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How Physicians Can Become Better Negotiators

“It’s very easy for all of us to say, I’m not a good ‘blank.’ We tell girls, “Don’t say I am not good at math. Maybe you haven’t been good at math, but you can become good at math.”  Same thing I would say to physicians. Maybe you haven’t been good at negotiating, but you can become good at it. And it’s a skill set that no one is born with. And everybody can come to the table with good negotiation skills, even when the other party does not have them.”

Dr. Sue Padernacht

The concept of negotiation can often make physicians uncomfortable, but negotiating is often necessary when it comes to self-advocacy and self-care. When we don’t ask for what we want or back down too easily, it can lead to burnout. No one is born a great negotiator, which means these skills can be learned and you can become stronger over time. Dr. Padernacht speaks in depth about the components of good negotiation so you can incorporate them into your life. Jill and Dr. Padernacht also discuss her five-step framework for becoming a better negotiator in both your professional and personal life.

Dr. Sue Padernacht is the CEO and founder of Ncline Leadership Strategies. She brings over 35 years of experience and expertise in leadership and negotiation, coaching, training, and facilitation to multiple levels of physicians in various medical specialties, from frontline positions to chief medical officers. Dr. Padernacht holds a Doctor of Education from the University of Southern California in organizational change and her doctorate focused on physician burnout during the COVID-19 pandemic. She’s also an award-winning adjunct professor at the University of California, Irvine School of Business, and has taught dozens of leadership and negotiation courses to physicians returning to school, earning their MBAs.

Dr. Padernacht’s passion for negotiation began in the 1980s in New York City when the banking industry became deregulated. She was early in her career and needed to learn quickly how to help bankers learn to negotiate. During the 1990s, Dr. Padernacht worked at the L.A. Times where she was tasked with teaching negotiations to the sales organization. In the 2000s, UC Irvine retained her as a member of the faculty, where she taught a course in negotiations. Her students included both health care executive MBAs and MD MBAs and she’s gotten a lot of joy from teaching negotiations to and coaching the physician population.

What’s Inside:

  • How a failure to negotiate for what you want and need leads to burnout.
  • Dr. Padernacht’s five-step framework for becoming a better negotiator.
  • How to formulate a Plan B for when negotiations don’t go your way.

Mentioned In This Episode:

DocWorking.com
Ncline Leadership Strategies
Dr. Sue Padernacht on LinkedIn
The Earned Life by Marshall Goldsmith

 

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Please enjoy the full transcript below

 

Dr. Padernacht: It’s very easy for all of us to say, I’m not a good ‘blank’. We tell girls, don’t say I am not good at math. Maybe you haven’t been good at math, but you can become good at math. Same thing I would say to physicians maybe you haven’t been good at negotiating, but you can become good at it. And it’s a skill set that no one is born with as we opened with. And everybody can come to the table with good negotiation skills, even when the other party does not have it. 

Jill: Hello and welcome to DocWorking: The Whole Physician Podcast. I’m Jill Farmer, a co-host of the podcast and lead coach at DocWorking. And we are really glad you’re here. As always, DocWorking’s Podcast is brought to you by Doc Working THRIVE. Go to DocWorking.com today and take our burnout quiz to find out where you are on the burnout to balanced continuum and learn how we can support you to have a life and practice that thrives. You guys are in for a treat today. We are going to have a great conversation so you can learn how to become a better negotiator. And to join us on that is an expert on negotiation. Dr. Sue Padernacht is the CEO and founder of Ncline Leadership Strategies. She brings over 35 years of experience and expertise in leadership and negotiation, coaching, training and facilitation to multiple levels of physicians in various medical specialties, from frontline positions to chief medical officers. Dr. Sue holds a Doctor of Education from the University of Southern California in organizational change and leadership and research for her doctorate focused on physician burnout in the COVID 19 pandemic. She is an excellence in teaching, award winning adjunct professor at the University of California, Irvine School of Business, and has taught dozens of leadership and negotiation courses to physicians returning to school, earning their MBAs. Dr. Sue, thanks so much for being with us here today. 

Dr. Padernacht: It’s wonderful to be here, Jill. Thank you for having me. 

Jill: When it comes to your background, start us with where you came to this work of recognizing that negotiation is an important skill for physicians to learn. What brought you to being able to support physicians in this way? 

Dr. Padernacht: Sure. Well, actually, it starts going all the way back to the 1980s in New York City when the banking industry became deregulated. I was early career and needed to learn quickly how to help bankers go from people begging them for loans to having to sell and negotiate. So angry New York bankers was where I cut my teeth on teaching negotiation and doing negotiations coaching. Fast forward to the 1990s where I worked at the L.A. Times. So there’s our journalism connection, and I had to do something very similar with the sales organization with all of the alternative options to advertising. I needed to teach negotiations to that large population. Fast forward to the 2000s, when UC Irvine retained me as a member of the faculty. One of the courses they asked me to teach was in negotiations. So I’ve had both health care executive MBAs, so those are people who are mid-career going back to their MBAs and M.D. MBAs, who are medical students who are also at the same time getting their MBAs. So since 2005, I have been teaching negotiations there. I also taught at Loyola Marymount. So I have had extensive experience working with physicians and kind of overcoming the kind of self-identity of gee, being a negotiator is not aligned with my self-identity and self-value. So I’ve gotten a lot of joy in doing negotiations, education, coaching and teaching with the physician population.

Jill: I love it. And you and I have talked before about this idea that often for physicians, the idea of negotiation makes them uncomfortable, right? For a variety of reasons. I hear a lot of times in my practice, things like, well, if I’m doing a really great job, why can’t I just be given, you know, the salary that I deserve and not have to do this? And I, like you, really help us see that self-advocacy that comes from negotiation is really part of self-care, which is really important in any career, but especially for physicians when it comes to sustaining that career for the long term. Can you talk a little bit more about that? 

Dr. Padernacht: Yeah, I mean, think about it. When we walk away from any engagement with somebody else and the more we don’t get what we want, especially when our self-identity is aligned with having had a great deal of control over our lives and career, and we are healers and treaters of others, so it gives us a sense of self efficacy and control over things. We have a lot of regret. So there’s the blame shame thing, right? We blame others and we feel like victims, whether people feel like they’re victimizing or not. And shame, right? I should have said that we all think afterwards what we could have, should have done better. That regret, Jill, is a huge source of burnout. It’s a victim thing from the environment. And it’s also I could have, should, would have done better. So I really encourage physicians to reframe thinking about negotiation as self-advocacy and self-care, as we said. But and to stop conjuring up the negative stereotypes of the used car salesmen and the Wolf of Wall Street, right. Or the people who are overly accommodating and being nice and giving in a lot, hoping others will return it in kind. Because I’m such a good role model. So those are fight-flight type of positional bargaining approaches as those are really what we mean when we say negotiation. 

Jill: I love it. So, so many good things there. One, I think that is important to say, because I know you and I have spoken about this before. Nobody really is born being a great negotiator. There’s this mythology out there that there’s people who are good negotiators and people who are bad negotiators, and that it’s some type of a fixed way of being in the world. And I love what you shout from the rooftops, not only to your MBA students, but in your coaching practice as well. This is a skill that can be learned. And I also love what you just said, that we can if we’re not aware and we haven’t learned the skills we can believe to kind of default mechanisms when it comes to negotiating, one is that it’s all about crushing the opponent, right? Whatever version that is or the other one is that if you’ll be nice to the other person and then they’ll be nice to you and everybody’s just nice and nothing has to get uncomfortable and you don’t have to ask for what you want. And really, both of those are kind of dead-end ways to be when it comes to negotiating. Am I hearing you right?

Dr. Padernacht: As Peter Drucker, the great management theorist, once said, hope is not a strategy. And so you allude to what we call in the behavioral sciences the difference between state and trait, right? So is this a skill that I can acquire or is this how I am wired? So I would just welcome physicians to think of the time when they were in medical school. They weren’t doctors then, right? But they became doctors with lots and lots of lots of training. And the good news is you don’t have to work as hard to become a good negotiator as you did to become a physician. It is a set of learned skills and everybody learns that. And there are some aspects of both. There’s an art and a science to it. There’s the human element of inter and intra personal skills, and there’s also a science to it, which is the analytical problem solving and decision-making elements of it. So it’s both in and all of those are things that physicians can learn and are already good at. 

Jill: Right. It’s just a matter of having a little bit often and just a little bit of framework, a little bit more understanding about what the components are of a good negotiation so that you can work through those. Speaking of which, you have really, you beautifully teach, I think, a framework that even for somebody who is new to the ideas of being a strong negotiator, there’s just a lot of easy ways for them to step into being a better negotiator by learning these five steps that you helped us lay it out. And so I want to go through those now with you just to help give the folks listening an idea of ways that starting even tomorrow, if they want to start practicing this in different aspects of their life, they could end up entering into relationships where negotiation is necessary and having more successful outcomes win-win outcomes, which is, I think, what a lot of us are trying to do when we’re in negotiations. So the first step that you lay out for us is emotional composure. What do you mean by that? 

Dr. Padernacht: Yeah, actually, let me take a step back for a second. I want to tell a quick story of the orange, which is a classic negotiation story that highlights some critical principles in negotiation. So imagine two children fighting over one orange one afternoon and a parent comes home seeing this. What do you think that parent typically does? Parenthetical question, typically that parent’s going to split it in half and each child walks away all dog face and mopey because they only got half of what they wanted. Each wanted the whole orange. That is a position, I want the whole orange. Second parent comes home and asks, Why did you want the orange so badly? And that child said, Well, I’m in gymnastics finals and can only eat healthy foods. And that was the only fruit at home and I was hungry. Why did the other child want it so badly? Because the other child wanted the outside peel to bake an orange cake for Grandma’s birthday to make her happy over the weekend. So when we look at the motivations, the things that we seek, right, love, recognition, appreciation and the things that we want to avoid pain, embarrassment, shame, bad luck, those kinds of things. Those are what we call our interests. And so had the first parents just ask so why do you want the orange so badly? They would have gone from that positional bargaining. You could. The best you can get is 51, 49, right? Or a 50-50 split, right? But have they found out why? The concept is if you if you understand what interests are, you can get, not what, you’ve heard this expression, not what you want, but what you need. I think that’s a Rolling Stones song, right? So why am I telling you the story? Because now let’s start to dig into the five steps. If we understand that negotiation is it’s a communication process to reach an agreement. When some of our interests are shared. Right, we both have strong needs that aren’t, but some are opposed. You know, we can make the best decisions based on those interests, right? Not just anyone. And by the way, getting away from the orange story for a quick second. Sometimes the best outcome is no agreement, but that interpersonal decision-making process is needed when we can get what we want on our own. So in other words, if I could get what I wanted by myself, I wouldn’t need to negotiate with you. So there is some level of interdependence. Even if, Jill, I was applying to work for you as an administrative assistant, as an example, right. You’re still dependent on me or the candidates to fill that role. So even though there’s a power differential, which we’ll talk about and it’s felt, it actually isn’t, you know, zero and 100. Right? Right. You know, it’s actually a little bit more balanced than candidates even think. So that’s why it’s important to reframe negotiations as self-advocacy, as self-care and self-expression so that people can be their authentic selves and not that used car salesman Wolf of Wall Street you know image that they have. So emotional composure, you and I talked about that as part of stress management and as part of emotional intelligence. So when anybody perceives a threat in the environment, a threat to their well-being, to their status, to their needs, to their sense of control, it’s going to trigger an emotional reaction, whether that is anger or sadness or fear, whichever it was, it’s usually fearing a negative emotion, right? Not a positive one. So I’m going to defer to the physicians to, you know, to take it from here. But that’s what we call amygdala override, right? The part of the brain that is the center of emotions.

Jill: I like to call it amygdala hijack. It’s just such a good visual, like oh wait, the emotional center that’s giving me danger and alert signals has taken over and it’s trying to drive the bus, even though it has no really higher thinking capabilities. 

Dr. Padernacht: Yes. And the trick to amygdala hijack is it tricks us into thinking that we’re being rational. Right. Who has not sent that angry email and regretted it the next day as an example or reacted impulsively in the moment and was sorry for it later. We’ve all done that. That’s human. So emotional composure is self-awareness, right? So knowing what our triggers are like, you just found out that you’ve got a schedule exactly at the time when your kid is performing in band. Right. Exactly. And you had asked for that, you know, that time off or to be scheduled at an alternative time. Right. That is going to trigger, you know, because it’s not just I was dismissed, but now my kid is going to be disappointed. Doesn’t mean dial it to zero, but, you know, dial it down from, say, a ten to maybe a four or five, you know, as you can see, because that four or five is going to, you know, give you the strength to stand up for yourself, which is what we need with that’s the self-advocacy part, but remaining in our rational mind. 

Jill: Yeah, I like that a lot because it’s not that having that, you know, sometimes physicians beat themselves up for having what are human emotions, right? As humans we are going to have emotions. It’s getting what Susan David, the author and researcher from Harvard, calls emotional agility, which is that ability to have the emotion, process, the emotion and, you know, the emotion of frustration or anger often is about boundaries being needed. And so in this case, in the in the example you gave us, which was an excellent one, the boundary that was crossed was schedule. You know, the physician was told that they could have some control over the schedule by telling and when they were able to work and not work, and that boundary was crossed. And so I think that’s just a good example of the frustration is not in of itself evil, it’s process and the emotion to a level where the frustration doesn’t self-sabotage you. And that’s beautifully said. Let’s talk about another step for successful negotiations, which is know what you want. And I think this goes back to the interest part of things that you gave us to such a rich story in the orange story to think about. So talk more about that. 

Dr. Padernacht: Yes. Thank you. And I told the orange story at that point, so now everybody knows what a position and what an interest is. So, you know, when you’re analyzing your positions, you know, you need to know what your issues are. So your issue is your schedules. And but that position is every time my kid performs band is the most that you want. And maybe that’s monthly on Thursday afternoons, but you may have a range, Jill. You may have a range because you know that you’re not going to get every Thursday afternoon off, but maybe the least you’d be willing to accept is at least once a month, you know, give me a week. I mean, that’s a big range, right? Understanding that there’s a physician that there’s a staffing shortage. Right. So that’s a big give. But I still want to aim for the most as much as possible, and I want to give that. And that’s something called a concession strategy, right? So you want to give what’s of most value to the other side and of least value to you, you know, so you know what? If you give me four, I am happy to work on Sundays which a lot of physicians don’t, right as an example because my kids and band anyway you know that’s practice day so that’s good for me. All right. So they may pursue that as a be a good compromise and it might not be as much at all. So let me just advise your audience. Please develop a range for yourself. That’s part of the analytical part. Please do not reveal your range. Because if I if you say to me, are you willing to work at least, you know, three times a month? I might say sure, but I. I’d rather do it once a month. You’re going to go. Okay. Well, you know, you said three, so I’ll take three. Yeah. So whenever we reveal a range, we were revealing the least we’d be willing to accept. So you always want to open and start and inch away from the most that you think is. And it’s, of course, reasonable. Contrary to that, though, you want to ask them for what their range is because a lot of people don’t know these negotiation principles. So you want to kind of see that. Underneath that you want to really understand what your own interests are for all of the different positions. Right? So what are you seeking motivationally and what are you avoiding motivationally? So clearly, I’m seeking to be a presence in my children’s lives sense and avoiding, you know, being an absentee parent. Right. That’s powerful and that is fueling the emotion. So I want to channel that into analyzing it and self-advocating using a problem solving approach. 

Jill: Okay. So we’ve talked about emotional composure, knowing what you want, going into it, and then a third step that you recommend is stepping into their shoes. What do you mean by that? 

Dr. Padernacht: So it’s important to kind of flip the binoculars, so to speak, and see things from the other party’s point of view, because otherwise we’re going, you know, I’m going to remain steeped in and you’re going to remain steeped in. And, you know, we’re not going to be able to bridge and problem solve this. So even when we disagree, even with getting ourselves out of feeling appalled is going to be critical, right?  And we may never agree with their point of view, but think of it as gathering data. You gather it just like you would gather data to diagnose a disease state. Right? You’re gathering data about what this person’s positions and interests are. And the more you can find out their interests. Well, of course, they want patient coverage. And of course, they’re trying to be concerned so that the nurses aren’t double, triple, you know, scheduled. Right. I mean, I’m concerned about that as a physician, too, right, we’re on the same. So as much as we can find where we’re on the same side, even if it’s 5%. That also builds trust. And the more that we can build trust and try to see things from each other’s point of view, it helps. Now, I would also caution the physicians listening to this that just because you’re doing it, don’t count on the other person to witness, right? Otherwise, you’ll be disappointed. 

Jill: Right. Right. Yes. Just because you’re doing a good job of looking at where the Venn diagrams cross, that doesn’t some people are more interested in their own position only and not thinking in those terms. However, I always think, you know, I think in any conversation we have the ability to lead up. And so by by modeling that connection in this third step of looking at things through the other person’s perspective, stepping into their shoes, as you said, flipping the binoculars, it’s just it’s a very good human way for us to interact in a meaningful way that is likely to have more values-based outcomes, in my experience. So let’s talk about the fourth step, which is where you call it the bridge, right? Bridging from where we are. You know, we’ve come into this as calm as we can be. We’re clear on what we want. We have thought about it from their perspective and tried to find a place where there’s some crossover. And we have shared thoughts, feelings and needs. So what do you mean by the bridge? What’s that? What does that encompass? 

Dr. Padernacht: So one is use their language, use their words right as part of kind of summarize. So it looks like, here’s where we are, Jill, and I’m going to use your words, I’m going to use your language. And I can see this is tough for you, too. I see that. I see you’re stressed out, too. Right?  So at the end of the day, when I’m bridging, I’m starting with a concept of, I see you. Like, I have flipped on the binoculars and I see you. I don’t necessarily stand where you stand. I’m not in your shoes, but I see you. And that’s where you want to step to problem solving. So, look, the core issue really is that, you know, that we don’t have enough physicians to cover all of the schedules. You know, here’s what I can offer. Right. I even though I did want, you know, four Thursday afternoons, what if we did three Thursday afternoons and I would take every Sunday, you know, and the one Thursday afternoon I would be working I would be also working with medical students and mentoring them for when the days that I’m out. Right? As an example, you know, as they’re doing their rounds, something like that. Right. So that’s where problem solving and kind of being creative and coming up with different ideas. Now, you might outright reject that. I’m like, I can’t make that work. You might outright reject that. And so the tendency might be to say, well, what do you think about this? Or what do you think about, don’t do that, you know, then I would say then I would say, Well, what? What do you think? What do you suggest? You know, taking you know, taking the issues that I’m bringing to the table out. 

Jill: Right. I love that. 

Dr. Padernacht: And if you stand your ground and you’re not giving an inch. So that that will bring us to the 5th strategy. I’ll stay I’ll get there in a minute. But you may you have to make some choices, right, based on your interest. This might be the best place and your best friends work there. And, you know, you’re my you might say, look, I’m willing to go down to two and but don’t go below your minimum. Right. Right. Stand your ground. Because think of that, that child who you’re disappointing who will at least see you 12 times a year. 

Jill: Right. That’s where we get into an almost a totally different topic. But it’s important, I think, to understand it’s what we’ve heard a lot as it relates to burnout, which is moral injury space, right. Where you feel like you’re being forced to do something that is outside of your values and that is a quick place for you to accelerate burnout. And so I think that’s it’s a really you know, it’s not that I know Dr. Sue or I’m trying to coach people to win or beat somebody. But if you in an attempt to please the other person or just make things work, you’re compromising something that is really important to your value system. There’s going to be consequences to that. 

Dr. Padernacht: That’s exactly right. You know, it’s exactly right. That sense of regret, that blame, shame that Brene Brown talks about and Marshall Goldsmith talks in his new book, The Earned Life, a lot about regret and not the little regrets. Like, I really shouldn’t have had that chocolate ice cream cone or you know, it’s like the large regrets, like disappointing my child at a critical time in their teenage life, right? 

Jill: That’s powerful.

Dr. Padernacht: Yeah. 

Jill: So that leads us to the fifth and final step, at least as part of this conversation today. I know that we could talk about this for hours. You have so much knowledge. It’s so interesting. But that’s having a plan B. What do you mean by that and what does that look like in real life? 

Dr. Padernacht: So your plan B is your best alternative if the negotiation fails to meet at least your minimum thresholds for your positions. Right. So what does that mean? That means if you’re not willing to give an inch and it’s Thursday afternoon included, you know. Or it’s Thursday afternoons. I mean, it’s you know, there’s no threat. It’s just this is what it is. You know, this is the life we live, you know, step up. So my plan B might be okay, well, let me think about this, Sue. There’s a physician shortage globally and it’s only going to get worse. You know, and I have quite a number of years’ experience under my belt. I’m sure I could fill a lot of holes, not just being a practicing physician. I could also fill a management role. I could mentor younger physicians. You know, I could teach. I could be at an academic teaching hospital. There’s lots of roles I could fill, you know, and starting from scratch, bringing my expertise and experience, I could just, you know, include in my in my demands as a candidate. You know, these are the hours, you know, that that I’ll be available. And it’s kind of a non-negotiable to have every Thursday afternoon off. Can you make that work? So it’s a source of power. Now, here’s the thing about plan B. 

Jill: So I just want to reiterate, I mean, I just want to confirm that I understand what you’re what you’re saying here. It’s not we’re not encouraging anybody to threaten, well, I’m going to leave. But mentally, it’s getting people to think through what they really have is options for themselves and other than getting exactly what they want when they walk into the negotiations, because if that’s the only thing you’re willing to accept, that’s going to put a lot of pressure on a situation that you don’t have any control over. Right. That you don’t have total control over? I should say so. 

Dr. Padernacht: That’s right. That’s right. That’s 100% right. So if so having it all thinking that look, I’m not stuck. That’s often right. The source of the stress that’s associated with that it’s this or nothing. And I’m sure that there are life circumstances around the globe where that is the case and there might be positions in situations where that might be the case, too. Most of the time it’s not the case. And, you know, whoever you have as a thought partner, as whether it’s a coach or a spouse or a friend, or if you reflect privately, right, you journal, you run whatever or whatever your way of processing your thoughts are, right? And that would be the time to really think creatively about what? How am I not 100% dependent on, you know, on at least getting my minimum here? So here’s the thing about plan B. Plan B is usually less desirable than getting the minimum in your current situation, right? So by definition, it’s not going to be as desirable. And yet you can start to make it more and more desirable. So I might hate the idea of change. I might be with this organization for 20 years and I may also be interviewing for a smaller organization. Right. It might not be multi hospital. It might be a single hospital. And they’re willing to be flexible with me with regard to scheduling and they’re willing to give me even a little bit more pay. 

Jill: Yeah I love that. So it’s that growth mindset around a situation instead of, well, either this works out the way I want it to, which I not sure that my leader or whoever the other negotiating party is going to deliver that for me, or I’m stuck in the status quo, which isn’t satisfactory to me. And so what plan B gives our brain the truth, which is that we have agency, we have options, and we know that when your brain recognizes where your choices are, it really helps. As a way to combat burnout as well is recognizing option harvesting, looking at choices. And so the plan B part of negotiations I think is important on many fronts. 

Dr. Padernacht: And I love the idea of kind of wrapping this with the growth mindset, right? So that so it’s very easy for all of us to say, I’m not a good ‘blank’. We tell girls, don’t say I am not good at math. Maybe you haven’t been good at math, but you can become good at math. Same thing I would say to physicians maybe you haven’t been good at negotiating, but you can become good at it. And it’s a skill set that no one is born with. As we opened with, and everybody can come to the table with good negotiation skills, even when the other party does not have it. 

Jill: Dr. Sue Padernacht, CEO and founder of Ncline Leadership Strategies, just so much good stuff for us to learn from today. And if you’re a pretty decent negotiator, you’re going to be better by what you learned today. And if you haven’t been a good negotiator in the past, trying even one or two of these different strategies is going to help move you toward life and work that you love, which is where you thrive. How can people get a hold of you Sue if they want more information on what the work you do in the world?

Dr. Padernacht: Sure. My website is www.Ncline leadership dot com. So Ncline is spelled N like in Nancy C L I N E, leadership dot com. Please reach out to me on LinkedIn. I’m pretty active on LinkedIn. And on my website, you can contact me and you can also reach out to me in messaging on my LinkedIn as well.

Jill: That’s great. Everybody can get that website link in our show notes as well to make it nice and easy for you. Thanks so much for this really rich conversation and thanks to all of you for joining in to listen to the conversation. We hope you share it with everybody you know, because this is really valuable information on any particular physician’s road to success. Also, make sure you go to DocWorking.com today to find out all the different ways we can support you in your life and work through coaching, peer support and all the other services we have for you. Until next time, I’m Jill Farmer on DocWorking: The Whole Physician Podcast. 

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