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Landing Your First Job After CRNA School
If you have been a reader from the beginning, thank you so much. Go ahead and do not forget to give me a review. I would love that. I love hearing from you guys. Also, make sure that you subscribe to this show. I would love to keep you around so that way we can hang out every single week. This topic is going to be one that even if you have not gained acceptance yet, is worth reading. It is how to land a job after anesthesia school, graduating, and passing boards. I am going to shed some light on that.
Set Yourself Up While Still At CRNA School
Whether you are already in a program or hoping to become a CRNA someday, it will help you guys think about these things as you embark on your journey. Let’s go ahead and get started. The first thing I want to point out, though it is not always the case, it depends on location, but some places hire students after they graduate. There are other places where you can have a job lined up with a year left in your program. This can vary based on location, state, job market, and all of those things.
However, I want to let you guys know that it is not uncommon for CRNAs to have a job lined up six-plus months prior to graduation. There is nothing wrong with not having a job lined up the day that you graduate, but you should at least be having interviews lined up. Keep in mind that by the time you pass boards, you are going to have a three-month process of accreditation on average. That is hurtful when you are broke and not working. You want to try to expedite that process as much as possible by having a job lined up. When you do pass boards, you are not waiting more than three months to start working and getting that first paycheck.
The question becomes, “How do you land that dream job after school?” I am going to share based on my own personal experience, and on the experience of my students, some good ways to tackle that. First and foremost, this might seem obvious, but the clinical rotations that you take on as a student are a great way for exposure, not only to the networking system but your performance. It is a small community. People talk.
You want to make sure you are putting your best foot forward when you are going into your clinical setting. Even if you are a senior, you are experiencing
burnout, you hate pediatrics, you are like, “I am dreading this rotation,” or you hate OB, do not have an attitude going into those rotations. Even if you know this is not for you and it is not something you want to do long-term, make sure you are still giving it your all because you never know who someone knows.
Just because you do not like pediatrics or like OB, your hospital could still do other things. You do not just have to do OB. Where I worked, you could choose to do OB or not to do OB. There are opportunities for a bunch of different types of specialty rotations within one hospital setting. If I were to go into my OB rotation and vomit, would that hospital even consider hiring me after school? I do not know. They would prefect someone else before you if they had the option.
Make sure in your clinical rotations that you are putting your best foot forward, even if it is not something you are excited about. Go prepared. Make sure you are friendly, a team player, and flexible. If they change your assignment, do not throw a fit. It happens. It even happens as a CRNA where your assignment can change last minute.
It is the nature of the game. Being flexible is a very big part of being a CRNA. It is about being adaptable and flexible because things change quickly, including your assignment. That is what I want to say from the get-go. Make sure you are going into your clinical rotations with your best foot forward. Make sure you are smiling at everyone. Make sure you are introducing yourself. Make sure you are not participating in any gossip.
I had a program director who was amazing. He no longer is the program director. He did retire. One of the things he used to routinely say has stuck as a slogan of the program, “Speak low, speak slow, and do not say too much.” I am not alone in the fact that that has stuck with me through all my years of being a CRNA as well as my time as a student.
Those are wise words. Not that I like the term, “Keep your head down,” but at the same time when you are a student, you want to make sure that you are staying calm. You are speaking slowly so people can understand you. You want to make sure the communication is clear. You want to make sure that you are not getting overly voice-y or extremely opinionated. Extremes of anything are never good.
The clinical rotations you take as a student are an excellent way to expose you to the networking system and your performance. Share on XIf someone is coming back at you with why they did not like the way you did something, you need to hear them out. You need to listen to them. You do not then automatically defend yourself. You need to say, “Let me listen to you and be open to the possibility that maybe I was in the wrong. Maybe I wasn’t wrong, but it is not your preferred way. Maybe there is a better way.”
We can agree to disagree. You do not have to say that openly or outwardly. You could say, “I know I did not do anything wrong in my mind. I like what I did for the patient because of X, Y, and, Z and the outcome, but maybe it is when I am working with this particular person. Maybe I cannot do it this way because they do not like it.” You’re going to have to smile and go with it and know that someday when you are out on your own as a CRNA, you can do it the way you like.
As a student, it is not your place to argue with your preceptor about something that is not important at the end of the day. As long as your patient is safe and what you are doing is good for the patient outcome, it does not matter how you do it, how you roll your towel, how you label your drugs, or whatever the issue is. I am speaking about little piddly things. You are going to get critiqued on all things as a student. Using your best judgment on how you react to that criticism; critiquing is key to creating a good environment to do your rotation in and as well as a good opportunity for a future job.
Keep in mind that even if you did not like a lot of your preceptors at a location, do not let that deter you from taking a job there. Remember, when you are a CRNA, you are not working in the OR with your coworkers. You are working in the OR yourself with your attending. It is more important you get along with the attendings versus the actual CRNAs. Not that you do not want to get along with people, you want to like who you work with, but you are not going to forced to be around them in the operating room day in, day out.
It is not like you are going to clash or butt heads every single day if that is the case during some of your rotations. Remember that. Also, make sure you are asking questions as an SRNA and as you are going through your clinical rotations. Make sure you are talking to CRNAs. Make sure you are asking difficult questions like, “Do you like your job? What are the pros? What are the cons? Do you think people are happy here? What is the most senior CRNA working here? Does your facility have high turnover?”
It’s asking what their work-life balance is. Do they get stuck all the time? As a student, most of the time, variations exist. Some students are expected to stay to finish their room. Some students automatically get out at 3:00 PM. It depends on where you are, but if you are always getting out at 3:00 PM, you may not realize that CRNAs get stuck all the time. If you are getting out at 3:00 PM, but your CRNA is getting stuck, is that the environment that you are going to be walking into when you take a job there?
As a CRNA, you are not going to get to go home at 3:00 PM. You are going to be expected to stay until you are told you can leave. Based on how they staff it and allow add-ons, I have worked at places where you routinely get stuck. Maybe the fourth quarter towards the end of the year is worse than January time. Maybe in January, you get out early sometimes. It can fluctuate, but you can count on the fourth quarter at least once a week to be stuck over the end of your shift, which is hard when you have obligations outside of work like taking your kids to basketball, swim practice, or an appointment you have to make.
Knowing whether that is the environment that you are walking into can help make your choice if you want to work there. Do not get me wrong. There is no such thing as a rainbow job. You are not going to find a job where everything is peachy all the time. You are going to have some positives and negatives to every position you can possibly take after school. You cannot look for perfection. It does not exist.
You have to consider the whole picture. What is the work-life balance like? Are they paid well, at least? Are they compensated to stay over for their time? Are the CRNAs happy regardless of that? Do they work with the CRNAs? If a CRNA has something they have to get out for, do they trade with one another so they do not get stuck on a day they have somewhere to be after work? There are a lot of factors that go into it. That is why it is important to at least talk to your CRNAs you are working with in the operating room to see if they are happy and have high job satisfaction with where they are working.
Also, if you have a CRNA that you are working with who has been to multiple facilities, sometimes you will run into a CRNA who took a job there after school and six years later, they are still there. That is the only experience they have. They are happy. Maybe it is not perfect, but they do not have anything to compare it to. It is nice to get to know a CRNA who has other experiences, maybe one who locums somewhere. I promise you that you will have much more insight because they will have seen other things.
I even have seen it in my time. I have only been to 3 different places in 7 years. Ideally, I like to stick around if I can. I was not anticipating taking 3 different jobs in 7 years. One of my first jobs, I was there for four and a half years. We only moved because I wanted to be closer to family. I was not super happy where I was and I left and I am happy again.
I have seen three different facilities, how they function, and how they are different. I can probably shed a little bit of light in comparison more than someone who has had one job only, and that is all they have to compare it to, other than their ICU job. Sometimes I see people complain about certain things and I am like, “In the big scheme of things, you have it good.” I have seen a lot worse. It is nice to get perspective from someone who has seen other variations.
Relationships And Connections Go A Long Way
Keep that in mind, too, when you are picking CRNAs. Ask these questions. You are maybe picking someone who can give you an outsider’s perspective on different facilities. It brings me back to networking. By doing this, you are networking. You want to be friendly. You are not going to like every preceptor you have, personality-wise, but you are going to find ones you do click with that you do like, and even become friends with. Make sure you are exchanging cell phone numbers, and emails. Make sure you are staying in contact with them even after you leave that rotation.
If you know their birthday, check up on them on their birthday and say, “Happy birthday. I hope you are doing well.” You never know, after graduation, you could need them for a job reference. Maybe even five years down the road, you could want to reach out to them for a job reference. You are moving and going to be working at that facility. Those types of relationships go a long way. Every single time when someone applies for a job at any facility, any hospital, that chief CRNA is going to then go to their staff and say, “Do any of you know so-and-so? Do any of you know someone who knows so-and-so?”
Most of the time, this is where it is more like 9.5 out of 10, someone will know someone who knows that person. You are getting a reference within a reference. You apply for a job and the first thing they are going to do is they are going to try to find someone who at least knows someone who knows this person who can vouch for the fact that they would be a good coworker and a good fit. Word of mouth gets around. The community is small.
I am in Ohio. I know CRNAs in Alaska, Hawaii, California, Tennessee, New York, and everywhere. I can reach out to someone and they will know someone somewhere. It is easy to find people to know in this community, which I like a lot. It is nice to have that tight-knit network. If you do not know anyone at the facility you are going to have your baby at, you can find someone.
Before you know it, you have five people you know who are going to look after you. You are going to know who is going to do your epidural. It is nice. It is a benefit of being a CRNA. You can ask about surgeons. You have insider knowledge. The same thing goes when you are looking for jobs. You are going to know somebody who knows someone, who is like, “I would love for her to come work here. I would love for him to work here. They are excellent. I knew him as a student or as a CRNA. I knew him even in the ICU.” You never know where the relationships can take you.
It is always key when you are working that you are making a good impression on the people that you are working with. Have reference letters and connections. A lot of students tell me, “I am looking for a job out of state. I have never rotated in these facilities. How am I supposed to get a job there?” Ask a CRNA if they know someone. Chances are, at least someone you talk to will know someone in that state who can put you in contact with the CRNA, who can then talk to you. There are endless possibilities. Utilize the network. Utilize the connections the CRNAs have to help you in your job hunt after school.
Another good way to get involved, especially if you want to get hired within the state, is to look for state organization events. Every state has a nurse anesthesia association. You need to be getting involved in those, not just for the profession’s sake and for your own sake, but because it is the right thing to do. The career gives back to you in many ways. You need to make sure you are supporting the associations, whether it is on a national level or at a state level. Looking for state association events to go to is a great way to network and get involved in the community to see the value of that. It is important.
I see it time and time again, and I am guilty of it. You graduate. You put your blinders on. You are making money. You have a family. You travel. You enjoy not being in school. You are like, “This is awesome. I am living life and everything is fine.” It was not until I was out of school for over five years that I realized the importance of supporting not only on a national level. I always did anyway because I always was a member of ANA. I just paid my dues. I did not do anything.
Being flexible is a huge part of being a CRNA. Share on XI am realizing that giving back to your profession is so key and vital because you want to support the profession that is giving you the career you love for future generations to come. The same thing can be said for the state association. Not only is it a great way to network, meet people, and find opportunities, but it is a good way to get involved. I am not saying you have to commit a ton of time to do anything. Being connected is a big part of being proactive in your own profession.
That is another way that you can get involved. The same thing goes for the national level. If you get involved on a national level, you are going to have connections all over the country. One of the students that I know is a friend of mine and he graduated. He is from Ohio. He has always dreamed of going out west to practice. He wants independent practice. He wants to live in a ski town. That has always been his dream after school. You would think, “Coming from Ohio, how are you going to get a new grad position out west where you have never rotated? They do not know you. It is independent CRNA practice. How do you do that as a new grad?”
He was smart. He planned for this. From the time he started school to the time he graduated, he planned to make sure his experience was going to set him up for success in that area. One of the things he did was made sure his program offered independent practice experience. He also made sure that that program knew he needed and wanted that experience as a student. I highly doubt they rotate all the students through those areas. It is probably based on do you raise your hand and say, “I would like that experience,” to speak up for yourself and advocate for yourself that you want that experience.
He made sure he got that. He made sure that he could build his resume, such that he had that experience. When he went out there to interview for his dream job someday that he could support himself and said he, as a new grad, can hit the ground running and go with all the independent CRNAs. He also networked with people out there from early on. It’s seeking out, “Who are the contacts out there? Who do I need to talk to? Who do I need to get in touch with to make that connection?” He did that and it enabled him to get an interview. He interviewed. He has got his dream position. That is awesome.
Even if you do not know what you want, try to be proactive as much as you can. Making those connections will go a long way. Remember, you always have Typhon which keeps track of all your numbers. It is a great way to say, “I have had this many regional blocks. I have had this many open-heart cases.” If you are going into a sub-specialty like Pediatrics, OB, or Open Heart, when you are a student, make sure you are trying to seek out extra experience.
I used to work for a place that would allow students in their last year to pick an extra specialty rotation. That setting was unique to that hospital. That was not offered to all students at all locations, but that particular hospital hired a lot of students. They wanted students to come into their work environment with the skills and knowledge they wanted, not just needed, so they could have the practice they also wanted.
If you wanted more open-heart experience, you can pick the second rotation in Open Heart. If you want more pediatric experience, you can pick the second rotation in Pediatrics or OB or whatever you wanted to get more skills and more hands-on with. I thought that was a great feature for the students. It’s seeking out opportunities like that. It never hurts to ask to see if you can get extra time in a specialty rotation. I also know programs, that if you make it known from the beginning that you want to do Pediatric Anesthesia, they can set you up for a longer specialty rotation in that area.
How To Nail CRNA Interviews
As far as the actual CRNA interview goes, it is going to be like a walk in the park compared to your anesthesia interview, maybe give or take. Some CRNA school interviews are pretty laid back. It is more like a normal interview, but some CRNA school interviews are extremely grilling. Even if it was not an extremely grilling CRNA interview, it is high pressure to interview for CRNA school. Not that the interviewing for a CRNA position is not high pressure, but it is not if you consider how competitive it is to get into anesthesia school versus getting a CRNA job.
We are very fortunate that we have a great job market. I am not saying you have no competition, but you are in high demand. As long as you have done a good job in clinical and people can speak highly of you, chances are you are going to get a position if there is a position open. In the CRNA interview, some of the common things they may ask you is, “Tell me about a weakness of yours.”
Like they would in a CRNA school interview, you have to be aware of your strengths and your weaknesses. Knowing those things going into the interview is key. They may ask you how you deal with conflict. They ask you, “What are you looking for? What do you want your practice to be? What are your long-term career goals?” Those might seem common sense, but make sure you are thinking about that. Make sure you should know what you are interested in. By the time you are getting ready to graduate, you should know what types of cases or things you want to be doing with your career long-term. That is all a CRNA interview is.
They may interview with a team of doctors, or a team of CRNAs. Get to chat with them and maybe ask them about their facility. I do encourage you to go into your CRNA interview knowing as much as you can about the facility. It will seem like you are not that interested if you walk in there, think they do hearts, and they are like, “We do not do any hearts here.” That should be something you should already know prior to going into your interview.
Make sure you are not walking into your CRNA interview thinking this is a facility that does a bunch of regional blocks and they do not do any. You should already know those types of things prior to going into the interview. It shows interest. If you already have a good handle on what they can offer you, it shows that you took the initiative to look those things up and ask around, and talk to CRNAs.
Before you go into any CRNA interview, you should already be trying to be connected with a few CRNAs in that facility to give you some information about it that you could not find out through the recruiter or online. You can usually talk to a recruiter prior to your CRNA interview and get some insight as to what to expect with benefits.
Look At The Whole Package And Be On The Lookout For Future Opportunities
That is another thing, too. You want to make sure you are looking at the whole package when you are picking out a job after school and knowing that you cannot have everything. You have to pick what matters to you the most. Is it the location? Is it money? Is it the acuity or the types of cases they do? Is it independent practice? Is it hours?
No matter where you go, that is all going to be slightly different. You cannot find a facility that does it all. I looked. I tried. When I was getting ready to graduate, my goal was I wanted to do it all. I want to do Open Heart. I want to do OB. I want to do Paeds. I did want to do regional. The fact that I found a hospital that did Open Heart, a bunch of Neuro, OB, and Pediatrics, in itself is pretty unique.
Most hospitals do not do Paeds along with adults. Most of the time, you have a designated pediatric-only hospital. I thought that was great. I thought it was great that CRNAs could rotate, do OB, and do Open Heart. I leaned towards that setting where I could gain my initial practice. I am glad I did. I loved it there, but I did not do any regional.
My second position as a CRNA was heavy regional. We did a lot of regional, but I found myself not liking it. It goes to show you that you think you want it all and you think you want these skills. Do not get me wrong. It was a great experience, but I did not even enjoy it. I would have enjoyed it if it was a different type of workload. It was a lot for me to take. I needed to do 30-some regional blocks in a single shift. For me, it was extremely overwhelming. That facility was fast-paced. I did not like it. It was a surgery center.
It is different than a Level 1 trauma center as far as the way things are set up and run. It is what it is. It is nothing against them, nothing against me. We both had to part ways and move on. Sometimes you think you know, but you do not always know. Make sure you are giving yourself some grace in knowing that your first job out of school is not going to be the end of everything. You are going to have plenty more in store for you down the road. Just because you get out of school and you know regional, does not mean you cannot get hired as a CRNA at a place that does a lot of regional.
I am living proof of that. I had no experience. I did all the on-the-job training. I had not had any regional experience since school. Within three months, I was doing 25 to 27 blocks in one day. It is possible. I only spent 2 to 3 weeks training on top of that, and then they are like, “You are on your own. Fly.” It was fine. It went well. I was better than I expected to be at regional blocks, but I did not like it.
Knowing that your first job could just be a stepping stone and if you do not get the independent practice job, maybe you do not even feel comfortable with an independent practice job. I know myself, I would not have been comfortable in an independent practice job as a new grad. That is me and my own personality, style, and comfort level. I did not want that. Does it mean I do not want it in the future? I am curious about it, potentially. You never know. I am a number of years into my career. I hope to work longer as a CRNA. The doors are wide open and the possibilities are endless.
There's no such thing as a rainbow job. You'll have some positives and negatives to every position you can take after school. So you can't look for perfection. It just doesn't exist. Share on XNever ever limit yourself. The only way you will limit yourself is if you limit yourself. You have to be willing and open to doing something you are not comfortable with and have never done before if you ever want to grow. Keep that in mind. The same thing goes with your CRNA career. If you get too comfortable in what you are doing and you think that this is it, it is only because you are making it, it. If you are willing to try and put yourself out of your comfort zone, you can do whatever you want.
Another thing I want to point out, too, is sometimes in school, you do not get good numbers. Maybe you have had a bad OB rotation. Maybe you had a bad Heart rotation. That was me as well. When I was in school, I came from the MICU. I did not have a cardiac background. I did not even think Hearts was something I would enjoy because when I was a nurse’s aide, I would occasionally rotate to an Open Heart unit.
I was somewhat traumatized a few times. One of them was that the patient fell on top of me and coded on me on the floor. I could not get him off of me. He was dying on top of me. That was a traumatic experience as a nurse’s aide. I remember every time I would go to that unit, I would watch someone get their chest cracked, do the massage, right there in the bed. Maybe they were twenty years old. I was like, “I do not ever want to do Open Heart. This is terrifying. This is awful.”
I ended up working in the MICU. I will be flat-out honest with you guys. I was not a diehard ICU nurse. I was not someone who was like, “I always want to do ICU.” I did not like my time in ICU, not because I did not like ICU. I loved the ICU part of it. I did not like the death and the suffering. It was depressing for me. It was hard for me mentally to cope with that all the time, day in, day out.
Back to your numbers in school, I only had 5 open-heart experiences, 4 of which were in-person, and 1 was an observation. You need five. I barely got my numbers in school for my Open Heart. It’s the same thing with my OB rotation. I had tons of spinals by the time I went to my OB rotation. Unfortunately, as a student, they always wanted to put me in these C-section rooms and I got stuck in there. They never let me roam the floor for an epidural.
The thing about an epidural is you have to be ready and available whenever they need it. To be stuck in a C-section room all day when you are getting your OB rotation experience, you are not going to be able to get out to do the epidural. Unfortunately, that happened to me. I barely got my numbers for my epidurals, even though I tried to stand up for myself. It did not work out. Oddly enough, that was the same hospital that I took a job at afterward, where I want to do Open Heart and OB.
When I took a job there, I was like, “I want to do open heart and I want to do OB, but these are my numbers. You guys gave me my OB rotation here. You are going to have to train me as a CRNA, just like a student who did not get good experience.” They did. It was fine. I spent a few weeks with a CRNA in Open Heart room every day, five days a week for a couple of weeks, and then I was on my own. It’s the same with OB. I would always have a backup resource person. I always had someone to come and help me troubleshoot if I needed help troubleshooting the epidural. Within a few weeks, I was fine.
I want to tell you guys that because I do not want you to stress about not getting your numbers in school. For me, that was stressful. I remember crying about it and being upset about it, thinking I would never be okay as a CRNA if I got bad numbers as a student. It was not true. Regional, Hearts, OB, for me, most of that was on-the-job training as an actual CRNA, not as an SRNA.
Knowing that should not limit you and your possibilities as you go into the workforce and look for a job. I mentioned that credentialing takes three plus months. Be aware of that. I graduated in August. I had a job lined up a year prior to starting school. I started in October and got my first paycheck in the middle of October. I had to go through that period of time with no income and not working. I graduated and took boards two weeks later, which is probably on the end of being a sooner rather than a later spectrum.
Most students take at least 2 weeks, maybe 3 or 4. I am not a procrastinator. I never have been. I am the person if you told me to do something, I will try my darndest to make sure it is done at the time that I am supposed to do it. I hate procrastination. I made sure I did everything my program told me to do. I did lesson plans every single week and prodigy. There is also an apex. I did the work they told me to do.
When I was done with school, I felt like I could pass boards. I did not have to worry about cramming. I am not a crammer. First of all, I do not remember things when I cram. I felt pretty confident I could go into boards with a pretty solid memory at that point. I encourage you to do that versus cramming because cramming is never going to benefit you long-term.
Briefly, I want to touch on stipends. A lot of students wonder about stipend opportunities. I did take a stipend. It came with a four-year work contract. My only piece of advice for that is, by all means, if you get one, take one, but make sure you are still researching your facility. Do not overlook bad things because of the money. Do not let the money blind you.
You do not want to take a job that you are going to be miserable at and be held to a four-year contract all for money. You will be miserable. I promise you. I have seen people do it. It is not pleasant. In a lot of these places when you break those contracts, you have to pay back part of your stipend, if not, part of that plus interest. It could be a big deal. It could be a very bad, expensive mistake. They will come after you. They have lawyers to do that. Do not think you are going to get off clean and dry because you will not.
Keep in mind who you are up against. You are up against these big hospitals. They have lawyers and people to go after you for the money. Do not take a stipend unless you are 110% certain you can withhold the contract that you agree to under the terms. Some of them are two years. Some of them are three. Some of them are four. They are all different. Most of the time, when a hospital gives you money like that, you are going to owe some type of time requirement to them. It’s something to keep in mind.
Make sure you are talking to the CRNAs who work there, “Are you happy? I want to take a stipend, but I do not want to sign my life away for the next four years.” Make sure you are doing your due diligence and still researching the facility. Do not just sign up for a facility that is offering the stipend without looking into the work environment first.
I hope that gives you guys something to think about when you are off on your journey looking for jobs. Do not stress about it. It will happen. It is hard as a student because you see your classmates get jobs and you are like, “I do not have a job yet. I am going to be in trouble.” You are going to get a job. The job market is great. It more comes down to what are you looking for. What are the most important things you are looking for? You are looking for a location. Are you looking for money? Are you looking for acuity? Are you looking for independence? Are you looking for your hours?
When I first graduated, I was more about the experience. I wanted a lot of hours. I wanted a place that could give me overtime because I had a lot of student loan debt. I wanted to tackle that. I wanted an opportunity to do 24-hour shifts, which I did. I have two kids. We have a third one on the way here. By the time you hear read this episode, the baby might already be here.
For me, I want my hours. I do not even care about money. My hours are most important to me. It is being home and being present for my family. There is going to be a day and time when my kids do not want to hug me anymore. When that day happens, I will go back, pick up my hours at work, and do things like that. For now, when they want mommy, I want to be around.
Things throughout your career are going to shift. Do not worry about the job you take right after school. It does not have to be your forever job. You do not want to hop around a bunch either because it is going to look bad on your resume if you cannot stay put somewhere. Things happen. Life happens and you have to adapt. You have to adjust to those changes. I hope that lessens the fear and anxiety going into it again. Thank you for reading. It is always a pleasure to be here with you. We will see you in the next episode.
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