How much do family doctors actually earn? Right after residency?

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I probably would feel differently if I was a lot younger and felt like I had the time to have an office and patient base. For me it's more important to work on my own bucket list than have an office. That's the beauty of medicine, we all have a niche that makes us happy and fulfilled.

I almost a year out of residency - but I also love my position with the Indian Health Services.

Don't really have protocols or people telling me what to do, move at my own pace, practice at my full spectrum, do what procedures I feel comfortable with. I am salaried, get great benefits, and could leave if I want.

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I almost a year out of residency - but I also love my position with the Indian Health Services.

Don't really have protocols or people telling me what to do, move at my own pace, practice at my full spectrum, do what procedures I feel comfortable with. I am salaried, get great benefits, and could leave if I want.

Would you mind sharing the state you practice in and your salary? I am very curious about the "benefits" of working with the IHS but have no one directly to ask.
 
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Right. You have no idea what you're talking about. Check out Atlas.md to learn a few things. Also, I didn't realize total autonomy, no burdensome insurance paperwork, seeing 7-10 (max) patients per day, and having ownership of a practice/being your own boss, was "hardly worth it" for $200,000 AFTER expenses (facilities, benefits, etc.)

I guess some people just love the piles of paperwork, 30 patients per day, hospital rounds, and non-medical administrators setting the pace and protocols for them. To each his own, I guess.

I never said the cash-only model doesn't work, I believe it does. The numbers you have brought up however, are totally unrealistic in a cash-based practice. Seeing peds patients for $10/month? Physician cost for vaccines alone is well over $100/year for vaccination age kids. If you're only charging $120/year to see kids with unlimited access to your practice, you'll be loosing money for every child you sign up.

So let's say you have a patient base of 350 and each one on average is paying you roughly $65/month. That's $273k gross profit. Assuming overhead is kept very low, say 35% (most physician practices are closer to 50%) that leaves you with $177,450 before taxes and benefits. When you're a business owner, overhead does not include vacation, 401k, pension, health insurance, and malpractice - all that comes out of your pocket.
 
I never said the cash-only model doesn't work, I believe it does. The numbers you have brought up however, are totally unrealistic in a cash-based practice. Seeing peds patients for $10/month? Physician cost for vaccines alone is well over $100/year for vaccination age kids. If you're only charging $120/year to see kids with unlimited access to your practice, you'll be loosing money for every child you sign up.

So let's say you have a patient base of 350 and each one on average is paying you roughly $65/month. That's $273k gross profit. Assuming overhead is kept very low, say 35% (most physician practices are closer to 50%) that leaves you with $177,450 before taxes and benefits. When you're a business owner, overhead does not include vacation, 401k, pension, health insurance, and malpractice - all that comes out of your pocket.

I guess you'll have to take it up with the practice owner. I think several links are provided on this thread, so you may look into it for yourself.
 
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I never said the cash-only model doesn't work, I believe it does. The numbers you have brought up however, are totally unrealistic in a cash-based practice. Seeing peds patients for $10/month? Physician cost for vaccines alone is well over $100/year for vaccination age kids. If you're only charging $120/year to see kids with unlimited access to your practice, you'll be loosing money for every child you sign up.

So let's say you have a patient base of 350 and each one on average is paying you roughly $65/month. That's $273k gross profit. Assuming overhead is kept very low, say 35% (most physician practices are closer to 50%) that leaves you with $177,450 before taxes and benefits. When you're a business owner, overhead does not include vacation, 401k, pension, health insurance, and malpractice - all that comes out of your pocket.
Most DPC doesn't cover vaccinations.
 
Finished residency in 2010. Base was $200K for the first two years. FP w/OB, rural community with a population under 25,000.

Here are some real world numbers taken from my tax returns:

2010: $124,000 (partial year includes residency salary)
2011: $211,000
2012: $290,000
2013: $339,000
 
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Can you comment on what in particular you did to jump so much from 2011 to 2013?
Special procedures? Hospitalist?
I don't plan on doing OB (I hate it) but will otherwise have a pretty broad-spectrum practice.
Encouraging numbers 🙂


quote="NDMD, post: 14988164, member: 75845"]Finished residency in 2010. Base was $200K for the first two years. FP w/OB, rural community with a population under 25,000.

Here are some real world numbers taken from my tax returns (rounded down):

2010: $124,000 (partial year includes residency salary)
2011: $211,000
2012: $290,000
2013: $339,000[/quote]
 
Finished residency in 2010. Base was $200K for the first two years. FP w/OB, rural community with a population under 25,000.

Here are some real world numbers taken from my tax returns (rounded down):

2010: $124,000 (partial year includes residency salary)
2011: $211,000
2012: $290,000
2013: $339,000

This is a healthy trend.

If you don't mind, how many hours per week do you work on average?
 
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Can you comment on what in particular you did to jump so much from 2011 to 2013?
Special procedures? Hospitalist?
I don't plan on doing OB (I hate it) but will otherwise have a pretty broad-spectrum practice.
Encouraging numbers 🙂

Generally speaking, jumps like that indicate production bonuses from having a full patient load once you're established.
 
Awesome! Thank you for sharing. Did you join a private practice or hospital-owned?
 
Finished residency in 2010. Base was $200K for the first two years. FP w/OB, rural community with a population under 25,000.

Here are some real world numbers taken from my tax returns:

2010: $124,000 (partial year includes residency salary)
2011: $211,000
2012: $290,000
2013: $339,000

Jesus. As a person who wants to do rural FM, this is awesome
 
Right. You have no idea what you're talking about. Check out Atlas.md to learn a few things. Also, I didn't realize total autonomy, no burdensome insurance paperwork, seeing 7-10 (max) patients per day, and having ownership of a practice/being your own boss, was "hardly worth it" for $200,000 AFTER expenses (facilities, benefits, etc.)

I guess some people just love the piles of paperwork, 30 patients per day, hospital rounds, and non-medical administrators setting the pace and protocols for them. To each his own, I guess.

According to the website, the physicians at Atlas MD have about 600 patients a piece. They say their overhead is around 35% (compared to like 70% in insurance practices). They make around 200-250K, which is completely possible on their pricing model.

They are available 24/7, they do see patients after hours, and do make house calls. It's not for everyone. I guess with a partner you could take turns being on call for these patients. This could be very attractive for someone who does not like to wrestle with insurance, doesn't like playing by someone else's rules, and likes to have the time to take care of people.

From what I've noticed, the physicians that do this love to talk about it, and to help others set up a similar practice. I'm just a med student, but they took the time to answer any questions I had. Not just the ones in Wichita, most of the others are pretty excited and eager to help you out too.
 
The average overhead in traditional family medicine is more like 60%. Half of that is staff salaries and benefits.

There are alternative practice types, such as the Ideal Medical Practice (IMP) model, that can significantly reduce overhead without forgoing insurance.

http://www.aafp.org/fpm/2010/0300/p38.html#fpm20100300p38-ut1

http://www.aafp.org/fpm/2007/0900/p20.html

I would expect staff would be a large portion of overhead, but I have absolutely no practical experience. I'm just a medical student, and I'll have to defer to your expertise.

From what I understand, they have only a single RN that can support 3 physicians quite easily in a DPC type practice. If employees are a large part of overhead, and they reduce employees to a single person, is this not advantageous? Is this already possible through a normal insurance based practice, or is this just not as big a deal as it sounds?
 
I would expect staff would be a large portion of overhead, but I have absolutely no practical experience. I'm just a medical student, and I'll have to defer to your expertise.

From what I understand, they have only a single RN that can support 3 physicians quite easily in a DPC type practice. If employees are a large part of overhead, and they reduce employees to a single person, is this not advantageous? Is this already possible through a normal insurance based practice, or is this just not as big a deal as it sounds?

The only way that you could get away with a single employee in a 3-physician practice would be to have the physicians themselves doing most or all of the administrative work. Having a single employee is, in and of itself, disadvantageous. If they quit, call in sick, or go on vacation, you're on your own.

I'll let AtlasMD weigh in on how he handles his staffing, but that's certainly not the way I'd do it.

IMP practices frequently employ a single staffer (not necessarily an RN), however.

FWIW, I have 9 employees in my 3-physician practice, which is below the industry average of 4:1 FTE per physician.

http://www.kevinmd.com/blog/2010/10/staff-doctor.html
 
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Can you comment on what in particular you did to jump so much from 2011 to 2013?
Special procedures? Hospitalist?
I don't plan on doing OB (I hate it) but will otherwise have a pretty broad-spectrum practice.
Encouraging numbers 🙂


quote="NDMD, post: 14988164, member: 75845"]Finished residency in 2010. Base was $200K for the first two years. FP w/OB, rural community with a population under 25,000.

Here are some real world numbers taken from my tax returns (rounded down):

2010: $124,000 (partial year includes residency salary)
2011: $211,000
2012: $290,000
2013: $339,000
[/quote]


i know you have no way of knowing this, but---what's the salary for FM that 'they' are aiming to get it up to? IDK if there's any talk in the community/academia of a target number to draw more people into the field. These numbers are crazy high. Please don't be fake :xf:

Also, are specialist salaries going down similarly as FM is going up? I haven't heard that happening but you'd think if there's a fixed pot of money then it has to be a zero sum game.
 
are specialist salaries going down similarly as FM is going up? I haven't heard that happening but you'd think if there's a fixed pot of money then it has to be a zero sum game.

The Feds call it "budget neutrality."
 
average hourly pay for urgent care physician in phoenix for fresh family medicine graduate???
 
For what its worth, I wouldn't work at an urgent care for less than 90-95 unless you're only seeing 1 patient an hour.
For me it comes down to how many hours I will be getting in a week. If the site guarantees 50+/week then I will take the lower rate. If they only give me 40/week then I expect the higher rate. Generally when I am away working urgent care I push 70+ a week.
 
Would you mind sharing the state you practice in and your salary? I am very curious about the "benefits" of working with the IHS but have no one directly to ask.

I am in rural New york, my salary is 185,000 moving to 195,000 my second year. I also work urgent care on the side.

I mispoke earlier- I am employed by the local tribe - but we are considered an IHS facility. The programs (loan forgiveness) are open to me, and we also follow IHS guidelines and recieve IHS awards (a lot like federal awards/guidelines for private/public facilities).

Another way to IHS is "US Public Health Service (USPHS)" one of the 7 "uniformed US forces" - you get a pension if you stay in this long enough, great healthcare benefits, free malpractice..

I think both of these options would provide you access to IHS loan replayment - 40,000 over 2 years, which is renewable - and also ranks highly if you want to do NHSC loan repayment 50-60,000 over 2 years - renewable.
 
In Seattle, a friend of mine was offered $210 for a faculty position plus benefits. While people are talking about urgent care rates, I thought I'd throw out ER rates. I've had two different non-trauma ER jobs in two different states. NC paid $175/hour. In WA I get $180/hour ($195/hr overnight). That gives me a lot of flexibility to supplement my regular clinic income with additional shifts when needed.
 
In Seattle, a friend of mine was offered $210 for a faculty position plus benefits. While people are talking about urgent care rates, I thought I'd throw out ER rates. I've had two different non-trauma ER jobs in two different states. NC paid $175/hour. In WA I get $180/hour ($195/hr overnight). That gives me a lot of flexibility to supplement my regular clinic income with additional shifts when needed.

How readily available are these non-trauma jobs for FM docs?
 
In Seattle, a friend of mine was offered $210 for a faculty position plus benefits. While people are talking about urgent care rates, I thought I'd throw out ER rates. I've had two different non-trauma ER jobs in two different states. NC paid $175/hour. In WA I get $180/hour ($195/hr overnight). That gives me a lot of flexibility to supplement my regular clinic income with additional shifts when needed.

Can one specify "non-trauma" for an ER job? Is it necessary as an FM doc who doesn't have trauma training? I would love to supplement income by moonlighting in an ER, but I also know that I couldn't handle some of the acuities that "walk" through the door... that's what an EM residency is for, correct?

I'm assuming that you worked in the fast track section of the ER, but you were still paid those big bucks. Sounds like an awesome deal.
 
Can one specify "non-trauma" for an ER job? Is it necessary as an FM doc who doesn't have trauma training? I would love to supplement income by moonlighting in an ER, but I also know that I couldn't handle some of the acuities that "walk" through the door... that's what an EM residency is for, correct?

I'm assuming that you worked in the fast track section of the ER, but you were still paid those big bucks. Sounds like an awesome deal.

I currently am working in a large ER in TX as an FM. I never did trauma in residency and they knew that when I got hired. This ER is 41 beds. So how it works with me is I watch the tracking board and sign onto cases that I know how to take care of. I don't do anything critical (trauma, stroke, MI). I also don't do children under 6 months since I never did inpatient peds and anything beyond fever, strep throat, and ears I don't have the training for. So, to answer your question, yes you can specifiy "non-trauma" if you are in a big enough place and they let you. You will not get the same pay as the ER guys. I am currently at $115/hr and anything that is "too hard" I put over on the "big" side for the ER guys to handle.

I have gotten the occasional emergent case that was discovered after triage. I had a guy with belly pain after a colonoscopy who ended up having a ruptured spleen that had been oozing for a week. A man with altered mental status, seemed sluggish with an acute on chronic subdural hematoma. Recently a lady came in with epistaxis with an INR of 5.2, I put in nasal packing an gave vitamin K. She went home and came back 4 hours later still with bleeding - ended up going into sudden mental status change and had an acute brain bleed. At least in a bigger place you have help and call the surgeon.

Now when I work in rural ER and trauma comes through, it's all stabilize and ship to the larger ER.
 
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In the two ERs I've worked in, there is generally one physician on and 1-2 PAs. The PAs do the fast track stuff and I do the rest. The ER I'm at now is a 12 bed facility, so not that big. The previous ER I worked in was 15 beds. The EMS system is set up so that most traumas are sent to the larger surrounding hospitals. That diverts a lot of the significant issues away from our facility. However, we do have a cardiac cath lab and a relatively robust inpatient service. 95% of the stuff is stuff you’d see in an urgent care center. It’s that 5% of stuff that’s different from FM that you need to work on. Fractures, eye injuries, chest pain, etc. are all stuff that we don’t normally see in clinic. With that said, there is nothing magical about ER. The information on what to do is out there. The literature is available, the review courses are available, the conferences are available. You just have to be willing to go out and acquire the knowledge to make yourself more comfortable. With that said, I’d say about 1/3 – ½ of the docs in these facilities were FM like me. I had no trouble finding these jobs and I’m sure others could as well.

Also, rural ERs are a little different with fewer resources and longer potential transport times, but those are often staffed by FM since there are so few ER guys willing to do rural.

I should also say most of these jobs specify ER trained or FM with ATLS.
 
I think this thread is misleading. I posted before about what my girlfriend makes working full-time. http://forums.studentdoctor.net/threads/little-pay-in-fm.1020919/#post-14549357 "She makes about $120k/year."

I take it back, she made about $130k/year when she started, and in year 2 they bumped her to $140k/year with 4 hours of "admin" time. I think if she stays, and commits to staying long-term, they might bump her up again to $150k/year with a day of admin time. The only other NHSC site in the area pays about $100k to starting grads to work full-time. Her NHSC commitment is up soon, which I thought would be liberating, but there are a few job listings in the area and they all pay poorly, dominated by large healthcare systems with no physician owned opportunities in sight.

Of the residents she graduated with--in an urban area in the northeast--starting salaries were in the low $100k range with little room for advancement, i.e. similar to what she's making here in a small city location in the south. One went to a very busy California practice making high 100s and promptly left because they totally overwhelmed him with volume. One grad went to his father's practice in rural South Carolina and makes good money. Yes, that's where the money is.

I think the salaries in this thread have been incredibly misleading and are not typical based on our experience. My girlfriend is afraid of the flames and meanness she'll get if she posts the reality of the situation on this forum. Personally, I think family practice should be renamed to something like "rural medicine". Sure, there are jobs around the cities, but they don't generally have pediatrics (unless it's very poorly reimbursing medicaid volume), and they don't generally have OB, unless you're within academics. Sure the academic positions exist, and my girlfriend's residency program did offer to hire one of her co-residents full-time for $80k/year plus bonus (guaranteed $130k/year yay). It seems that urban and near urban jobs pay poorly for a high volume of adult outpatients. Meanwhile, there's tremendous encroachment by midlevels which is driving down current and future earning potential.

Any suggestions for where to find local jobs are welcome. We're at a loss.


Wow. That is ridiculous. Why the hell would anyone go to medical school for this? Especially with 400K+ in loans? This is absurd.
 
Wow. That is ridiculous. Why the hell would anyone go to medical school for this? Especially with 400K+ in loans? This is absurd.

she's an NHSC student, so she won't have 400k in loans......the NHSC spots pay less than avg because they know you have to take one of them
 
Sure the academic positions exist, and my girlfriend's residency program did offer to hire one of her co-residents full-time for $80k/year plus bonus (guaranteed $130k/year yay). It seems that urban and near urban jobs pay poorly for a high volume of adult outpatients.
Any suggestions for where to find local jobs are welcome. We're at a loss.

Wow. Maybe it's the city you're living in. I know for a fact of academic urban FM programs that pay at LEAST double that amount. Everyone in my graduating class (except those that went into fellowship obviously) clear at least $200k. Some went urban some went rural.
 
I think this thread is misleading. I posted before about what my girlfriend makes working full-time. http://forums.studentdoctor.net/threads/little-pay-in-fm.1020919/#post-14549357 "She makes about $120k/year."

I take it back, she made about $130k/year when she started, and in year 2 they bumped her to $140k/year with 4 hours of "admin" time. I think if she stays, and commits to staying long-term, they might bump her up again to $150k/year with a day of admin time. The only other NHSC site in the area pays about $100k to starting grads to work full-time. Her NHSC commitment is up soon, which I thought would be liberating, but there are a few job listings in the area and they all pay poorly, dominated by large healthcare systems with no physician owned opportunities in sight.

Of the residents she graduated with--in an urban area in the northeast--starting salaries were in the low $100k range with little room for advancement, i.e. similar to what she's making here in a small city location in the south. One went to a very busy California practice making high 100s and promptly left because they totally overwhelmed him with volume. One grad went to his father's practice in rural South Carolina and makes good money. Yes, that's where the money is.

I think the salaries in this thread have been incredibly misleading and are not typical based on our experience. My girlfriend is afraid of the flames and meanness she'll get if she posts the reality of the situation on this forum. Personally, I think family practice should be renamed to something like "rural medicine". Sure, there are jobs around the cities, but they don't generally have pediatrics (unless it's very poorly reimbursing medicaid volume), and they don't generally have OB, unless you're within academics. Sure the academic positions exist, and my girlfriend's residency program did offer to hire one of her co-residents full-time for $80k/year plus bonus (guaranteed $130k/year yay). It seems that urban and near urban jobs pay poorly for a high volume of adult outpatients. Meanwhile, there's tremendous encroachment by midlevels which is driving down current and future earning potential.

Any suggestions for where to find local jobs are welcome. We're at a loss.
Its well known that the Northeast and California are the worst paying locations in the country (for everyone, not just family docs). Its also very true that the more urban you get, regardless of geography, the less money you'll likely make.

The salaries listed on this site are what those of us here have personally witnessed. I'm not sure how that can be misleading. I know, for example, that I haven't interviewed for a job in the last year that offered less than 150k/year, all with decent productivity bonuses. The only reason the numbers haven't been higher is because I do want to be relatively urban.
 
The reason I think this thread is misleading (>10,000 views of this thread!) is because I'm seeing something completely different with my own eyes. I don't know where you are in the country. Like I posted, the salaries in this thread must be for rural and/or midwestern positions. We can't find jobs offering these salaries in multiple cities or suburbs thereof.

I'm in SC. We may have different definitions of what a "city" is, but the place I'm 4 days from moving to is the largest in the state and starting FP outpatient only jobs are at 150k with productivity based on a wRVU value of $40 at one hospital and I think $38 at the other. There was a PP job I interviewed for (I didn't take it because of the 45 minute drive each way) that offered more like 170k with production bonuses similar to the other two places. Another place, still looking for people if you're interested, is an open-access FM clinic/urgent care that pays $97/hour for 36 hour weeks with 3 weeks vacation = 170k.

A soon to graduate resident from my old program is moving to Charlotte (big city), starting at 160k.

The money is there, you just aren't going to find it in the northeast or Cali.
 
I addressed this in my post. Yes, she is a NHSC grad, which gave her two fairly lousy options in a large geographic area. But, I thought when she finished NHSC this summer, she could move into a job where she could make more money, especially for how hard she works! We found out there is nothing paying significantly better that we can identify within a 45 minute driving area (covering well over 1 million people). We don't live in the northeast or California.

Also, I addressed NHSC in advance by pointing out the experiences of her graduating residency class. I don't know if those FM attendings who took jobs for ~$130k/year are doing better now, but none of the initial offers were over 200k in the first year except the guy whose father already has an established successful, rural practice. Most starting offers even without NHSC were in the low to mid 100s. There may be productivity bonuses, but they don't kick in until year 2 or 3 with that practice, which is not the question asked by the person who started this thread.



The reason I think this thread is misleading (>10,000 views of this thread!) is because I'm seeing something completely different with my own eyes. I don't know where you are in the country. Like I posted, the salaries in this thread must be for rural and/or midwestern positions. We can't find jobs offering these salaries in multiple cities or suburbs thereof.

Are you geographically limiting yourself? Also I wouldn't say that the thread is misleading but more of a YMMV thread. For example, I know here in TN where I am, Family Physicians start off at 120 but my last rural job in TX docs start off at 170 but that didn't include call, midlevel supervision etc..
 
I'll be going to a town of 2500 in NE TN in a few months. My salary is 140k year and RVU bonus of up to 10% of my salary (4000 patients in a year or 18/day). I'll also get a % of the 2 PA's bonuses that will be in the clinic with me. This is an FQHC, outpatient only, M-F 8-5, no call. The 140k is for residents 1-3 years out of residency. This goes up to 160k for 4-6 years out of residency.

I'm currently getting a stipend to pay for loans from the TN rural partnership in exchange for 3 years at an under served location. After that I can do the NHC loan repayment program because this place is Tier 1 and will get max amount.
 
I'll be going to a town of 2500 in NE TN in a few months. My salary is 140k year and RVU bonus of up to 10% of my salary (4000 patients in a year or 18/day). I'll also get a % of the 2 PA's bonuses that will be in the clinic with me. This is an FQHC, outpatient only, M-F 8-5, no call. The 140k is for residents 1-3 years out of residency. This goes up to 160k for 4-6 years out of residency.

I'm currently getting a stipend to pay for loans from the TN rural partnership in exchange for 3 years at an under served location. After that I can do the NHC loan repayment program because this place is Tier 1 and will get max amount.

Crisp,

how much different is the pay for non-FQHC jobs? What about for pediatricians and internists?
 
I did not apply for jobs in pediatrics or as an internist so I can't comment on that. I also did not apply to any other clinics because this was where I wanted to work for now. This is the pay at the group of clinics pay, not standard for all FQHC clinics.
 
I'll be going to a town of 2500 in NE TN in a few months. My salary is 140k year and RVU bonus of up to 10% of my salary (4000 patients in a year or 18/day). I'll also get a % of the 2 PA's bonuses that will be in the clinic with me. This is an FQHC, outpatient only, M-F 8-5, no call. The 140k is for residents 1-3 years out of residency. This goes up to 160k for 4-6 years out of residency.

I'm currently getting a stipend to pay for loans from the TN rural partnership in exchange for 3 years at an under served location. After that I can do the NHC loan repayment program because this place is Tier 1 and will get max amount.

Would you mind sharing more about the stipend you are getting and how difficult it was to obtain?
 
You have to be in a residency in TN (I think) and work in an under served area with a certain percentage of your patients Medicare and medicaid in TN for 3 years. It was not difficult for me because I am in a residency program here in TN and the people at TN rural partnership are always recruiting here. Their website is tnrp.org. You have to be in a residency to receive it and it starts as soon as you are accepted. It is $35k a year for 3 years. It has been nice getting it during residency because it would have been very difficult to make my student loan payments without it. You cannot receive this if you have other obligations (NHC) at the same time. Do you have specific questions?
 
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