[wallflower]

Thanks for writing this very insightful comment. Unfortunately, many people will never read it since it is not a “hot” submission. Many years ago, I met with a primary care doctor who explained to me how presenting at conferences is a signal (and perhaps driver) of the doctor’s reputation. He says that it goes: local then regional then national then international. He was working on his regional reputation in his speciality (not primary care, I believe he was a resident).