Laurel Road Head of Design & Content, Eric Sutton
Dr. Nicolet Finger and Dr. Shiv Vyas
Eric Sutton [00:00:07] Hi, everyone. This is Eric, and you’re listening to Financing Ambition, A Laurel Road podcast. On today’s episode, we’re talking about the financial journey of medical residents and, in particular, the unique financial challenges that they face.
Earlier this season, in Episode 2, we explored the experience of Match Day with two of our doctor members. So, today’s discussion is a follow up focused on exploring what lies ahead for early-career doctors after they’ve matched and are in the thick of their residency training program, which can last anywhere from 3 to 7 years, depending on a doctor’s specialty.
Today’s guests are current medical residents, Dr. Nicolet Finger and Dr. Shiv Vyas, who will share some of the personal financial challenges they face so far and how they manage them. Dr. Finger is a fourth-year medical resident, and Dr. Vyas has just started his program this summer. So, I’m looking forward to hearing the different insights each of you will bring to the conversation, from the beginning to the very near end of residency. Welcome to you both and thanks very much for being here!
Dr. Finger [00:01:25] Thanks for having us.
Dr. Vyas [00:01:27] Yeah, Thank you so much. Appreciate the opportunity.
Eric Sutton [00:01:29] Well, we’re very fortunate to have you. So, let’s get started with a quick introduction for our listeners, if you wouldn’t mind. We’d love to hear where you went to med school, where you’re currently based, and maybe a bit about your residency program.
Dr. Finger [00:01:45] Hi, Eric. It’s great to be here. I am Dr. Nicolet Finger. I am a fourth- year resident physician at UT San Antonio in Texas. I’m specializing in physical medicine and rehabilitation (PM&R). It’s also called the physiatry. Lots of names for the specialty. I went to medical school at UNT Health Science Center in Fort Worth, Texas, and my interests within the PM&R field include inpatient rehab, as well as headache and spasticity management. As sort of a side gig, I’ve built a social media presence under the handle @nicolet.life, and I’ve gained a passion for using my platform to mentor other medical professionals on work-life balance, which includes mental and physical health.
Dr. Vyas [00:02:28] Hey, I’m Dr. Vyas and I am originally from Chicago – actually, a little town right outside about 20 minutes southwest, called Wheaton, Illinois. And from there, I went to Case Western for undergrad. From there, I had a short stint as a banker. And then I went to Cal State up in Sacramento for med school. And now, I’m currently down at the University of Southern California for my anesthesiology residency. So, just starting out in sunny L.A., it’s been a good time so far.
Eric Sutton [00:02:59] Well, thanks to you both. It feels like we know you a little bit better now. And Doctor Vyas, very interesting that you spent some time in the financial industry. Hopefully, that set you up for success. And I hope you’ve had a chance to get settled in and explore L.A. a bit despite all the long hours of residency.
Dr. Vyas [00:03:19] Yeah, I’m trying to take advantage of my days off. And, you know, I wouldn’t say completely settled in, but we’re trying a little bit every day. But there’s just, you know, a lot of onboarding. I feel like every day there’s something new that I didn’t know about that needs to get done. Got to make sure the forms are turned in and everything needs to be kind of good to go to make sure nothing is kind of forgotten or impacts residency.
Eric Sutton [00:03:44] Yeah. So since you’re fresh off your move and you’re just starting your residency and talking about all of the sort of onboarding and stuff, I’ll start with you. How did finances impact your decisions about what residency program you wanted to pursue in the first place?
Dr. Vyas [00:03:59] So, as far as the application fees and program costs, when you start considering residency, the application portal is pretty broad. So, you really want to look at programs individually. And as far as considering which programs I wanted to go to, a few things were very high up on my list. Number one was the city. Cities can vary in how expensive they are, versus what a [residency] program can offer. Some programs have a lot of stipends and funds and things like that that can really help you out. And I wanted to take advantage of hopefully a good medium of being in a city that’s fun, but also have the financial support of a lot of those funds and stipends from a residency program.
Eric Sutton [00:04:48] Yup, that makes a lot of sense. So, multiple factors playing a role in that decision for you. Dr. Finger, what about for you?
Dr. Finger [00:04:56] So for me, application fees were what got pretty expensive. The more programs that you apply to, the more your application costs. So, this definitely made me more aware of how many programs I was applying to and which programs I was truly interested in. PM&R is a very competitive specialty and getting more competitive every year. So, when I applied there were only about 90 programs nationwide. I applied to about 40 programs and this left me with almost a $2,000 application bill. But, I made the decision that it was important to me to match, and so it was worth it.
When you start residency, you do have to get your physician-in-training medical license and you have to renew your CPR training, which ends up costing a few hundred dollars altogether. Some programs will help you cover these fees, but others will leave it up to you.
A couple other things: Away rotations and interviews can rack up the costs of your fourth year. I did a total of four away rotations and that really added up. All of mine were in-state though, so I was able to drive, I got rid of my apartment, got rid of most of my things, and stayed in short-term rentals. During this time, when I was interviewing for residency, all interviews were in person, so that meant a plane ticket and a hotel for every interview. But luckily, I think most interviews have now moved to virtual, which helps a ton from a financial perspective. And then, of course, relocation costs will largely depend on how much stuff you have and how far you’re moving.
Eric Sutton [00:06:32] I see. So, some similar financial considerations for you and then some very different ones, which is interesting. So, Dr. Finger, since you’re now at the end of your program, when you look back to the start, was there anything financial that you wish you would have done differently at the beginning?
Dr. Finger [00:06:50] Hindsight is 2020, but looking back, I did not need to apply to that many programs. I probably would have applied to 20 or 25 programs if I could go back, which would have cut my application cost in half. I would have also asked when I interviewed at residency programs, what kind of financial support they provide their residents, especially in this transition. Specifically, do they provide stipends for CPR training, buying books, going to conferences? Most residency programs do. And I wouldn’t necessarily choose your residency program based on this because you really want to focus on your quality of training. But it is good to know going into that time between medical school and residency, so that you can prepare and save up for these costs. So, once you match, ask yourself: What costs will I have when I start residency? Add up these costs and just make a plan for how you’re going to cover them.
Eric Sutton [00:07:48] Okay. Very helpful insights for any listeners who are starting a residency program for sure. Doctor Vyas, before you started your residency, did you get any helpful tips from anywhere, especially money-related tips from doctors who had been through it already?
Dr. Vyas [00:08:02] Yeah, and it was a lot of what Nicolet had echoed. You definitely don’t want to base your training on what kind of little nuances programs can offer, but you definitely want to consider the big picture. And there are a lot of educational allowances, stipends, and funds that universities cover. Fortunately for me, I have things like a food allowance where I get $60 a day. We have an educational allowance that covers that position and training license. And there’s more. There’s a housing stipend. It gets taxed. So, it’s a little bit less than what is offered when you get it, but it’s still better than nothing.
So, knowing your knowing your contract and what is offered as far as how to get the insurance plan and ready to go through all the options, because when you do have that phone call with benefits, there’s a lot of different options. You really want to know what’s going to be taken out of your paycheck and what you can receive back if there is any difference, as well as if you’re dealing with student loans and going down that path of understanding the grace periods, understand the payback options, deferment, refinancing, because you really don’t want to say, well, this in between that time of graduation to starting residency, that that window goes by a lot faster than you would think.
Eric Sutton [00:09:23] Very important things to get clarity on. And I’m glad you brought up student loans, Dr. Vyas. That’s a topic we’ve been discussing in depth on this season of Financing Ambition, between the federal student loan payment and interest pause, which is coming to an end this Fall, and potential changes to IDR – income-driven repayment plans – and Public Service Loan Forgiveness that could make even more borrowers eligible. So, I’m curious, how much did each of you know about these programs before you started your residency and how did you learn what you know? Dr. Finger, let’s start with you.
Dr. Finger [00:10:00] I actually started studying up on student loans and personal finance when my husband matched to residency. He was one year ahead of me in med school. So, he went through all of this before I did. So, I kind of got to get a taste early. We knew he would have to start paying back his student loans, and we both wanted to be financially literate and set us up for success. So, you know, honestly, we used a ton of free resources. We used things like White Coat Investor, Laurel Road’s videos on their website, and just searching random videos on YouTube to answer specific questions that we had.
My husband and I ultimately decided that our plan would be to refinance as soon as that was reasonable. Of course, with the student loan payment pause, we’ve pushed that off, but we have continued to make sort of “pretend payments,” you could say, into a separate high yield savings account while we wait to refinance. We didn’t want to get out of the habit of putting this money aside and living without it. We will not be going for PSLF, so we want to get the lowest rate we can on our student loans and then pay them back as fast as possible. So, we’ve actually been looking into refinancing with Laurel Road, actually, and we’ll probably make this move within the next month.
Eric Sutton [00:11:22] Okay. So, you started with some inroads with your husband and found some resources online and then made some really smart decisions about your finances and preparing for that student loan burden. So that’s really interesting and commendable. And what about you, Dr. Vyas?
Dr. Vyas [00:11:41] Yeah. So, I think my situation is a little bit different. Fortunately, having my stint as a banker definitely helped take that burden of medical school off, which I’m very fortunate for. But I definitely picked up a few things along the way of financial literacy and learning how to not only budget but make your money work for you. And speaking with upperclassmen as well as family in medicine, you hear about programs that are going on and what opportunities you can take to help reduce the burden of student loans. And I have a few federal loans myself from undergrad, so I had a consultation with Laurel Road, actually. And when I talked to the GradFin team and going through the loan specialists, I found out about the PSLF program as well. And I had heard about it before, but getting educated on it and understanding what it was more definitely helped make a decision for myself and which way I want to go forward.
Eric Sutton [00:12:37] Cool. That’s great to hear that you both took really proactive approaches and you were thinking about student loans well ahead of time. Dr. Vyas, I’m glad you were able to set up that consultation and get that expert guidance. That’s a really smart approach, in my opinion. You know, student loans are obviously one of the most stressful aspects of personal finance that we hear about from our doctor members and residents. Given that the average med school graduate owes $251,000 in student loan debt, whereas the average resident salary is much lower than that at around $65,000 per year.
So we’ll talk more about student loans and how they factor into a resident’s budget in just a minute. But first, I want to talk more about another financial challenge faced by early career doctors that you both touched on a bit, which is relocation. Moving is always a major hassle for anyone, but many doctors have to move to new cities or states, even often across the country, far away from their homes and their historical support systems in order to pursue their careers. So, I’d love to talk about your individual moving experiences and if you’re comfortable sharing – your moving costs – so that you know, our listeners that are currently in med school could get a realistic idea of what’s ahead. So, Dr. Vyas, since you’re fresh off your move again, let’s go to you first.
Dr. Vyas [00:14:08] Yeah. So, as I mentioned earlier, there are some residency programs that offer a moving stipend then that will help you get from one place to another, pay for movers and getting your furniture all over. Unfortunately, I didn’t have that, but I my move was pretty straightforward. Going from Sacramento to Los Angeles. So I was able to pack up the U-Haul and kind of just drive down at six hours straight shot south, Did I want to drive the U-Haul and do all that and pack it up? Not necessarily, but it was definitely the most economical and, thankfully, I had some of the best friends in the world because I was going to pay for movers and have them load up my furniture and things like that. But they actually. So I’m really grateful for my friends that helped me. But finding a living situation was definitely the most difficult. The moving is just kind of a burden. I think everyone has to deal with that at one point or another. Finding a living situation is definitely difficult. I wanted to live alone originally a one bedroom, one bathroom apartment. But in L.A., once you add up the costs of parking, utilities and rent, I was looking at somewhere in the neighborhood of $3,000 to $3,200 for a one bedroom, one bath. And that would have been almost all my paycheck, especially after you deduct the retirement accounts and other expenses going out.
I got pretty fortunate where I ran into a classmate of mine. She was actually an internal medicine resident at the University of Southern California, and she’s a year above me and actually invited me to live in the house that she is in because a bedroom opens up and it’s been great so far. It’s a third of the rent and it’s been awesome. And I’ve been making new friends, obviously, with the rest of the housemates and just knowing people around the hospital, obviously seeing familiar faces from the house to the hospital. And so it’s been a really good time.
Eric Sutton [00:16:06] Okay. So multiple moves from Illinois to California, Sacramento, and then another move to L.A. And then, you know, you were flexible in trying to figure out the right living situation to work with your budget. So that’s some that’s interesting. Dr. Finger, did you face similar challenges with multiple moves and multiple housing scenarios, or what was it like for you?
Dr. Finger [00:16:33] So I was lucky in that my residency program had my intern year connected, which for those of you who don’t know certain specialties like PM&R or opthamology or radiology, you have to do a separate intern year. So I was super lucky that I didn’t have to move between my intern year and my second year of residency, which is a huge factor in why I ranked my program number one. So, I used to work for a commercial apartment company, and after seeing how things run behind the scenes at those places, I much prefer private rentals. You can find private rentals online for sale by owner on a ton of different websites. And you can also ask residents at the program that you’re going to if they know of any rentals.
So, perks of renting from a private owner are that you can sometimes negotiate your rent or your cost for utilities, and you usually have much quicker access to your landlord if anything goes wrong or you need repairs. The downside is the upfront cost. So, for example, I’m in San Antonio, Texas. My rent when I moved here was $900 a month, so in the long run – saved me a ton of money. Very cheap. But upfront, my private landlord wanted first month, last month, and a security deposit equal to my month’s rent. So that’s $2,700 upfront that I had to pay. Right. So even though long run saved me a ton of money, I had to have that big chunk at the beginning. Other than that, the move itself, I, like to Dr. Bias rented a U-Haul, cost me about $500 and a couple of days and lots of favors from friends, but ultimately was able to kind of get by with $500 and a drive.
Kind of one last cost that I don’t think is talked about a ton is relationships – long distance and residency. There’s a lot of us that do that to programs separate from our significant other. I was one included, and thankfully that long distance is over now, but my husband and I were long distance for three years. My last year of med school and my first two years of residency. We spent a ton of time and money driving to see each other and looking back we were really lucky to even be within driving distance. But that drive still cost us about $50 per trip in gas and we made this drive almost every weekend. So that comes out to about $2,500 per year just on gas. Not to mention paying two rents. So, these are just kind of all things I think you should think about going into residency when planning your budget and planning for that start time, you know, those big upfront costs.
Eric Sutton [00:19:26] Yeah, the long distance relationship aspect, I hadn’t thought of that. It’s already such a challenge. But from an emotional cost perspective, like you mentioned, and then having to factor in also the actual financial travel cost to see each other. And that’s just got to be tough to manage. So, you really must have kept close tabs on your budget, as you said, to be able to afford that. What did you learn about budgeting during your residency and now that you’re at the end of your program, what advice would you give at newer residents about budgeting? Any do’s or don’ts or anything?
Dr. Finger [00:19:59] Absolutely. I think it’s important to manage our expectations for what we can afford in residency. I do not want to be one to promote a scarcity mindset, but with the delayed gratification that we’ve all been promising ourselves, it’s important to be realistic about our budget and residency, and in order to both stick with a financial plan while also having some fun, a budget is going to get you there.
So, personally, I like to use the pay yourself first model. It’s actually a business model, but I apply it to myself. And basically, you pay yourself first by portioning out your paycheck into your savings goals before you do anything else with the remainder of your paycheck. So instead of saving whatever is left over at the end of the month – whatever, you know, pennies you haven’t spent – you’re now prioritizing saving first, and then you’re able to use the rest on whatever you want. So, a good example of this is the 50/30/20 budgeting method. 50% of your paycheck could go to your needs, 30% to your wants, 20% to your savings. Your needs would be things like housing, car, health care, utilities, those sorts of things, including your monthly debt payments. And your savings would be for things like an emergency fund, retirement accounts, and investments. And of course, your wants are pretty self-explanatory. One thing that my husband and I put into our budget from the very start was our student loan payments. And as I mentioned before, even with the pause in effect, we never wanted to get used to having that money as disposable income. And so we always set that aside. Budgeting is just a habit.
Eric Sutton [00:21:53] Alright. All very excellent points. And the 50/30/20 method of budgeting is very popular indeed. In fact, we’ve got some resources on laurelroad.com to learn more about that budgeting method. Dr. Viyas, as you move into your first weeks of residency, what are you learning about budgeting so far?
Dr. Vyas [00:22:14] Again, I really do like the 50/30/20 method. It’s something that when I was in finance, it was definitely preached pretty strongly. And as the paychecks start coming in and as the hours increase throughout the week, I’m kind of realizing that one, I definitely preach paying yourself and taking care of yourself first as far as the financial goals are. So, I maxed out my retirement accounts and things like that. I can’t say that everyone in my resident cohort or others may agree with that. We haven’t had an extensive conversation or anything like that, but. It does take a lot out of your paycheck, obviously, when you do that. But that long term goal, we talk about that delayed gratification. I think it’s very important for myself. So, understanding your goals and where you are willing to skip costs or where you’re willing to spend less, I think is important. What I’ve learned and for me, I’m pretty fortunate because I can cut costs on food pretty easily because I have three meals at the hospital a day and we have an allowance for that. So it kind of plays into my hand that I can afford to move some money around and have that freedom. I’m not paying for food all the time, but more so as things come up – being flexible and having the opportunity to see what kind of little things may pop up that I can address. And just being very true to the goals that I want, like I said, of retirement and having a nest egg, that if things pop up an emergency fund, that that’s kind of where I’m starting off. Obviously being just a few weeks in, I’m sure that will change down the road. But, just I’m trying to monitor my ins and outs as best as I can.
Eric Sutton [00:23:58] Yeah, the balance I think is really important. I think it also impacts, you know, your work-life sort of balance. And I think that’s really important from what we understand during residency to avoid burnout with all the long hours of work ahead. And it’s in fact, it’s an idea we explored in a recent award-winning series, I’m happy to say, which is called I’m Also a Doctor, which was all about cultivating interest outside of medicine and how that can actually help you recharge and show up better for your patients and ultimately be a better doctor. And, of course, there are financial impacts to consider there. But if you’re interested in hearing that, you can find that on laurelroad.com as well. So. All right, Dr. Finger, and the topic of work life balance for doctors is something that you’re particularly passionate about. So what are your tips for managing all those long hours of residency and avoiding that burnout that we hear about?
Dr. Finger [00:24:57] So, of course, everyone’s residency experience is going to be different depending on your specialty and your program and your social support. I want to start off by saying I’m really lucky to be training at a residency program that prioritizes wellness and, you know, not just wellness lectures and lectures on how important sleep is, but we actually have a really positive culture surrounding work and learning. But not everyone is that fortunate, right? So, we have to think for ourselves, what can we control when we are fulfilled in our own lives? We’re well rested, nourished, we’re better physicians for our patients. So, first you have to take care of your necessities similar to this setting your budget, right? That’s the first thing I know. We all hear this so much, but it’s true. You have to prioritize quality, sleep, nutrition and exercise. I would argue that sleep and nutrition should take priority over formal exercise because you don’t always have the time, but you can, despite what people think, control your sleep and your nutrition. And if you don’t have time to formally exercise, make some changes like taking the stairs instead of the elevator at work, keep good sleep hygiene. So put the phone away when it’s time for bed and make nutrition simple. If you don’t have time to meal prep, you know you can eat at the hospital, like Dr. Vyas was talking about. Or, let’s say you don’t have that option or you don’t like the food and you’ve still got a low budget for food – buy a rotisserie chicken, some frozen veggies, frozen grains, right? That you can heat up at work.
Maybe you have a higher budget, You can sign up for a meal delivery service. Right. These are things that you just have to kind of decide what fits in your budget. And then and then we move on to your wants, which is really important in burnout. So, what is most important to you besides your career? Is it family? Is it experiences and travel? Right. What is it? Because this is what you need to weave into your time outside of work. We cannot always control how much we work, especially in residency, but we can control what we do with those hours outside of work. This is where keeping a calendar comes into play, right? Even if you’re planning three months in advance – plan it. Even if it’s infrequent, there is always some amount of time that you’re in control of. And this is where that budgeting comes into play. That savings goal for your wants. That’s where all of this fits in. You only have so much money. Math is math. You can’t change how much money you’re making in residency. So you have to decide, do you want designer clothes in your wants? Do you want travel? Right. Either is fine, honestly, but your budget will only allow you so much. So think about those things, right? Ask yourself what fulfills you? What recharges you outside of work? What’s your favorite way to de-stress? These are the things you need to be prioritizing along with your necessities.
Eric Sutton [00:28:03] That’s a lot of great points you made there and a lot of really solid advice. Thank you for that. Doctor Vyas, over to you. Anything else you’ve seen so far that you think might help our listeners balance time and stress from the start of residency and how finances might factor into that?
Dr. Vyas [00:28:21] Yeah, I completely agree with the biggest point that Nicolet made is that you really have to prioritize your sleep in the hours outside of work. But from that, you have to find what really keeps you going. And like we said, we talked about budgeting, we talked about balance, I really enjoy spending time with my friends and whether that’s going out to dinners or nicer restaurants or X-Y-Z, whatever you want to do. Of course, we talked about the food allowance that I have. I’m able to spend a few more dollars maybe going out with my friends and having that meal or spending that time going to the gym on your day off. So, it is about your wants on your days off. And echoing the sentiments, Nicolet said, Just taking that time, realizing what makes you constantly go because you have to prioritize your sleep. If you’re not well rested, it’s going to be a bad day the next day. But then you want to find out maybe a gym, maybe it’s not the most affordable. You want to go to an equinox or some type of high-level crazy gym, or you can find one that might offer a resident or physician’s or a health care workers discount. So, I think doing some research as well and figuring out what you want to do and where your money can work for you with those discounts or programs and just taking advantage of your time off to really make the most of it, I think is my tip. And whether that means rest or exercise or shopping for those designer clothes. Either one is fine.
Eric Sutton [00:29:54] So it sounds like you’re strategizing already around how to manage your stress levels, which is really good that will serve you well. So, thank you both for those really great pointers. I’m afraid we are nearing the end of our time together today, but you’ve shared some really valuable information, some helpful tips for residents listening today.
So, I’d like to close out today’s discussion, if I may, with one quick piece of advice from each of you for new and future residents. And that is, after you’ve matched to a residency program, what are the super high level, top three money related things you would do? Dr. Finger, why don’t you go first and then you can chime in with yours, Dr. Vyas.
Dr. Finger [00:30:39] Of course. So number one, start consuming information on personal finances and student loans. This does not have to be high stress. It can be passive learning, like listening to this podcast. There are plenty of free resources out there. Number two, write out your necessities and prioritize your wants so that you have a very clear picture of how you will frame your budget around these things. And number three, plan ahead and keep a calendar so that you can take advantage of the time that is in your control while you’re planning within your budget.
Dr. Vyas [00:31:17] For me, I think number one is really just paying attention, and that’s knowing your contract, knowing what allowances, stipends, what’s given to you, and as I’ve mentioned earlier, tracking what your costs are and what’s coming in, what’s going out that way, you really understand how you can maximize what you’re getting as far as the income and what’s coming into you. And you don’t have to double dip. Maybe you don’t have to spend money on something that would have been covered for you. Number two is we all have our financial goals and it’s important that you know what yours is. That way you can set up and appropriately pace yourself for your goal, but be flexible because you don’t know what’s going to pop up. You don’t know what obstacles may come along at the end of your first year or your last year, or even when you’re in fellowship or as an attending. So, it’s important that you consistently work towards your financial goals, but it’s not the end all, be all, and it’s not a black and white hard line in the sand. So, keep that in mind. And I think three – we mentioned that window from Match Day or graduation to the start a residency. It moves so fast. I mean, that that timeline of finding a place, getting the U-Haul or moving, getting settled in the onboarding orientation, a move so fast that taking the time to talk to student loan specialists know your options. I think it’s worth knowing what your options are and maybe talking the time to talk to someone at Laurel Road to get educated on your student loan options.
Eric Sutton [00:32:55] Awesome. I could not agree more with both of you. Thank you very much to both of you. You’ve provided really great advice today and truly helpful perspective, I think, for our listeners who are residents or who are about to start their residency journeys. So, a big thanks to you both.
And thank you all for listening. Stay tuned for the next episode of Financing Ambition and for more information and financial resources for residents. Follow Laurel Road on Facebook, Instagram and LinkedIn and visit us online at laurelroad.com/doctors.
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This podcast is produced for information purposes only and is not an offer or solicitation of any product. Any views, opinions, findings and conclusions expressed in this podcast are solely those of the participants and do not necessarily reflect the views of Laurel Road or its affiliates. Laurel Road, KeyBank and its affiliates are not providing any financial, economic, legal, accounting or tax advice or recommendations in this podcast. The information contained in this recording may not be current, and Laurel Road has no obligation to provide any updates or changes. Neither Laurel Road nor any of its affiliates makes any representation or warranty, of any kind, as to the accuracy or completeness of the information in this podcast and expressly disclaims any and all liabilities around such.
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