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Excellent thoughts. As a family physician/emergency medicine specialist for over 40 years, now volunteering treating mostly immigrants in a free clinic, I taught medical students, physician assistants, and nurse practitioners since at least 1980 as many procedures as I could, and particularly how to suture competently. There were too few opportunities to suture in medical school and in residency I got most of my experience from moonlighting. Just before I retired after selling my practice to a multi-specialty practice owned by a regional hospital, I had the second-highest RVU (Relative Value Units) of anyone due to my procedural expertise. After I retired, the two younger physicians who maintained my practice started sending all lacerations to the ED thereby plummeting their RVUs, and they resigned because they didn't receive raises. I can't say I took out a guy's appendix with a grapefruit spoon like Robert DeNiro in "Ronin," but I did darn near everything all in a day's work. Can't imagine sending anyone to an interventional radiologist for an LP!