Healthcare

Our team of experienced healthcare recruiters play in this space all day.

Check back often for their insights on the industry, hiring, & what’s to come.


The Key To Success In Rural Health: Positivity

Rural Health, Hospital, Positivity

As a recruiter, I talk to dozens of leaders in rural health every day. One of the things that sets healthcare facilities apart most in a sea of small communities struggling to keep up, is their positive mindset. When I call to learn more about their organization or share a great candidate looking to move to their area, the discussions are different. Their tone and happiness on the other end of the phone are absolutely contagious.

My first experience with the true difference positivity can make was actually in healthcare about 10 years ago. At the time, I was faced with the unthinkable. However, two leaders in childhood cancer taught me that positivity can actually have a significant effect on outcomes. They looked me straight in the face at 8 months pregnant and told me that my two-year-old daughter had a very aggressive form of acute lymphoblastic leukemia. But their next words are ones I’ll never forget: “Stephanie, as long as you stay positive, the outcome will be much more favorable.” So, I put my trust in these doctors with some of the highest success rates in the world. I avoided the statistics and continued to empower a positive mindset. Here I am almost 10 years later with both my girls and I couldn’t be more grateful.

Partnering With Rural Health

This experience completely changed my outlook. Now, I am so excited to come to work every day and have the opportunity to make an impact on the lives of my clients, candidates, and ultimately, their patients. I love connecting with rural health facilities every day and have noticed a direct correlation between how engaging a hospital is over the phone, and how passionate they are about their jobs and local communities. This then makes it easier for me to sell these remote opportunities to the best talent on the market. When I’m able to convey my clients’ positive outlook and happiness at work, candidates can’t wait to work there.

For example, one of the great rural hospitals in Kansas is experiencing tremendous growth. They are beyond delighted about the construction of their new facility and you can even watch a live feed online of their progress. This growth is impressive despite the ongoing struggles that rural healthcare facilities face every day. Moreover, it’s probably due in large part to the entire team’s dedication and passion for their jobs.

The positive mindset in healthcare is real. And it consists of trust, patience, comfort, and kindness. I like to picture myself in one of these rural communities that I recruit for. I imagine their attitude if I lived there when I learned that my daughter was sick. As I prepared for the toughest journey of my life, it would have been the exact reassurance I needed.

If you find that your rural healthcare facility is missing an enthusiastic leader or a passionate team member, contact me and my team! We have the experience to find the talent you need.

healthcare trends

Healthcare Trends to Watch in 2019

healthcare trends

We are officially halfway through the year and the healthcare industry has been scorching with growth. In June 2019 alone, there were 35,000 jobs added to the U.S. healthcare industry. And over the last 12 months, the industry added a staggering 403,000 jobs, making healthcare the largest employer in the country. Now that it’s finally the 3rd quarter of 2019, here are some healthcare trends to watch for in the second half of the year.

Increased healthcare spending

Throughout the last decade, healthcare spending has continued to skyrocket. Between 2013 and 2017, global healthcare spending increased at an annual rate of 2.9 percent. However, over the next four years, global healthcare spending is projected to increase at an annual rate of 5.4 percent between 2018 and 2022, according to Deloitte.

This increase in spending along with shrinking hospital margins are pushing healthcare organizations into mergers and acquisitions. In fact, in 2018, there were 1,182 mergers and acquisitions, up 14.4 percent from 2017. That’s the largest amount of M&A deals in a single year. And in 2019, this trend will not slow down as healthcare organizations continue to consolidate organizations in order to grow with strength.

Rural healthcare continues to struggle

Despite rural communities measuring approximately 62 million Americans, access to healthcare services is becoming increasingly scarce for rural residents. Sadly, more and more rural healthcare facilities continue to close. Since 2010, 107 rural hospitals have closed, according to the University of North Carolina Cecil G. Sheps Center for Health Services Research. And according to a recent report from Navigant, nearly 21 percent of rural hospitals are at high risk of closing.

This is even more troubling when you think about the low physician-to-rural resident ratio. To illustrate, the patient-to-primary care physician ratio in rural areas is only 39.8 physicians per 100,000 rural residents. However, the ratio is much greater in urban areas, measuring in at 53.3 physicians per 100,000 residents. In other words, rural residents have significantly smaller access to healthcare services than those living near cities. As a result, rural residents must make the commute, which in some cases can be hours, to the nearest physicians. Quicker access to medical treatment drastically improves survivability and speed of diagnoses, and thus, saves lives. As more rural healthcare facilities close, more and more rural residents fail to get the medical treatment they need.

How rural healthcare can combat these trends

However, many rural healthcare organizations are finding ways to buck these struggles by finding new leadership that will facilitate growth. A great example of this is Meeker Memorial Hospital in Litchfield, MN. For years, Meeker Memorial struggled with shrinking margins, outdated technologies, and a failure to attract great leadership to the hospital. However, Meeker Memorial’s Board of Directors hired a talented CEO, Mark Madden, who had a growth-oriented mindset with an eye for politics. In Madden’s seven-year tenure, he restored Meeker Memorial back to profitability and generated funding for a massive expansion of the hospital.

In other words, with the right leadership and talent, rural healthcare facilities are overcoming these hurdles. This is one of the many reasons that we are passionate about partnering with rural health systems. Our healthcare team of recruiters specializes in rural health and can help you find talent, like Madden, to help fight the struggles rural health is facing. We understand how essential it is for you to have the best non-clinical staff on the market in order to serve your communities and stay strong.

Get the talent your team needs

These healthcare trends have no signs of slowing down in the second half of 2019. If your organization is feeling the pressure to find new talent, reach out to our expert team of healthcare recruiters. Our team specializes in recruiting for rural healthcare facilities, and we understand your struggles and can help you source the talent you need to keep your operations running smoothly. Contact a recruiter today and let us help you find the candidates you need to keep up with the ever-changing world of healthcare.

data analysts

Why Data Analysts Are Important In Healthcare

data analysts

In today’s modern age, there is an increased focus on the processes and the technology of quality. Many organizations already have data architects and data analysts. In fact, by the end of 2019, 50 percent of healthcare organizations will have dedicated resources for accessing and analyzing data. These roles use powerful analytic technologies to provide insights to decision-makers. As a result, this empowers frontline staff and analysts to collaborate using data that drives value and improves processes.

The overwhelming majority of healthcare workers will never directly write reports or analyze data. They rely on someone else to pull data, analyze it, and produce a report. With all of the changes in Healthcare, it is important to stay on top of patient satisfaction. Leaders of organizations recognize that poor patient satisfaction ratings lead to reduced reimbursements, which inevitably affects the bottom line. Organizations who leverage these professionals and technologies increases patient satisfaction and employee engagement.

Healthcare has experienced phenomenal growth in data

The field for healthcare data analysis only continues to grow. The U.S. Bureau of Labor Statistics (BLS) predicts that careers related to data gathering, data interpretation, data storage, and the use of electronic health records are expected to grow by more than 15% through 2024. That’s twice as fast as the overall growth rate estimates for all other professions.

Data analysts get down to the heart of what matters. For example, the healthcare industry now captures demographic data as well as direct and indirect cost of delivering that care. It not only captures how patients feel about their care, but also a host of ancillary data like income, family history, and genetics. However, technology can only do so much. It’s necessary to have critical thinkers to process that data and produce reports detailing the critical information needed to help with a variety of clinical, operations, and financial decisions and how they affect patient outcomes.

If your healthcare organization is one of the hundreds seeking talented data analysts, or are looking to grow your career in this field, reach out to me and my healthcare team. We’re partnering with multiple hospitals to fill critical needs for this flourishing profession.

Timing Is Everything In Healthcare Hiring

Healthcare has an inherent nature of change. It is and always will be a huge platform for change, simply due to the basic tenants and morphology of disease. In addition, breakthroughs in research, population health concerns, new physiological discoveries, and battling terminal illnesses spark continuous change.

Qualified candidates are a huge part of this equation for success. The healthcare industry continues to grow. Growing shortages in trained and certified professionals and turnover rates still drive financial bottom lines significantly in one direction or the other. In the months of March and April alone, the turnover rate in healthcare exceeded 1.1 million! With an average cost of turnover of $50k, that number is a staggering $56,100,000,000 to healthcare organizations over a two-month time period.

What sparks changes in employment?

The most common reasons for a change in employment is often not even career advancement. I often hear it is company culture, new leadership, or changes in state regulations or community environment. The important aspect of all four of these reasons is that they are, for the most part, completely beyond one person’s control. If you experience any of these changes and they are to your liking, great! If not, it’s time to make a change in your career and/or location.

So, you made the decision to make a change. You update your resume and field the first call from a recruiter or hesitantly hit ‘apply’ on a job you see in a great location. The gauntlet has been thrown! The next steps are pretty predictable: First phone interview, second phone or video, and finally an onsite. This final step will determine fit – if you like them, they like you, and the location is ‘all it’s cracked up to be.’

What happens if a wrench gets thrown in your plans?

Unfortunately… life can get in the way. You get a call from a family member that there is a serious health issue, or you have put your house on the market and you don’t get five offers from the first showings as your realtor promised. Maybe you even find out you have an extra month or two on your lease that you did not figure into the cost factor of relocation. Or you have a family member that has a current issue that needs your support, and… Well, you can fill in the blanks.

Now don’t get me wrong, these are all valid concerns and issues that give pause for consideration; after all, family is everything in my book. However, how does that change the nature of the situation that caused you to look in the first place? Will putting off pursuing your career change provide any sort of solution? If you put off an interview or offer, will that change the atmosphere of your current employment situation or community conundrum?

There are some valid reasons to turn down an offer. Although situations outside of your control, that can be managed via telephone or travel on your time off, are not on the list. Bluntly, that’s what airports are for. Fearing change as a reason to postpone what is best for you and your future is not advisable. My advice is to do yourself a favor: When you make the decision that it’s time for a change, see it through. You owe it to yourself and the healthcare industry where you can make a difference. If you made the decision to make a career change, reach out to me or my healthcare team. We can help you make the change you deserve.

job market

How Good is Today’s Job Market?

job market

You’ve read the news and seen the reports. The labor market is competitive. But is today’s job market really as strong as people think it is? The short answer is yes! Here’s a brief overview of today’s job market and how to navigate it if you’re an employer.

According to LinkedIn’s May Workforce Report, gross hiring in the United States was 7.4 percent higher in April 2019 than in the year prior. And we are also experiencing an unemployment rate of 3.6 percent, which is a near 50-year low.

The labor market is really strong, and some industries are more competitive than others. To put this in perspective, the three industries Johnson Search Group specializes in (Mining & Heavy Industrial, Banking, and Healthcare) have all seen tremendous growth over the last 12 months.

Mining

The Mining & Energy industry has come back to life in recent years. Over the last year alone, the number of unemployed mining professionals has been cut in half from 39,000 to roughly 17,000 people. Moreover, year-over-year growth in the Mining & Energy industry is 4.9 percent. And over the last two months, the growth has been 2.2 percent, from April to May. In April 2019, the unemployment rate in Mining was just 2.4 percent, well below the nation’s average.

Banking & Finance

In April 2019, there were 12,000 Banking & Finance jobs created. And over the last 12 months, 110,000 jobs were generated in the industry. Average hourly earnings in the industry have also risen over the past year from $34.46 an hour to $35.53. The unemployment rate in this sector is well below the national average at 2.1 percent. The Banking & Finance industry has a 7.7 percent growth year-over-year.

Healthcare

263,000 Healthcare jobs were added in April 2019, overshadowing the average monthly gains of 213,000 for the last 12 months. Not surprisingly, the Healthcare industry has continued to grow rapidly over the year. The industry experienced year-over-year growth of 7.5 percent over the last 12 months. And this growth will keep climbing. Healthcare became the largest U.S. employer in 2018, and by 2026, the industry will add nearly 4.0 million jobs.

How to navigate this market

With how competitive the market is, it can be difficult to find the talent your team needs. It’s a candidate’s market and employers cannot afford to drag their feet when making hiring decisions. You must move quickly to ensure you secure top talent.

Have you ever thought of the costs incurred from a vacancy on your team? There are several hidden costs associated with unfilled positions at your organization. According to SHRM, the average open position takes 42 days to fill at a cost of $4,129. The cost of vacancies can certainly add up as good employees take advantage of this hot job market and move onto other opportunities. Many of our clients are incurring these indirect costs and don’t even realize the financial impact of unfilled positions.

If you find yourself in this same boat, have you thought of partnering with a recruiter? A recruiting company, like Johnson Search Group, will help you find the qualified talent your team needs quickly and help you mitigate these costs. We have a huge network of great candidates ready to make a move and make an immediate impact on your organization. Let’s have a conversation and help you fill some of those vacant positions.

technology

Technology in Healthcare

technology

Health Information Technology is constantly changing and is a great career field to be in. Not long ago, all records were captured on paper and charts could only be shared by fax or courier. They’re not always legible and accessing healthcare information was difficult and often very tedious.

Faster diagnosis and results

With 5G now available and the demand for receiving accurate information in seconds improves the care and safety of patients. It has proven that the benefits are substantial. With recent technological changes in the healthcare industry, time for getting accurate patient records has drastically decreased. Consequently, over 82 percent of healthcare professionals reported that electronic prescriptions save time and reduce efforts.

Furthermore, healthcare professionals can now efficiently diagnose patients. Better technologies allow doctors to take preventive measures before medical issues become more serious. Or in some cases, lethal.

For example, 5G will allow doctors to send MRIs and other images, which are very large image files, almost instantly. Specialists will be able to examine and diagnose patients quickly, allowing them to serve even more patients. The more patients that can be seen in a single day, the more patient lives we can save.

With better, faster technologies available, patients and healthcare professionals now have even more control of their well-being. Reviewing information, requesting additional information on their diagnosis, making appointments, and even contacting their doctor are now much easier and quicker to accomplish.

Additionally, technological advancements even help reduce medical costs. According to a study from the University of Michigan, shifting from paper to electronic health records has reduced the cost of outpatient care by 3 percent.

How technology affects the healthcare industry

Technology is drastically changing the healthcare industry. As a result, healthcare employment is being forced to adapt to newer technologies and medical advancements. Hospitals and other healthcare organizations are finding themselves having to hire new employees to accommodate these changes.

Some of the hot jobs in Health Information Technology include:

  • Information Systems Analyst
  • Interface analyst
  • Senior Applications Analyst
  • Nurse Informaticist
  • Facility Information Security
  • EHR applications

Technology advancements continually help save patient lives and improve the quality of life of each and every patient. So, if your organization needs help finding the talent you need to keep up with these demanding IT trends, let’s have a conversation. Because my team and I specialize in placing talented professionals in healthcare organizations every single day.

Rural Health

What Can We Do to Save Rural Health?

Rural Health

Fairfield, WA’s Military Wall of Honor

The spiraling costs of healthcare have created the need for shared resources and regionalized services. It only makes sense. After all, why outfit two labs and clinics, stretch the time of doctors and healthcare professionals between multiple locations? When one, centrally located clinic or medical office should be enough? And why not share the expenses of the supporting staff needed? The rural communities can just seek medical assistance in urban centers that are often within a half hour drive. Sounds simple when analyzing the cost-saving potential. But what about the human cost? Does this ever factor into the equation?

The financial struggles of rural health

According to Becker’s hospital news, finance woes were the primary cause of the closure of 64 rural hospitals in the four years between 2013 and 2017. And during the previous U.S. rocky financial period in the mid-to-late ’80s, 140 rural hospitals closed. Recently, the small community of Fairfield in Eastern Washington is one of the latest rural communities to fall prey to the need for regionalized cost savings in healthcare services.

A large healthcare organization purchased the local doctor’s group. The organization announced via a letter to the locals that they’re relocating the doctors to nearby urban Spokane. As a result, this is leaving a small community home to two skilled facilities, without a doctor or nurse practitioner. Many would argue “what’s the big deal? It’s only about 30 miles away to get medical attention.”

Rural healthcare facilities save lives

Rural communities already face a large challenge by not having a local doctor and relying on local EMTs only for medical emergencies. Survivability of these emergencies are often measured in seconds, not minutes, and certainly not hours. The quicker access to medical treatment, the better survivability and quality of life after a catastrophic event. There is a saying revolving around the treatment of heart attacks that goes, “time is muscle.” The longer the time for treatment, the more damage to the heart muscle.

The CDC also reports that unintentional injury deaths are 50% higher in rural communities than urban communities. And delays in service are a common reason. Rural communities with limited access to healthcare can also create delays in diagnosis of diseases like cancer and diabetes; delay routine checkups that identify signs of stroke or other life-threatening factors; and rural communities are home to many elderly residents. Whom are part of the 12% of the 65 and over age population who consume over 34% of all prescribed medication. This also requires monitoring and care from a licensed medical professional.

The beauty of rural communities

So why not just move? The flip side of the equation is the quality of life and community that is offered in rural communities. Reduced cost of living, less stress, less noise and pollution, and quality of time with family are all well-documented benefits to rural life. Additionally, the sense of community and active preservation of American values coupled with a continued celebration of life, tradition, and family is the backbone of the rural landscape. This beautiful community of Fairfield is one such example of the celebration of life with the installation of their Wall of Honor, dedicated to those who have served our country. They continue to honor tradition, family, and community values.

But who will continue to serve our rural communities? What can we do to take the human equation of lack of transportation to a doctors appointment into consideration? What cost do we allocate to a life lost due to inaccessibility of healthcare? And what about the local businesses that support the services of the visiting doctors? What can be done when the population demographic is not the model to welcome telemedicine and needs licensed medical professionals to tend to the residents in person?

It is an open-ended question that may not have an ideal solution. But for Fairfield, WA, sharing the belief in rural community and having a passion for rural health is everything to them. And if you’re looking to possibly open a practice, you know for sure there is a source of revenue ready for you to grab onto. Moving to this rural community that rewards and celebrates loyalty may be the perfect opportunity for you!

Thanksgiving

Work With Us So You Can Enjoy Your Thanksgiving Holiday

Thanksgiving

Thanksgiving is one of my favorite times of the year. Sometimes it’s easier to focus more on the negatives in life. But this time of year, we get the opportunity to reflect on all the good that happens in our lives.

In my personal reflection, there has been quite a bit to be thankful for in this past year. I’ve had the privilege of not only working with, but learning from, a wide variety of wonderful people from our clients, candidates, and my amazing colleagues.

The job market is crazy busy

Of course, there is SO much more to be thankful for outside of my own personal journey; one of which is a job market that’s on fire! We have been lucky enough to enjoy a booming economy and the labor market with the unemployment rate remaining at 3.7 percent in October AND the number of job openings at over 7 million. Right now, in this candidate-driven market, there is more than one job opening for every unemployed person. If that isn’t something to be wildly excited about, I don’t know what is.

Over the past 12 months, there were 323,000 jobs added in the healthcare industry alone! Not only that, but The Conference Board also reported the highest level of job satisfaction at 51% based on their latest survey, which is the highest level reported since 2005.

Get the help you need

Of course, with such a booming job market, there are a lot of difficulties for employers in finding the qualified candidates they need. Luckily, this isn’t something you need to do alone. That’s what we at Johnson Search Group are here for!

We have a great network of talented and experienced candidates and we love to help our fabulous clients out by matching them with the right people for the job. This holiday season, I encourage employers who may be struggling to find qualified candidates not to try and do everything on their own.

Spend time with your family and loved ones this holiday season and let us take some of the stress off your shoulders. After all, that is not only why we are here but it is also what we love to do.

Rural Healthcare

Why Rural Healthcare? Why not!

Rural Healthcare

We tend to get caught up in the hustle and bustle of trying to juggle a successful career and raising a family. With so much going on in our lives, we often forget to “stop and smell the roses,” so to speak.

By working in rural healthcare, you have a better chance of finding that work-life balance and still have a very successful and rewarding career. Having the possibility of stretching the boundaries by forging innovative programs and services, making rural life healthier and more compassionate. Isn’t that one of the reasons why you embarked on a career in healthcare? To have the opportunity to help people?

What’s not to love?

Better quality of life, no sitting in traffic for an hour. Living in a rural community often costs less, a chance to afford a larger home and be a part of a community. And who doesn’t love farm-fresh produce!?

Many of my clients that I work with in rural healthcare enjoy who they work with. The organizations they work for feel more like a large extended family rather than a group of co-workers. With the CEO walking the halls and having lunch in the cafeteria, rural health is much more welcoming. Having the ability to be a part of the community and seeing the difference that you can make is extremely rewarding.

Start your career in rural healthcare

There is a shortage in rural healthcare and now is the time to consider that option! Rural health is a great way to grow your career. You often see cases you might not normally come across in medical school or residency. You could see a broader scope of chief complaints, and that’s experience you just can’t buy.

I am working with some great Critical Access Hospitals that are looking for talented healthcare professionals just like you! Your patients will appreciate you and trust you. The need is real, and the reward is enormous! Working in rural health will very possibly reshape how you think the way you deliver care throughout the rest of your career!

If you’re ready to start your career in rural healthcare, reach out to me. My team and I are ready to help you find the next chapter in your career.

industries in review

JSG’s Industries in Review: Looking Towards 4th Quarter and Beyond

industries in review

It’s officially the 4th Quarter of the year. The labor market is as strong as it has been in almost two decades. With current projections of 3.1 percent growth for the U.S. economy for 2019, it doesn’t look like the job market will be slowing down anytime soon. We sat down with Johnson Search Group’s divisional managers to hear their thoughts on our candidate-driven market and the challenges their teams face moving into 4th Quarter and even 2019.

Mining in Review

Dana Belstler, Mining Divisional Manager

What trends do you see in the Mining industry as we approach 4th Quarter and 2019?

The mining industry is on fire. The Permian Basin is expanding faster than talent can be brought in and mining companies across the U.S. are growing. Frac sand companies are opening multiple new plants across the country. Even the gas and oil companies are getting into the frac sand business. Since October 2016, the Mining industry has added a total of 104,000 jobs; 6,000 jobs were added in the month of August alone. It’s a good time to be in mining, and I see this growth trend continuing into and throughout 2019!

What challenges is your team facing in this tight job market and how are you addressing them to help your clients find qualified candidates?

Candidates are in the driver’s seat, without a doubt. With 6.7 million job openings and only 6.3 million people to fill them, the disparity is glaring. The mining team at JSG has noticed that candidates are becoming more selective with the opportunities they will consider. They are sticking to their guns on salary requirements and many are choosing to not relocate. This is where our partnership with our clients and our understanding of who they are and their vision for the future, comes into play. We take the time to educate the candidates on the companies; My team shares the company’s vision and helps them visualize how their career could grow. We are truly matchmakers, and our goal is to make both our client’s and candidate’s happy with their mutual decisions.

Healthcare

Tracey Smith, Healthcare Divisional Manager

What trends do you see in the Healthcare industry as we approach 4th Quarter and 2019?

Technology is being integrated more often to meet many of the challenges faced with additional patient load and regulations; that includes addressing organizational planning, patient outcomes, and protection of health information. Technology has become a huge part of healthcare and I see it continuing to be this way. Although, this can be both good and bad and it may create unforeseen challenges when there aren’t enough people to address the need. And this is especially true when we are so reliant on technology to fill this need. One example we addressed in a recent blog discusses the human difference compared to the technology of applicant tracking systems. This illustrates how technology differs from the human touch, but it’s certainly needed because of how rapidly the Healthcare industry is growing!

What challenges is your team facing in this tight job market and how are you addressing them to help your clients find qualified candidates?

With Healthcare becoming the number one employer in the U.S., hiring managers are becoming busier than ever. Finding time for interviews is a huge challenge for many hiring managers. Which is why now is the best time to be working for a recruiting firm whose process is concise like ours. This includes us doing all the initial interviews, so we can get to the very best talent. This helps to not waste hiring managers’ valuable time, that could end up taking away from patient care.

Banking

Tracy Isakson, Banking Divisional Manager

What trends do you see in the Banking industry as we approach 4th Quarter and 2019?

All things are looking very busy. The fed rate will rise again, but the economy appears so good, it will most likely only create a small hiccup in the future. With that being said, banks and financial institutions are busier than ever. We will also see more mergers and acquisitions activity as institutions are looking for strategic growth.

What challenges is your team facing in this tight job market and how are you addressing them to help your clients find qualified candidates?

We are seeing candidates who are ready to make a move today. When a candidate is ready to find a new career opportunity, they are getting in contact with three, four, or even five institutions that are all wanting to hire them. Some banks are not making hiring a priority which is causing them to lose great talent. When they take weeks to ask great candidates for an interview they are leaving the door open for another institution to move in on the candidate. This creates a problem for banks who need to fill their critical roles quickly because they lose out on great candidates to the competition. It’s essential that financial institutions are moving quickly in this tight job market.

Let’s work together

4th Quarter is among us, and many organizations are looking to add talented candidates to their teams. If you are struggling to fill open positions in this tight market, you’re not alone. Reach out to us and let’s have a conversation. We can help you find the talent your organization needs as we quickly approach the new year.