Meanwhile, orthopedic surgery had an average income of $436,000, with 94 percent of residency spots filled by U.S. Students. A separate study in JAMA discovered that while from 2002 to 2007 there were 2,600 fewer U.S. Doctors trained in primary treatment specialties, the amount of foreign graduates pursuing those professions rose by 3,300. Study co-author Edward Salsberg of AAMC said, Primary treatment is holding steady but only because of international medical college graduates . Related StoriesIdentifying obstructive coronary artery disease in women: an interview with Dr.Furthermore, tiotropium reduced the rate of exacerbations leading to treatment with systemic glucocorticoids by 18 percent , exacerbations resulting in treatment with antibiotics by 10 percent , and exacerbations resulting in treatment with both systemic glucocorticoids and antibiotics by 20 percent . The consequences of tiotropium as compared with salmeterol on the time to a first exacerbation and the annual rate of exacerbations per patient were consistent across prespecified subgroups according to age, sex, smoking status , severity of COPD , body-mass index, and use or no usage of inhaled glucocorticoids at baseline .