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What's "down" or "less competitive" this year???

Discussion in 'General Residency Issues' started by lilycat, Dec 5, 2005.

  1. lilycat

    Moderator Emeritus 10+ Year Member

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    :confused:

    Just curious if anyone else has noticed the trend where it seems like every specialty is "more competitive" this year, ie meaning an increase in # of applications per students, program directors, etc. I've just been noticing that on several forums, specifically anesthesia, OB, and IM, they are all talking about how this year seems to be "more competitive." Then, for other specialties such as general surgery, ENT, ophtho, EM, derm, rads, etc., no one is necessarily talking about things being more competitive, but it seems like the same level of demand/competitiveness as previous years. On the interview trail, I've even heard that the number of Psych applicants at various schools has gone up considerably (double the usual number).

    If this is truly the case, what is actually "not competitive" right now? FP??? And in that case, does that mean the number of FP applicants has dropped drastically (since the supposed increased number of applicants in certain fields must have come from somewhere).

    Anyways, I'm just curious what other people's thoughts are. Personally, I'm not sure that I really buy the fact that so many fields have become increasingly competitive this year, since at least the number of US grads stays pretty constant year to year. Are people just applying that much more widely (to a minimum of 25 programs when maybe the minimum used to be 15?). Or is this just the annual hype that I'm not used to?

    Thoughts? Ideas?
     
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  3. deuist

    deuist Stealthfully Sarcastic
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    Thoracic surgery is definitely on the way down. Of course, in another 15 years, we won't have a need for such invasive procedures---you'd be out of a job if you take this route.

    As for IM being more competitive: are you kidding? There are way more spots that than applicants for internal med. If you can at least spell your name correctly on the application, you'll get in somewhere.

    Generally speaking, not competitive are FP, IM, peds, and psych. Some programs---e.g., Harvard---will always be competitive, not matter what the field is.
     
  4. Mumpu

    Mumpu Burninator, MD
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    Wouldn't be surprised if FP is tanking. You can't keep violating people and expect newcomers into the profession. I hear the EM bubble is deflating too because they've oversaturated the market which is hurting the salaries. General surgery was saved by the 80-hour week so they are on the rise again.

    So, uh, are people assuming something is competitive this year because 20 SDN posters said so or listed a school/program as their first choice?
     
  5. lilycat

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    There is a thread in the IM forum where posters are commenting that certain programs are talking about around a 20% increase in number of apps. I don't think it applies broadly across the field, but I thought it was interesting that it came up at all. I don't think they were talking exclusively about "top tier" programs, but I could be wrong (I don't think any specific names were mentioned). The programs being discussed were likely university/academic programs and not community programs though (I'm guessing, but that seems likely in this scenario).
     
  6. lilycat

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    For anesthesia, I think it is based on a few factors, all somewhat anecdotal. 1) Most applicants I've talked to have said that the number of applicants from their home school is up this year, at least 1.5x-2x the number of the last few years; 2) When talking to programs about applications this year, most applicants have had the experience of the program directors or coordinators talking about a large jump in number of applications this year, and an overall increase in "quality," (this could be hype, but the ones I've spoken with do seem genuinely astonished by the increased # of apps).

    For OB, the PD's I've spoken with (not a huge number mind you) all have indicated that they feel the "tide is turning" -- apps are up slightly, and "quality" has gone up.

    It just seemed to me that "everyone" seems to think their field is "more competitive." This just doesn't seem possible to me, so I can only imagine that it's "hype." Just curious. ;)
     
  7. MDgonnabe

    MDgonnabe your royal travesty
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    i bet this phenomenon is more to do with the fact that the same number of students are being scared by their deans to apply to more programs to ensure a match somewhere. eras makes this easy. all you do is click a few more times and you've applied to 10 more schools in just as many seconds. the only limitation in the end is $$$.
     
  8. BKN

    BKN Senior Member
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    EM has had a shortage of physicians since it's inception in the 60's. The number of visits continues to increase nation wide. We project that the market will not be mature (read saturated) until 2020-2030.

    That said- we essentially started from 0. We now have about 25-30 K physicians in the field. Some markets are tight. However none of my graduates have any trouble finding a satisfactory job. In our area, income continues to increase.
     
  9. EM Junkie

    EM Junkie SDN Donor
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    Good to know! I guess I should start saving $$ after residency so that around 2020-2030 I can take a slight decrease in income.

    I do agree with the poster that suggested that the ERAS system has made everything more "competitive" just because of the ease of applying to dozens of programs with the click of a mouse.
     
  10. robotsonic

    robotsonic Senior Member
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    Maybe programs should implement secondary applications, not really for more info but just to make it slightly more difficult to apply to tons of programs. Then people might limit their applications to programs they really want and PDs wouldn't have all of these extra applications.
     
  11. MDgonnabe

    MDgonnabe your royal travesty
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    nah. that's common sense. what we need are mandatory second looks and optional third, fourth, fifth and sixth looks. seventh if you REALLY wanna show you're interested. :rolleyes:
     
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  12. dodo2

    dodo2 Senior Member
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    One factor that has increased competition this year is that a there is a sharp increase in # of FMGs applying this year. For example, in the days past there were limited number of USMLE centers in Asia. Now they are in every major city. A lot more medical students in Asia take USMLEs and apply for residencies. It used to be very difficult to get a visa for a medical student. Now the US government is inviting them to come.
     
  13. Poety

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    MDgonna, you know 7 looks is not enough with the competitiveness of todays medical student - I'm voting for the 10th look to hand deliver the letter of interest written in caligraphy and framed- sound like a plan? :laugh: :laugh:
     
  14. Mumpu

    Mumpu Burninator, MD
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    Secondaries would be unfair to people who actually have to apply to 60-70 programs in this ******ed system we have in order to get interviews.

    Lifestyle is becoming more and more of a deciding factor if you can trust the research, so no surprise that anesthesia etc. are on the rise. The tide turning for surgery and OB has everything to do with 80 hour weeks (though I'm yet to see anyone actually consisntely comply).
     
  15. MDgonnabe

    MDgonnabe your royal travesty
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    so what'd those people do before eras?

    beyond the lack of adherance to the law as it is, don't people know that the "80 hour" workweek is just during residency? once you're out you slave your @$$ off as an attending and the sky's the limit.
     
  16. Sebastian.

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  17. Sebastian.

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  18. Selznick

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    There isn't any way to actually know any of this until after the match, is there? :confused:
     
  19. Mumpu

    Mumpu Burninator, MD
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    Nope...

    This is all one big moot point.
     
  20. neilc

    neilc 1K Member
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    actually, even after match it is tough to guage "competitiveness, IMO. simple increases in applications don't mean a lot if the applications are weaker than in years past. that doesn't mean more competitive, right? it just means more crappy applicants. and, seeing as how we have no data on stats and qualifications, it is really hard to say what is tougher to get. all we get is the SDN data, which are obviously skewed (see the usmle step scores for an example).
     
  21. lilycat

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    The "why" of certain fields increasing in apps, numbers, etc., I understand. My question was where applicants are coming from, if some fields are actually getting significantly increased #s of applicants. I just have trouble believing people when they are saying "X field is getting more competitive/more applicants, etc." because these applicants have to come from somewhere. Either FMGs/IMGs are making up all the difference (likely for some fields, unlikely for others), or some field or fields are taking a big hit in #s (that's what I'm curious about), or it's all completely bogus and things aren't substantially different this year from previous years.
     
  22. Annette

    Annette gainfully employed
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    I'd add the requirement that it be in three languages as well- Arabic, Russian, and Chinese (your choice of dialect ;) )

    There was an article in a recent local news paper where this kid was taking 3 college level classes, spoke 2 foreign languages and could read a 3rd, but was still worried that he wouldn't get into college! This world is going nuts.
     
  23. Poety

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    You're not kidding - even the PD's must be going nuts with all this stuff!
     
  24. carrigallen

    carrigallen 16th centry dutch painter
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    I think that a folklore circulates about the relative 'competitiveness' of any field. I agree with lilycat.

    Program directors inflate their numbers to look good. No one wants to be the director who had declining applications.

    Deans want to avoid having unmatched students. Although this is mostly for the students' own benefit, it also promotes less than accurate information.

    Applicants want to impress their friends and family. No one wants to go into a 'slumping' field.
     
  25. MacGyver

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    This is where your logic goes astray.

    The number of people applying to residencies is going UP, its not constant. This is due to a myriad of factors, which I'll lay out below:

    1) There have been many new DO schools opened up the last few years, and more DO schools on the way. They are fools and aggressively pushing an expansion of nationwide DO programs.

    2) Many of these new DO graduates are aggressively pushing after MD residencies. Before they always stuck to their FP and osteopathic residencies, but many more DOs are now pursuing other specialties that are currently relegated to the MD realm.

    3) The number of FMGs has gone up. As somebody else mentioned above, the ECFMG has made it progressively easier for FMGs to enter hte match. Lots of barriers have been removed, and now more FMGs are applying than ever.

    4) More MD schools. FSU, Cleveland Clinic, and a couple of other new med schools in the USA have opened up recently. that means more MD graduates. Each school puts out an extra 100-200 grads. It gets worse too. 3 more MD schools are being planned in florida alone. Texas is going to add 2 more med schools (UT Austin, UT El Paso). California is also considering expanding the med school system there.

    5) Backdoor entry programs. Many US MD programs now have partnerships with foreign countries to allow their FMGs to come in as "american medical graduates" and bypass the ECFMG rules. Some MD programs are outright building new foreign med schools, but attaching the "american university" label to them, thereby granting their graduates american medical student status. Cornell has a program in Qatar, Harvard has a program in United Arab Emirates, Univ of South Florida is starting a program in India.

    6) Some MD programs have increased their enrollment.

    7) the number of residency slots has remained constant the past few years.

    So what we have is more competition for fewer slots. The biggest threat is the increase in DO programs. They are aggressivley pushing more DO schools. There are already 5 new DO schools in the works and they want to expand beyond that as well. They are doing this so they can increase their "image" in the marketplace. The idiots are going to hurt all of us (MDs and DOs) if they continue to pursue this aggressive strategy.

    It also doesnt help when just about every state in the country wants to open up a new med school. As I stated, Florida is going to build 3 new MD schools in the next couple of years.
     
  26. deuist

    deuist Stealthfully Sarcastic
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    We keep building more medical schools when what we need most is (1) more people to enter primary care---maybe use an incentive package---and (2) a decrease in malpractice insurance in the crisis states. Good luck finding a neurosurgeon in Florida.
     
  27. Taus

    Taus .
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    If the need for more primary care docs is a legit one....then the opening of several more DO schools (who have a propensity for producing primary care docs) seems like a good idea overall....though there are definitely some other concerns that go along with it (as expressed in this post and several on the osteo/pre-osteo forums)...
     
  28. Mirror Form

    Mirror Form Thyroid Storm
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    I don't really see why you consider DO's as a "threat." They're a necessity since allopathic programs have FAILED COMPLETELY to produce ANYWHERE NEAR the required number of doctors in this country. It's pathetic that we have to hire a good third of our doctors from overseas, meanwhile americans are being turned away from med school right and left.

    -Sledge, M.D.
     
  29. sophiejane

    sophiejane Exhausted
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    It is a all a crap shoot. You have 100% chance of getting the residency of your choice if they interview you, like you, and rank you, and 0% if they don't. All else is conjecture and won't help you one bit. We have all heard the stories of so-and-so from East Boonesville U. getting into a very competitive program, and some guy from Ivy U. not matching his first 3 choices. Most of us fall somewhere in between.

    So, in the meantime, just apply to the places you like in the field you like, do your best, and save your brain waves for more relevant and important topics, like your patients and your family.

    DOs a threat...that's a good one! Don't engage MacGyver. This is his favorite rant. Next he'll launch into the looming threat of PAs, NPs, med techs, CRNAs, the guy who empties the trash cans, delivery truck drivers delivering medical supplies, the old lady in the gift shop....
     
  30. MacGyver

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    Your implicit assumption is that residency slots are created/reduced to match population supply and demand.

    Thats patently false. Residency slots have nothing to do with real doctor supply needed in this country.

    Residency slots have EVERYTHING to do with getting more $$$ from the federal government. Thats why every podunk hospital in the country has FP residency slots when in fact most of them dont need it to supply their communities.

    Each residency slot is funded at 100k per year courtesy of Medicare. Small hospitals who have no business running a teaching program jump at the chance to get their hands on this money. If you'd let them, they'd open up 100 more FP slots and fill them all with FMGs.

    So the high supply of FMGs in this country has NOTHING to do with a real doctor shortage and everything to do with taking the federal government's money.

    US has one of the highest doctor/patient ratios in the industrialized world. We dont have a doctor shortage.
     
  31. bigfrank

    bigfrank SDN Donor
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    he's right.
     
  32. PatrickBateman

    PatrickBateman Senior Member
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    Really? Is that true? Anyone know a link to a table of doctor/patient ratios?


    Our problem is one of regional/class disparities then, right?
     
  33. deuist

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    Yep

    Nope. Anytime that people are required to wait weeks or even months to see a physician, we have a shortage. Why, just look at neurosurgeons in Florida, ob/gyns in crisis states, and psychiatrists throughout the country. Some specialities definitely need more practitioners. The real question is the cause of the shortage---e.g., number of residency programs vs high insurance rates.

    Our ratio might be better than other countries, but it still needs some work.
     
  34. 3dtp

    3dtp Senior Member
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    The problem is one of regional maldistributions, I think. There are two links of interest:

    1. American Board of Medical Specialties
    http://www.abms.org/statistics.asp

    2. Bureau of Health Professions of the US DHHS
    http://bhpr.hrsa.gov/healthworkforce/reports/factbook.htm


    Concerning the comment about hiring 1/3 of our physicians from overseas, this is not necessarily a good thing. I have done work overseas and see the dearth of healthcare in Africa and Asia.

    Our J-1 visa program was set up to allow FMGs to come here to be trained in our residency programs with the proviso that they return to their home country for two years before attempting to emigrate. The waiver program makes a mockery of this provision.

    Here's how it works. A J1 waiver can be applied for if the applicant agrees to work in a "medically underserved" area. What is a medically underserved area? Anywhere where an ad in the local newspaper fails to recruit a US citizen/permanent resident. If you try to recruit a neurosurgeon by placing an add in the local Journal-Star, and no one answers the ad, then the FMG you're considering is elgible for the J-1 waiver. Once the waiver is granted, the waiver holder is on track for a permanent resident I-9 status in three years or so, and then with green card safely in hand, heads off to the burbs where the bucks are.

    Net result: The "medically underserved" area has a relatively high turnover, the burbs are overpopulated and we've created a huge brain drain on the rest of the world.

    Is this really how we should be doing business? Those who get in think so, but what about their own countries needs? Looking at this from a global perspective we are exacerbating the maldistribution of physicians and sometimes at our own expense.

    FWIW
     
  35. MacGyver

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    this is exactly right. I'm sick of this myth being spread around that FMGs help out rural areas. The net result is temporary at best, because as soon as they get that waiver status and permanent residency (which is a total joke and one of the biggest freaking loopholes in immigration law) they immediately run off to the posh cities.

    Take a look at the FMGs serving in rural areas. I guarantee you they've all been there less than 5 years and have no plans to stay there long term. They're not stupid, they're taking advantage of wide open loopholes to get access to the "good life" in the rich suburbs.
     
  36. 2006MD

    2006MD Beda hell ker 4 Kalifonya
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    Interesting. I guess if they were better compensated they'd have no reason to leave the rural areas.
     
  37. Miklos

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    For all you xenophobes out there posting utter non-sense on this thread, it wouldn't hurt to look at the facts.

    While the statistics for this year will only be known after the match, the NRMP datatables clearly show that there were fewer FMGs in the match last year than five years ago. Yes, you read that right.

    Prior to 9/11, in 1999 a total of 13,985 true FMGs entered the match. Last year, by comparison 8,943 did. That is a drop of 5,042. Yes, last year's figure is up a couple hundred from the nadir of 8,572 in 2002 but it is certainly not a flood. (BTW, the US government has not made it any easier to get a visa. If anything, post 9/11, it is much more difficult. For instance, one needs a visa to take the Step 2 CS unless one comes from a visa waiver country.)

    USIMGs are admittedly up, but not nearly enough to compensate for the difference from 2,859 to 3,507. That's only 648.

    As far as DOs go, they're up from 1,451 to 2,043, meaning an increase of 592 over the same time period.

    Regarding the number of J-1 waivers, this was discussed on another thread in great detail. There is no point in rehashing it here.

    In addition to being a xenophobe, you are also a troll. That's utter non-sense. Honestly, grow up.

    The LCME does not accredit those programs. They are IMGs, like everyone else and can either get ECFMG certified or go through the 5th Pathway. They do not have the advantages of LCME graduates. Those schools, BTW, are listed in IMED.

    From http://www.lcme.org/functions2005oct.pdf

     
  38. Miklos

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    Let's see now.
    1. The number of residencies is capped by the federal government.
    2. The AAMC, in its infite wisdom decided that there was a physician shortage a while back and kept the numbers of US allopathic medical graduates very steady.
    What has the result been?

    Read the outgoing AAMC president's speech:

     
  39. gtleeee

    gtleeee D.O. in the E.R.
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    Have worked with (and aware of many more) FMGs in rural areas (Mostly graduates of medical schools in India) who have been there in practice for 10-30 years. "They've all been there less than 5 years" is a foolish statement.
     
  40. Fantasy Sports

    Fantasy Sports Senior Member
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    Florida needs 3 new MD schools. Also, I think the fact that the AMA wants to increase the class size of medical schools across the nation plays into this as well.

    But what you have to remember is that these are basically MD residencies. It is a courtesy that we allow DOs to apply, considering how we are not allowed in their residencies. Same with FMGs. As territorial as doctors are about their specialty turf, the last thing the AMA will do is destroy the MD degree by having unmatched MDs. Every MD has an incentive to make MDs look respected, and having lots of unmatched MDs is the last thing anyone involved in the AMA would want.

    As much as I disagree with the AMA on several items in their agenda, when it comes down to it, they have been pretty good at defending our turf-- and even where they have failed they at least made a large fight of it. I wouldnt worry too much about the DO expansion or the FMG issue unless you are a DO or FMG, because the announcement of all these new MD schools and increase in MD class size is overseen by the AMA which actually has been pretty competent in general on this issue.
     
  41. Fermi

    Fermi Senior Member
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    You are correct. I did a research project on this--the largest bolus, by far, of IMGs was in the late 60s to mid 70s, and many of these physicians went to smaller cities and towns during/after their training. The majority that I know personally have been in practice over 20 years.
     
  42. Miklos

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    Couple points:

    1. Read the outgoing AAMC president's speech above. It is clear that the AAMC has historically not managed this properly in their own interest.

    BTW, if there is an expansion, all this means is that more US premeds will end up at AAMC schools as opposed to going AACOM or abroad.

    2. Despite what you may think, they are not US allopathic spots "only". As they are funded by the taxpayer, anyone who has the proper qualifications can apply to them. In fact the regulatory language regarding disbursement of federal funds for this purpose prohibits discrimination.

    Aside, note that DOs are highly limited in allopathic surgical specialty and subspecialty residencies due to the policies of the governing boards.
     
  43. f_w

    f_w 1K Member
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    LoL, If it was that easy !

    A J1 waiver physician has to work in an area defined by the secretary of health and human services to have a shortage of primary health care providers (HPSA) or is medically underserved (MUA). The way the feds arrive at these determinations is by counting the number of primary care provider FTEs/(county/town/census tract) and comparing it to the national average and minimum numbers they have established. For the MUA status, other metrics go into the equation but it is a similar concept (an area can also be classified MUA by request of the state governor). These shortage determinations are used to steer the allocation of grants for community health centers, 'critical access hospitals' and other safety net facilities.

    Obtaining a J1 waiver is a multi-step process involving the department of state, the state health department, the citizenship and immigration service and the department of labor.

    In order to obtain permanent residency (green-card) through work as a physician in an underserved area, you have to proove to the feds that you actually worked there full time for 5 years out of 6 years after the initial application is approved.

    I wish it was as easy as 'putting an ad in the paper'.
     
  44. southerndoc

    southerndoc life is good
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    I actually like FMG's. It adds variety to the residencies.
     
  45. Stinger86

    Stinger86 Intern year? Ha!
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    Has anyone considered that maybe the real issue here isn't necessarily physician shortage, but actually patient excess?

    Maybe if people would do a better job of taking care of themselves and their families in the first place, there wouldn't be such a huge need for more doctors.
     
  46. funkless

    funkless Apatheist, Anestheologist
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    Maybe we should repeal our seat belt and motorcycle-helmet laws.
    That should do the trick...
     
  47. Stinger86

    Stinger86 Intern year? Ha!
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    Darwinism in action, baby
     
  48. southerndoc

    southerndoc life is good
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    Isn't it shocking that Georgia has a helmet law, but Connecticut doesn't?

    I see a lot of motorcyclists with severe head injuries from their bikes. I now refer to them as donorcycles because that's exactly what they are when the rider doesn't wear a helmet.
     
  49. f_w

    f_w 1K Member
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    CT had a helmet law, but repealed it. God only knows why.
     
  50. funkless

    funkless Apatheist, Anestheologist
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    I was shocked by that, when my wife and I lived in CT (briefly).

    Dirty South, baby!
     
  51. f_w

    f_w 1K Member
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    Funny enough, CT also has gun laws a lot more lenient than the other new-england states and NY.
     

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