Anesthesia Residents Has 2nd Highest Percentage of Career-Choice Regret

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DrTroll

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From recent JAMA study, link here

According to the JAMA study, residents in these five medical specialties experienced the highest percentage of career-choice regret:
  • Pathology—32.7 percent.
  • Anesthesiology—20.6 percent.
  • General surgery—19.1 percent.
  • Neurology—17.4 percent.
  • Psychiatry—16.9 percent.
Pathology and anesthesiology, however, had a low prevalence of burnout. The low prevalence of burnout among pathology and anesthesiology residents signals that career-choice regret might be due to other factors.

LOL, I wonder what these other factors are? Getting pooped on by surgeons on a daily basis? CRNAs who think they are doing a better job than you? Attending who micro manage the **** out of your case?

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I can see why people have regret. Many factors play into that. And you have mentioned several. CRNAs may take over the field in the next 20 years. That is a REAL possibility, which would severely limit us and our salary. Not so much being pooped on by surgeons but having to abide by their schedule and the OR schedule. If I have to drop the kids off of school at 715 am I cant be there for the case. I cantsay ill be there in 15 mins. Ill be fired. Not having control of your own schedule gets old real quick. other things.. having to deal with bureacracy, administration sleeze bags, people having no idea what we do, etc etc. There are many factors which make ME regret my decision. Even though I am good at what I do.
 
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One of my med school friends switched out of anesthesia when she realized she couldn’t wear nice clothes at work.
 
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One of my med school friends switched out of anesthesia when she realized she couldn’t wear nice clothes at work.

Lol, that’s a reason you don’t hear very often. She could have done pain and wear nice clothes in clinic all she want.
 
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The "regret" survey was given to PGY2s; for anesthesia residents specifically, can't tell if these residents were CA1s fresh out of their IM intern year, or it's an almost-CA2.

Either way - why survey residents at the PGY2 level?
 
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The "regret" survey was given to PGY2s; for anesthesia residents specifically, can't tell if these residents were CA1s fresh out of their IM intern year, or it's an almost-CA2.

Either way - why survey residents at the PGY2 level?
The percentage would be even higher if they had sureveyed pgy3 and 4. and it would progressively gone up the further away you get from residency
 
If the study was what percentage of people regret sleeping with residents from various specialties, it makes a lot more sense.
 
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I can see why people have regret. Many factors play into that. And you have mentioned several. CRNAs may take over the field in the next 20 years. That is a REAL possibility, which would severely limit us and our salary. Not so much being pooped on by surgeons but having to abide by their schedule and the OR schedule. If I have to drop the kids off of school at 715 am I cant be there for the case. I cantsay ill be there in 15 mins. Ill be fired. Not having control of your own schedule gets old real quick. other things.. having to deal with bureacracy, administration sleeze bags, people having no idea what we do, etc etc. There are many factors which make ME regret my decision. Even though I am good at what I do.

You must work with those CRNAs with the fancy online doctorates, the ones I’ve seen in action aren’t anywhere close to being able to displace anesthesiologists or “take over” anything. And this is several decades worth of them.
 
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I am not surprised at all. Anesthesia residency is tough...you have to deal with POS academic surgeons...useless CRNAs...tons of studying plus long hours...and being responsible for critical aspects of patient survival very early on. Can be overwhelming.

Things are a million times better in PP. Hard to see the light at the end of the tunnel. But I couldnt have dreamed of a better specialty now that I have been out for a few years
 
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You must work with those CRNAs with the fancy online doctorates, the ones I’ve seen in action aren’t anywhere close to being able to displace anesthesiologists or “take over” anything. And this is several decades worth of them.
You are entitled to your opinion. I am entitled to mine. We both have the same opinion. the lawmakers have theirs. They differ from your opinion. And guess whose opinion is relevant! Hint: not yours and not mine.

10 years CRNAs will have done significant damage to our workforce. Take that opinion with a grain of salt of course but I sure as sh** wouldnt be going into anesthesia if I were a medical student now.
 
You are entitled to your opinion. I am entitled to mine. We both have the same opinion. the lawmakers have theirs. They differ from your opinion. And guess whose opinion is relevant! Hint: not yours and not mine.

10 years CRNAs will have done significant damage to our workforce. Take that opinion with a grain of salt of course but I sure as sh** wouldnt be going into anesthesia if I were a medical student now.
Also been hearing those doomsday predictions for a few decades. Almost verbatim.
 
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Also been hearing those doomsday predictions for a few decades. Almost verbatim.
You dont think CRNAs have made progress in their independence goals in 20 years?
 
I am not surprised at all. Anesthesia residency is tough...you have to deal with POS academic surgeons...useless CRNAs...tons of studying plus long hours...and being responsible for critical aspects of patient survival very early on. Can be overwhelming.

Things are a million times better in PP. Hard to see the light at the end of the tunnel. But I couldnt have dreamed of a better specialty now that I have been out for a few years

Anesthesia residency was great compared to medicine intern year
 
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I've been hearing those Doomsday predictions since I joined the forums in '05, and heard that they've been going on for longer. While they have not fully come to pass, there have been massive changes in the anesthesia landscape in parts if the country in the last few years to decade. When I was a med student, most of the practices in my home state (east coast) were physician-only, or just had a couple of CRNAs, with the exception of a few in the bigger metro areas, or the super rural "hospitals." Now, there are only a handful of predominently physician practices in the state. AMCs moved in and purchased most of the practices along the major interstate, too. So, in some parts of the country, the predictions are coming true.

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I've been hearing those Doomsday predictions since I joined the forums in '05, and heard that they've been going on for longer. While they have not fully come to pass, there have been massive changes in the anesthesia landscape in parts if the country in the last few years to decade. When I was a med student, most of the practices in my home state (east coast) were physician-only, or just had a couple of CRNAs, with the exception of a few in the bigger metro areas, or the super rural "hospitals." Now, there are only a handful of predominently physician practices in the state. AMCs moved in and purchased most of the practices along the major interstate, too. So, in some parts of the country, the predictions are coming true.

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True, but the treat isn’t the CRNAs, it’s the AMCs. We have ourselves to blame for that not the AANA.
 
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True, but the treat isn’t the CRNAs, it’s the AMCs. We have ourselves to blame for that not the AANA.
Those aren't the only practices there that have changed, though. While the big metro areas and interstate corridor are now their territory, the groups in the smaller cities have mostly transitioned to either entirely ACT, or are mostly ACT with <50% solo coverage practices now.

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Those aren't the only practices there that have changed, though. While the big metro areas and interstate corridor are now their territory, the groups in the smaller cities have mostly transitioned to either entirely ACT, or are mostly ACT with <50% solo coverage practices now.

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As blademda says the job of an anesthesiologist will be putting out fires that he/she didnt even start in the future.. Not the worst job, but pretty close to it.
 
Those aren't the only practices there that have changed, though. While the big metro areas and interstate corridor are now their territory, the groups in the smaller cities have mostly transitioned to either entirely ACT, or are mostly ACT with <50% solo coverage practices now.

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Again, our own fault. Not because of anything CRNAs did to improve their market share.
 
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You dont think CRNAs have made progress in their independence goals in 20 years?

Yes, and yet hospitals by and large still require our presence. Tons of good practices still out there that aren’t anesthesiologist sweat shops.
I live in an independent CRNA state, they are relegated to tiny flyover hospitals that honestly most docs probably don’t want to work at anyway. And nowhere anyone is going to choose to have surgery if they have any sort of means or know better.
Medicine and anesthesia have both changed since I started a long time ago. Anyone my age will tell you it was better to be a doctor in general 30 years ago, in any specialty.
 
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I've been hearing those Doomsday predictions since I joined the forums in '05, and heard that they've been going on for longer. While they have not fully come to pass, there have been massive changes in the anesthesia landscape in parts if the country in the last few years to decade. When I was a med student, most of the practices in my home state (east coast) were physician-only, or just had a couple of CRNAs, with the exception of a few in the bigger metro areas, or the super rural "hospitals." Now, there are only a handful of predominently physician practices in the state. AMCs moved in and purchased most of the practices along the major interstate, too. So, in some parts of the country, the predictions are coming true.

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The reason many of the the more rural our outlying groups changed their practice model was secondary to the direct threat of the AMC that move in at the time 5-10yrs ago. The AMC would be talking to the admin at all of those hospitals saying they could either provide the same service cheaper or provide more service at the same price with the intent to do so by using an ACT model.
 
I also didn’t touch on the fact that these critical access hospitals with independent CRNAs are being paid pass through money for CRNAs and not anesthesiologists. As the reins get tightened financially and that money goes away, their salaries will tank and those jobs will be among the worst in anesthesia- those CRNAs are already taking a ton of call. That’s if those hospitals don’t close completely, which is a huge possibility.
 
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Yes, and yet hospitals by and large still require our presence. Tons of good practices still out there that aren’t anesthesiologist sweat shops.
I live in an independent CRNA state, yet they are relegated to tiny flyover hospitals that honestly most docs probably don’t want to work at anyway. And nowhere anyone is going to choose to have surgery if they have any sort of means or know better.
Medicine and anesthesia have both changed since I started a long time ago. Anyone my age will tell you it was better to be a doctor in general 30 years ago, in any specialty.
Now this is where I always want to know people’s thinking. The part of tiny flyover hospitals most docs don’t want to work in.
Now why is that really? Are we as doctors really different in the ways we live? We must be in the city, in a large hospital and not the tiny flyover hospital? Why would doctors not want to work at the tiny flyover hospital? I really would like to know where this comes from?
 
A majority of docs wind up living within a short distance of where they went to med school, residency, college, or their or their spouse’s family. That usually isn’t small town America. Plenty of CRNAs will also put up with a lot to work independently as opposed to having to answer to an anesthesiologist.


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Having worked in a very tiny fly-over hospital for six years as a CRNA, before going to med school/anesthesia residency, I can tell you why nobody who wants a life would sign up for that kind of practice.

Two main reasons: every other day call and degradation of skills.

Even if you don’t get called out in the night too often, being on call that much will suck your soul from you. These practices are usually two-three man groups. One guy on vacation most of the time, adds up to QOD call. You can never party with your partners, because one of you cannot hav a drink that night. Doesn’t sound bad for the first couple of years, but after that...

Even 3-4 man groups, but with an OB labour epidural service, have killer schedules.

The other reason... B&B cases will, over 5-6 years, begin to slowly degrade your ability to handle truly big bloody, physiologically complex cases. It’s a slow decline, but inevitable. I’ve experienced it twice to varying degrees. One place I worked after residency, I gave a grand total of 10 units of blood in 6 years. Not the big 28 unit cases, with all the accompanying physiological changes you have to remember and deal with.

Believe me, no amount of CME and literature reading will prevent it.

Anyway, that’s my take, from having been there-done that, on why so few doctors sign up for very small town positions.
 
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Yes, and yet hospitals by and large still require our presence. Tons of good practices still out there that aren’t anesthesiologist sweat shops.
I live in an independent CRNA state, they are relegated to tiny flyover hospitals that honestly most docs probably don’t want to work at anyway. And nowhere anyone is going to choose to have surgery if they have any sort of means or know better.
Medicine and anesthesia have both changed since I started a long time ago. Anyone my age will tell you it was better to be a doctor in general 30 years ago, in any specialty.
so you agree that CRNAs have made progress into blurring the lines between MD and CRNA!!

IM just forecasting that those lines will become more blurry when every CRNA calls themselves DR. "So and SO" from anesthesia. The distinction between MD and CRNA will become less saliient. What's driving this? Political vendettas against physicians who have little power and spines. And Money. Hosptals figure they can pay a CRNA a lot less than MD.

There was no such "Dr CRNA" 20 years ago. Heck there was no "Dr CRNA: 10 years ago.

It was better being ANYTHING 30 years ago.
 
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so you agree that CRNAs have made progress into blurring the lines between MD and CRNA!!

IM just forecasting that those lines will become more blurry when every CRNA calls themselves DR. "So and SO" from anesthesia. The distinction between MD and CRNA will become less saliient. What's driving this? Political vendettas against physicians who have little power and spines. And Money. Hosptals figure they can pay a CRNA a lot less than MD.

There was no such "Dr CRNA" 20 years ago. Heck there was no "Dr CRNA: 10 years ago.

It was better being ANYTHING 30 years ago.

Who cares? They’re still losing where it counts. If they want to soak up the crappiest Q2 call jobs in these tiny hospitals with no acuity so they can beat their chests online about not needing no stinking supervision, they can be my guest. They’re being taken advantage of, not me.
They can have the scraps. I don’t agree with it for the patients’ sake, but it really doesn’t affect my job prospects and never has.
 
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Now this is where I always want to know people’s thinking. The part of tiny flyover hospitals most docs don’t want to work in.
Now why is that really? Are we as doctors really different in the ways we live? We must be in the city, in a large hospital and not the tiny flyover hospital? Why would doctors not want to work at the tiny flyover hospital? I really would like to know where this comes from?

I am actually the minority I think who enjoys country living, but I like high acuity cases. And I don’t enjoy Q2/Q3 call with 100% Medicaid OB, all for $300k or less.
 
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Having worked in a very tiny fly-over hospital for six years as a CRNA, before going to med school/anesthesia residency, I can tell you why nobody who wants a life would sign up for that kind of practice.

Two main reasons: every other day call and degradation of skills.

Even if you don’t get called out in the night too often, being on call that much will suck your soul from you. These practices are usually two-three man groups. One guy on vacation most of the time, adds up to QOD call. You can never party with your partners, because one of you cannot hav a drink that night. Doesn’t sound bad for the first couple of years, but after that...

Even 3-4 man groups, but with an OB labour epidural service, have killer schedules.

The other reason... B&B cases will, over 5-6 years, begin to slowly degrade your ability to handle truly big bloody, physiologically complex cases. It’s a slow decline, but inevitable. I’ve experienced it twice to varying degrees. One place I worked after residency, I gave a grand total of 10 units of blood in 6 years. Not the big 28 unit cases, with all the accompanying physiological changes you have to remember and deal with.

Believe me, no amount of CME and literature reading will prevent it.

Anyway, that’s my take, from having been there-done that, on why so few doctors sign up for very small town positions.

If I were a young doc I may consider one of these hospitals if they paid off all my student loans and paid decently for a few year commitment. COL is low, so one can bank their cash while looking for their permanent job.
 
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Thanks @Man o War and @Dejavu for explaining further. I personally prefer the smaller town. I hate traffic and feeling like there are people everywhere, all the damn time everywhere I go. I hated when I used to frequently travel to Baltimore and people were on top of each other. I thought maybe acuity was the main issue, but didn't know about the call schedule being so bad. I am currently looking at medium to small towns for jobs as many of the small towns are desperate for docs. This is for the ICU so will see what pans out. But plan on doing some anesthesia in a larger facility prn to keep up my skills.
 
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The "regret" survey was given to PGY2s; for anesthesia residents specifically, can't tell if these residents were CA1s fresh out of their IM intern year, or it's an almost-CA2.

Either way - why survey residents at the PGY2 level?

Well thats a pretty important detail.

I'm betting the results would be very different if they surveyed people 10 years out of residency. My choice of anesthesia feels like a better decision the more time I spend in it. I see what my colleagues in other specialties go through, and I want no part of it.

Also, why would they be asking about burnout to PGY2's??
 
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so you agree that CRNAs have made progress into blurring the lines between MD and CRNA!!

IM just forecasting that those lines will become more blurry when every CRNA calls themselves DR. "So and SO" from anesthesia. The distinction between MD and CRNA will become less saliient. What's driving this? Political vendettas against physicians who have little power and spines. And Money. Hosptals figure they can pay a CRNA a lot less than MD.

There was no such "Dr CRNA" 20 years ago. Heck there was no "Dr CRNA: 10 years ago.

It was better being ANYTHING 30 years ago.
Excellent points, especially the latter.

In my experience, unless one PROVES to the patient the superior medical knowledge and interest in his well-being, the patient will confuse the role of the MD and CRNA. The AANA made a very good point in their famous ad: when we are dressed the same way, it's hard to tell who the doctor is, and who the nurse. Most patients have minimal knowledge about who we are and what we do; we are just the people who put them to sleep, some kind of tech/nurse under the surgeon's supervision. They have no idea that there are at least TWO doctors in every OR.

The ASA made a major mistake when it didn't push for different uniforms for physicians in the OR, at least different hats. Let's not mention having the same locker rooms etc. (the military knows why they separate the officers from the hoi polloi). Doctors are the stupidest group of employees I know, when about protecting their interests; even the most uneducated workers would have known to protest vehemently against somebody else being allowed to wear a white coat (or being called "doctor") in clinical areas (and many other abuses we suffer on a daily basis).

Also, most surgeons don't really appreciate the value of an anesthesiologist (the same way they don't appreciate intensivists or non-surgeons in general), except for the 5 minutes when one saves their butts. All they care about is to have a "provider" to do whatever they want "at the head".

One needs a ton of naivete or denial to go into anesthesia nowadays.
 
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Well thats a pretty important detail.

I'm betting the results would be very different if they surveyed people 10 years out of residency. My choice of anesthesia feels like a better decision the more time I spend in it. I see what my colleagues in other specialties go through, and I want no part of it.

Also, why would they be asking about burnout to PGY2's??

I agree with you. The most physically demanding and draining year I ever had was PGY2. I used to go home after work and accidentally fall asleep on the couch only to wake up 5 hours later and go crawl into bed.
 
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I work in a position of extreme vulnerability.
I signed a NO CAUSE termination. Which means they can give fire me for any reason. They dont have to give me a reason. Which means if they are not happy with the way I handle cases, or I put my foot down and one of the surgeons or preop nurses lodges a complaint. Im selling the house taking the kids out of school and looking for another job. Even though I will likely find another job the possibilty is SOUL CRUSHING. It really changes the way you pracitce.. Ive seen it happen to other anesthesiologists. Look at what has happened in CHarlotte? And it will happen more and more. Especially when everyone thinks we are basically superfluous.

It is impossible for trainees to know or appreciate this dynamic. And people who say well every specialty has to deal with that. That is true but not to the extent that we have to deal with it.
 
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I work in a position of extreme vulnerability.
I signed a NO CAUSE termination. Which means they can give fire me for any reason. They dont have to give me a reason. Which means if they are not happy with the way I handle cases, or I put my foot down and one of the surgeons or preop nurses lodges a complaint and they terminate my contract. Im selling the house taking the kids out of school and looking for another job. Even though I will likely find another job the possibilty is SOUL CRUSHING. It really changes the way you pracitce.. Ive seen it happen to other anesthesiologists. Look at what has happened in CHarlotte? And it will happen more and more. Especially when everyone thinks we are basically superfluous.

It is impossible for trainees to know or appreciate this dynamic. And people who say well every specialty has to deal with that. That is true but not to the extent that we have to deal with it.
 
They make as much as doctors??? Wow
And that's on an anesthesiologist's license and liability. Best of both worlds. That's why some of them are actually very happy with the ACT model, especially a loose one; they get to do whatever the heck they want, and the physician suffers the consequences.

That was 10 years ago, btw. Nowadays they make MORE than some specialties, especially on an hourly basis.
 
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And that's on an anesthesiologist's license and liability. Best of both worlds. That's why some of them are actually very happy with the ACT model, especially a loose one; they get to do whatever the heck they want, and the physician suffers the consequences.

That was 10 years ago, btw. Nowadays they make MORE than some specialties, especially on an hourly basis.

in my state the nursing board is way more penal when bad things happen than the medical board is so can't act like they just get to do whatever they want with no liability
 
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Nurses graduate school at age 22 and start making $90k or more. With 20 years of saving/investing and living on the same salary as a resident, a nurse is a millionaire before the the doctor has paid off his student loans. The regret is not the specialty, the regret is going to medical school in the first place. College students reading this, do yourself an enormous favor and choose nursing instead.
 
Nurses graduate school at age 22 and start making $90k or more. With 20 years of saving/investing and living on the same salary as a resident, a nurse is a millionaire before the the doctor has paid off his student loans. The regret is not the specialty, the regret is going to medical school in the first place. College students reading this, do yourself an enormous favor and choose nursing instead.
Doctors graduate school at age 26 and start making ~60k for 4 years. After that they start making at least $300k a year at age 30 if they chose the right specialty.
8 years of interest is not going to make up for a 200% difference in salary unless the nurse invested in bitcoin while it was less than a dollar.
 
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Doctors graduate school at age 26 and start making ~60k for 4 years. After that they start making at least $300k a year at age 30 if they chose the right specialty.
8 years of interest is not going to make up for a 200% difference in salary unless the nurse invested in bitcoin while it was less than a dollar.

They also take on $300k+ in debt (not including undergrad debt). The $90k nursing salary is base for 36 hours a week and doesn’t including earning potential from overtime or per diem shifts.

Med school is a bad deal in its current state.
 
Nurses graduate school at age 22 and start making $90k or more. With 20 years of saving/investing and living on the same salary as a resident, a nurse is a millionaire before the the doctor has paid off his student loans. The regret is not the specialty, the regret is going to medical school in the first place. College students reading this, do yourself an enormous favor and choose nursing instead.

Nurses in the Midwest, south, north central aren’t making 90k for 3/12s.
Plus there’s that whole butt wiping sponge bath thing.
 
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Nurses in the Midwest, south, north central aren’t making 90k for 3/12s.
Plus there’s that whole butt wiping sponge bath thing.
They only have to do that for a couple years before they become CRNA/APNP/DNP/FNP/PhD/MBA.
 
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