (students at MD Programs).
Ortho do not have any programs that match directly into PGY-2 positions. They are all categorical spots where you apply for ortho, you do your internship right there in that one program for five years.
[07:25] Allopathic and Osteopathic Students
There is always this DO versus MD “competitiveness” going on in the premed world. Here is where there is some bias among residencies. Orthopedic Surgery has been known historically as one of the biggest residency programs out there that has some negative bias towards DOs.
NRMP Match Data Table 2 shows matches by specialty in applicant type and looking at Orthopedic Surgery with 717 positions, 717 filled, 650 were U.S. Allopathic Seniors, 49 were U.S. Grads (this refers to those who either took some time off and didn't apply during the normal time you're supposed to apply to residencies or maybe didn't match the first time, went and got some research opportunities and ended up matching after graduating), and only 4 of the 717 were osteopathic students. That is just about half of 1%.
Compared to other specialties, Anesthesiology seemed very favorable to DO's with osteopathic students comprising 14.4% of all that matched. While in Emergency Medicine, 11.8% of those that matched in the filled spots were osteopathic students. Apparently, Orthopedic Surgery stuck with the the tried and true position of not being very “DO friendly.”
Remember that osteopathic schools and students can apply to osteopathic residencies and you can also apply to the MD residencies which accounts for the number of osteopathic numbers on the NRMP (allopathic) data. But in the osteopathic world, there are orthopedic surgery residencies. Therefore, don't think that just because you only got into an osteopathic school that your chances of getting into an orthopedic surgery residency are going to be slim to none.
Based on the AOA Match Data for 2016, there are 40 Orthopedic Surgery programs in the osteopathic world, with 121 positions, 118 were filled, 3 went unfilled. In the MD world, it's highly unusual to have unfilled orthopedic spots.
[11:06] Growth, Positions Filled, U.S. Seniors and All Applicants
NRMP Match Data Table 3 shows the growth of each of the specialties over the period of five years (2012-2016). Orthopedic Surgery is among those growing at a good pace around 2.5% each year. With 682 spots in 2012, it has grown to 717 in 2016 which suggests a pretty steady growth. This is good for you especially if you're thinking about Orthopedics since it means there are more and more spots offered.
The data in Table 7 confirms how Orthopedic Surgery is usually a specialty that doesn't go unfilled. There were no available spots in 2016, 2015 and 2012, only 2 spots in 2014, only 1 spot in 2013.
Looking at Table 8, it shows the Positions Offered and Percent Filled by U.S. Seniors and All Applicants (again, U.S. Seniors being MD Seniors that have graduated from an MD school).
In 2012, 94% of those offered a position consist of U.S. Seniors. This percentage dipped to 91.9% in 2013 and went back up to 93.4% in 2014, and 94.3% in 2015, and then dropped down further to 90.7% in 2016. This tells us that there are a lot of students who are non-U.S. Seniors filling these spots. They could be international medical graduates or U.S. grads that were not Seniors who are people that have taken some time off.
[14:15] PGY-1 for All Applicants and Osteopathic Students and Unmatched Students
Table 9 shows the percentage of applicants that have matched to a PGY-1 spot in each specialty compared to the whole. Anesthesiology is at 4%, Emergency Medicine with 7.1%, Family Medicine 11.5%. Orthopedics is 2.7% which is pretty small compared to some of the bigger ones like Family Medicine, Internal Medicine, and Pediatrics. Even Psychiatry is pretty big at 5.1%.
For the Osteopathic students looking at the NRMP Match Data Table 11 shows the percentage of students that are osteopathic graduates that matched into Orthopedics with only 0.2% of all osteopathics students that matched did match into Ortho that means only 0.05% osteopaths matched into a spot. And comparing this to the bigger programs, Anesthesiology at 6.4%, Emergency Medicine at 9.3%, and Family Medicine at 15.9%. Again, it is very hard for an osteopathic student into a MD orthopedic surgery residency.
NRMP Match Data Figure 6 shows the percentages of unmatched U.S. Seniors and independent applicants who ranked Ortho and other specialties. 25.1% of all those that applied to Orthopedic Surgery went unmatched, 20.8% were U.S. Seniors, 56.6% were unmatched independent applicants (the DOs and international medical grads). As a non-US allopathic medical school grad, it's very hard to match into an allopathic orthopedic surgery residency.
[17:05] Charting the Outcomes for U.S. Allopathic Seniors
Looking at the data found in NRMP Charting the Outcomes 2016, Table 1 breaks down the number of applicants per position for Orthopedic Surgery. With 717 positions offered and 1,034 applicants, there were 1.4 applicants per position. Outside of four other specialties, Orthopedic Surgery is the most competitive. Dermatology is last at 1.4, General Surgery at 1.49, Psychiatry at 1.54, and Vascular Surgery at 1.91. This goes to show how Orthopedic Surgery is a highly competitive residency.
Chart 4 shows the Median Number of Contiguous Ranks of U.S. Allopathic Seniors. This is the ranking of how many programs they've ranked, they've matched and didn't match. And this is always one of the biggest question marks if you don't match into a residency, which is: Did you apply to enough spots? The answer is usually no. This is very similar to medical school application where if you didn't get it, you'd have to ask yourself if you applied to enough schools to increase your odds.
For Orthopedic Surgery, the median number of contiguous ranks was 12. Those that did not match was only 6. So if you only ranked half of those that matched, then you'd have a much better shot at not getting in.
[19:15] USMLE Step 1 Scores, Research Experiences, and AOA
If you're a medical student getting ready to study for the Boards or if you're in your first year and just preparing, we are launching a Step 1 Level 1 Board Review Podcast called Board Rounds in the next couple of weeks so stay tuned for that! Subscribe to it now.
Charting the Outcomes 2016 also shows the USMLE Step 1 scores for U.S. Allopathic Seniors. For Orthopedic Surgery, it's at the top spot with some of the other more competitive specialties with those that matched averaging at 248-250 and those that did not match were right there on 240. Therefore, you need to do well on Step 1 to match into Ortho.
One of the misconceptions about Orthopods is them being dumb jocks but that's not true of course. You need to get really great board scores to get into Ortho and research experience doesn't lack either. Based on Chart 8, the mean number of research experiences is 4 for those that matched and 8 for those that did not match. So if you're interested in Orthopedics, do some research as it seems important based on this data.
Chart 12 shows the percentage of U.S. Allopathic Seniors who are part of AOA (Alpha Omega Alpha), the honor medical society that highlights the students who do well the first couple years of medical school. For Orthopedic Surgery, 34% of those that matched are AOA students while 12% for those that did not match. The takeaway here is to start off medical school doing really very well so you can try to get AOA.
[21:47] Medscape Lifestyle Report 2017
The Medscape Lifestyle Report 2017 presents data on burnout, bias, race, etc. Orthopedic Surgery is in the bottom half of the burnout chart at 49%. Yes, this is still a lot but this is the bottom half of the chart. The biggest takeaway is that a lot of physicians are burned out and Orthopedics is one of the least, which is good.
How severe is the burnout? Orthopedic Surgery is in the lower half of the chart.
Which physicians are the happiest? Orthopods make up the top half with 37% saying they're happy at work and 71% saying they're happy outside of work. This is another pretty good data compared to the rest.
[23:00] Medscape Physician Compensation Report 2017
Looking at the recently updated Medscape Physician Compensation Report 2017, Orthopedics is at the top of the list for most compensated physicians with an average annual compensation of $489,000. If you're interested in Orthopedics then you will probably make a very good income which is well-deserved. And this is up 10% from last year.
Only 48% of Orthopods feel fairly compensated and this is strange considering they're the highest paid of all the specialties. 79% of Orthopods say they'd choose Medicine again, and unsurprisingly, 95% of Orthopods say that they'd choose Orthopedics again. In general, Orthopods are pretty happy with their career choice.
[24:29] My Final Thoughts
I hope this helped you get some clarity with Orthopedics Surgery if this is something you're interested in. I hope you're also pretty early on in your journey because as I've mentioned, research is necessary and you need to do well on Step 1 as well as try to get AOA. Therefore, you need to start setting yourself up for success as soon as you can.
Dr. Ryan Gray: Specialty Stories, session number 19.
Whether you’re a premed or a medical student, you've answered the calling to become a physician. Soon you'll have to start deciding what type of medicine you will want to practice. This podcast will tell you the stories of specialists from every field to give you the information you need to make sure you make the most informed decision possible when it comes to choosing your specialty.
Welcome to the Specialty Stories Podcast, my name is Dr. Ryan Gray, and I am your host for this journey on your journey, your path to choosing a medical specialty. Today I'm going to do a deep dive into some match data. I've done a couple of these already, the first one was Anesthesia, the second was Emergency Medicine, and this one is going to be one that's near and dear to my heart, a specialty that I wanted to go into when I was applying to medical school, and even after medical school the specialty that I applied for, and that specialty is Orthopedic Surgery. Probably one of the more competitive specialties out there, and we'll look at the data to see if that really holds true.
I would love for you to help me find more physicians to bring on this podcast. So if you know a physician who would be interesting to talk to, and hear about their specialty, shoot me an email, Ryan@medicalschoolhq.net.
Main Residency Match Data for Orthopedic Surgery
Alright so I am looking at the NRMP Results and Data 2016 Main Residency Match PDF. So if you Google ‘match data 2016,' this is the PDF that will pop up pretty easily. And where I like to start is Table 1, looking at Orthopedic Surgery. So let's talk generically about Orthopedic Surgery. Orthopedic Surgery, obviously a surgical specialty. It's a five year residency and has a lot of sub-specialties after that. I had Dr. Muppavarapu on to talk about being a hand surgeon many episodes ago, and there are many other things. You can do joints, you can do hand like Dr. Muppavarapu, you can do so many things I can't even think about them right now, you can do so many. You can do spine as an orthopedic surgeon, so there are lots of things to do. So we'll talk generically about Ortho residency matching as a medical student.
So let's take a look at Table 1, again looking at the NRMP match data. So NRMP is for MDs, the MD application. If you're listening to this way in the future, post-ACGME and AOA merger, then these kind of words don't really mean much because the MD and DO residency programs will have merged assuming all goes well. I can't predict the future but that's the plan, and that plan is supposed to be done by 2020.
So looking at the MD data for right now, there were 163 programs in the country for Orthopedic Surgery. Just to give you an idea of the number of programs, if you look at Anesthesiology, Anesthesiology had 119 PGY1 spots, and 77 PGY2 spots, so if I do some quick math, 120 plus 77 is roughly 200, we'll round up. 200 spots compared to 163 for Orthopedic Surgery. If you look at Neurosurgery there were 105 programs for Neurosurgery, so Emergency Medicine 174, so a little bit less than Emergency Medicine, gives you an idea of how many programs are out there for Orthopedic Surgery.
The other important number here is how many spots are available. So Orthopedic Surgery, there were 163 locations, 163 programs, and there were 717 different spots available. So a little over- or a little less than four and a half spots per program. So that's an interesting number. Again comparing if you look at a program like Emergency Medicine, Emergency Medicine had only 11 more programs, but had more than double the number of spots offered. So something very important to keep in mind.
Out of the 163 programs, none of the programs went unfilled for Orthopedic Surgery. Now there are, when you're looking at the match data, there are many residency programs here that had 100% fill rate, so it's not unusual but it's important to keep in mind as you are thinking about your specialties, how competitive is it for you to match into? How many spots are going to be available? If for some reason you don't match, can you do the Supplemental Offer and Acceptance Program, the SOAP- what used to be Scramble, can you do that and find an open program? For something competitive like Orthopedics, probably not and it's going to be much, much harder for programs that typically go completely filled.
There were out of the 717 available spots, there were 1,058 total applicants, and 874 of those were US seniors. So more US seniors applying than positions offered. So pretty competitive. And out of the number of students that matched, 650 were US seniors, and obviously 717 total because that's the number of programs. So a little over 90% of all of the students that matched into orthopedic residencies were US seniors. So US senior for our purposes- or for the NRMP data, US seniors are allopathic US seniors. So students at MD programs. And that is all of the important information in Table 1.
So that's just the overarching summary for Orthopedic Surgery. Ortho is not- they do not have any programs that match directly into PGY2 positions, they're all categorical spots where you apply for Ortho, you do your internship everything right there in Ortho in that one program for five years.
DOs versus MDs in Orthopedic Surgery
Alright so Table 2 in this 2016 match data from the NRMP is an interesting one that a lot of students that I talk to are always interested in because there's always this DO versus MD ‘competitiveness' going on in the premed world, and here's where there is some bias among residencies. Orthopedic Surgery has historically been known as one of the biggest residency programs out there that has some negative bias towards DOs. And so Table 2 shows matches by specialty and applicant type. So if you look at Orthopedic Surgery, you've got the 717 positions, 717 filled, 650 of those were US allopathic, so MD seniors, 49 of them were US grads. So meaning somebody that either took some time off, didn't apply during the normal time that you're supposed to apply to residencies, maybe they didn't match the first time, went and got some research opportunities, and ended up matching after graduating already. 4 of the 717 were osteopathic students. So 4 of the 717. That is less than or about half of 1% of the students that matched into Orthopedics were osteopathic students. If you go back and remember the first one, the first specialty that we talked about Anesthesiology, it seemed very favorable to DOs at a little bit more than 14% of all of those that matched were osteopathic students. And in Emergency Medicine almost 12% of those that matched and filled spots were osteopathic students. So Ortho sticking to the tried and true position of not being very DO friendly.
But let me- I'm going to jump over into the osteopathic data which you can find if you just Google ‘AOA match data for 2016,' it's the National Match website which is www.NatMatch.com. You have to remember that osteopathic schools and students can apply to osteopathic only residencies, and you can also apply to the MD residencies which is why there are osteopathic numbers on the NRMP, the allopathic data. But in the osteopathic world, there are Orthopedic Surgery residencies, so don't think just because you only got into an osteopathic school that your chances of getting into an Orthopedic Surgery residency are going to be slim to none. There are as of this recording and the date that it's showing here for 2016, there are 40 Orthopedic Surgery programs in the osteopathic world, with 121 positions, 118 of those were filled, 3 were left unfilled. So again something that's highly unusual in the MD world with unfilled osteopathic spots, the DO world had 3 unfilled orthopedic spots.
Alright so moving back to the NRMP data, Table 3 shows the growth of each of the specialties over the period of five years. 2012, 2013, 2014, 2015, and 2016. And Orthopedic Surgery is among those that are growing at a good pace, around 2.5% each year. And so back in 2012 there were 682 spots with 717 in 2016. So pretty steady growth which is good to see for you, especially if you're on this journey and thinking about Orthopedics, there's going to be more and more spots which is awesome.
I've talked about it already a little bit about how Orthopedics usually is a specialty that doesn't go unfilled, and Table 7 kind of confirms that a little bit and shows the data behind that. In 2016 there were no available spots, 2015 no available spots, 2014 there were two. Two available spots in Orthopedics. And in 2013, one spot in Orthopedics that went unfilled. And in 2012 back to full up with no available spots.
One interesting thing to look at in Table 8, looking at the positions offered and percent filled by US seniors and all applicants- so again US seniors being MD seniors that have graduated from a US medical school, and MD school. Table 8 shows the percentage of those US seniors that made up the total number of people accepted, and if you look back at 2012, 94% of those that were offered a position were US seniors. It dipped in 2013 down to 91.9, went back up to 93.4 in 2014, 94.3 in 2015, and then dropped a lot down to 90.7 in 2016. So there are a lot of students that are non-US seniors filling these spots. Maybe international medical grads, maybe- obviously we talked that very few of those were DO students. There were some non-US seniors, so US grads that weren't seniors, people that have taken some time off. So this can be skewed a little bit, these could be US graduates from an MD school, but because they weren't seniors at the time of applying, then that kind of skews the numbers. So this could be a year where there were more students that it's unusual, students that have graduated already that have been doing some research or something else, and now are applying to a program.
Matching into PGY1 Programs
One of my favorite charts to look at is Table 9 which shows the percentage of applicants that have matched to a PGY1 spot in each specialty compared to the whole. So if you add up all the specialties, all the PGY1 spots, it adds up to 100. Anesthesiology we talked about several episodes ago is at 4% of all of those that matched, matched into Anesthesiology. Emergency Medicine, which again we talked about, was 7.1%. Family Medicine, 11.5%. Orthopedics is 2.7%. So it's a pretty small specialty compared to some of the bigger ones like Family Medicine, obviously Internal Medicine, Pediatrics, and those big specialties. Even Psychiatry is pretty big at 5.1%.
And for the osteopathic students out there looking at the NRMP match data, Table 11 shows the percentage of students that are osteopathic students or graduates that matched into Orthopedics, and it's only 0.2% of all of the osteopathic students that matched, matched into Ortho. So we already covered it's less than 0.5%, so 0.005 osteopaths matched into a spot. If you look at all osteopathic students that matched into an MD program, only 0.2% of those matched into Orthopedic Surgery. And again, looking at some of the bigger ones, Anesthesiology was 6.4%, Emergency Medicine, 9.3%, Family Medicine 15.9%. So ortho, again very, very, very hard as an osteopathic student to match into an MD Orthopedic Surgery residency.
Alright so continuing down the NRMP match data for Orthopedics, Figure 6 shows the percentages of unmatched US seniors and independent applicants who ranked Ortho and all of the other specialties. So looking directly at Ortho, 25.1% of all of those that applied to Orthopedics went unmatched. 20.8% were US seniors. 56.6% were unmatched independent applicants. So those are the DOs and the international medical grads. So it's very hard as a non-US medical school, allopathic medical school grad to match into an allopathic Orthopedic Surgery residency.
Charting the Outcomes
Alright so now I want to move into the Charting the Outcomes for US allopathic seniors, and again if you just Google ‘NRMP Charting the Outcomes 2016,' Table 1 is interesting because it easily breaks down here the number of applicants per position for Orthopedic Surgery, and there were 717 positions offered, 1,034 applicants, there were 1.44 applicants per position. Now outside of three other specialties that I can see here- four actually, it was the most competitive outside of those others. So looking at it, Dermatology was last at 1.4, General Surgery was a little bit more which is very surprising at 1.49, you had Psychiatry, which again very surprising, 1.54, and Vascular Surgery at 1.91. So Orthopedic Surgery is a very, very- if you haven't heard by now, very competitive residency.
Another chart that I really love from Charting the Outcomes is Chart 4, the median number of contiguous ranks of US allopathic seniors. So again, US allopathic seniors, these are ranking how many programs did you rank if you matched or if you didn't match. And this is always, always, always one of the biggest question marks. If you don't match into a residency, the question comes, did you apply to enough spots? And the answer is usually no, and very similar to applying to medical school, if you didn't get in, did you apply to enough schools to increase your odds? So Orthopedic Surgery, no difference here. The students that matched, the median number of contiguous ranks was twelve. Those that did not match was only six. So if you ranked half of what those that matched ranked, then you had a much better shot not getting in.
Charting the Outcomes also shows USMLE Step 1 scores, and I guess this is the perfect time to mention, if you're a medical student getting ready to study for the boards, or if you're in your first year and you're just kind of preparing, we're launching a board Step 1, Level 1 board review podcast pretty soon in the next couple weeks, so stay tuned for that. You can actually go subscribe to it now, there's an intro episode just saying hello, it's called Board Rounds. Find it wherever you're listening to this podcast. Alright so USMLE scores, Step 1 scores for US allopathic seniors, Orthopedic Surgery is right up there at the top with some of the other more competitive specialties with those that matched an average right around 248-250. Those that didn't match, right around 240. So you need to do well on Step 1 to match into Ortho.
One of the misconceptions for orthopods is that they're dumb jocks and it's actually not quite true. As you've heard, you need to be really smart to get great board scores to get into Ortho, and research experience doesn't lack either. So as an orthopod, if you want to match, the mean number of research experiences is 4 for those that matched, 3.8 for those that don't match. So if you're interested in Orthopedics, do some research. It seems like it's important based on the data which you can find in Chart 8 in Charting the Outcomes for 2016.
Chart 12 for Charting the Outcomes showing the percentage of US seniors- US allopathic seniors who are part of AOA which is the Alpha Omega Alpha honor medical society, which highlights students that do well the first couple years of medical school, and orthopods- those that matched, 34% are AOA students, 12% for those that didn't match. So again, a pretty important number there if you are interested in Orthopedics, you need to start off medical school doing very well to try to get AOA.
MedScape Lifestyle Report
Alright so I want to dive into the MedScape data which I've been covering for the other specialties as well. We'll start with the MedScape lifestyle report, and this is the 2017 report, so new and updated for you. The lifestyle report shows a lot of physician burnout and some other information as well. So starting off at the beginning, Orthopedic Surgery, they are on the bottom half of the burnout chart for those who are the most burned out, Orthopedics only at 49%, which you're like, ‘Oh that's still a lot,' but it's the bottom half of the chart. So the biggest takeaway is that a lot of physicians are burnt out, Orthopedics is one of the least which is pretty good. And how severe is the burnout? Again they're on the lower half of the chart.
They have a slide in here saying, ‘Which physicians are the happiest?' Orthopods are the top half with 37% saying they are happy at work, and 71% saying they are happy outside of work, which is pretty good compared to the rest of the chart.
Alright and moving over into the MedScape Physician Compensation Report for 2017, this was just updated a week or two ago as I'm recording this, Orthopedics is at the top of the list for most compensated physician with an average annual compensation of $489,000. So if you are interested in Orthopedics, then you will probably make a very good income, which is awesome and well-deserved apparently because you have to work really hard. And that's up 10% from last year which is awesome.
So one of the more interesting slides in this Compensation Report is that Orthopedics at only 48% which is the sixth on the list, only 48% of orthopods feel fairly compensated which is strange considering that they're the highest paid of all the specialties. So I'm wondering where that difference comes in. What is good is that the chart for ‘I would choose medicine again,' orthopods are near the top at almost 80%- 79% of all orthopods say that they would choose medicine again, and not surprisingly 95% of orthopods say they would choose Orthopedics again. So orthopods are pretty happy with their career choice.
So I hope that helped you get some clarity with Orthopedic Surgery if that's something you are interested in. I hope you listening are pretty early on in your journey, because as you heard you need some research, you need to do well on Step 1, you need to try to get AOA, it's one of the higher AOA programs out there, so you need to start setting yourself up for success as soon as you can.
Again I hope that was helpful. I would love for you to leave a rating and review in iTunes for me, and more importantly I would love for you to share this podcast with somebody else. As I mentioned at the beginning as well, I'm always looking for new physicians to interview on this podcast, new specialties. I got a request today for a urologist so if you know a community-based or academic-based urologist who you think would make a good guest to talk about their career, let me know. Ryan@medicalschoolhq.net.
Have a great week, we'll see you next week here at Specialty Stories.
Man, orthopods make a lot of money.
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