Ep. 50: Creating the Ideal Schedule for Your Dental Practice, Part 2
Scheduling is important in any business, but in dentistry it is absolutely crucial. The office schedule is the heartbeat of the practice. It is no fun running hectically from room to room all day and working through lunch just to find out you only produced half of your daily production goal. This week we wrap up our series on scheduling with the “how-tos” and important steps for implementing an efficient scheduling system.
Topics:
2:15 – Double booking done right
15:17 – Maintaining flexibility for emergencies, exams, unexpected occurrences, etc.
22:55 – Building time in for case presentations and consults
30:33 – Implementation steps
Links:
Downloads for this episode - https://www.mgeonline.com/scheduling-downloads
Team training video courses - https://ddssuccess.com
The Scheduling for Production Seminar - https://www.mgeonline.com/the-scheduling-for-production-seminar
Learn more about MGE - https://www.mgeonline.com
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Questions From This Episode
What are the four conditions that have to be in place to properly double book a schedule?
Each treatment room needs its own assigned dental assistant, the appointment book needs adequate primary procedure time blocked every single day to hit the production goal, the doctor can never be scheduled in more than one room at the same time, and every procedure has to be broken down into doctor time versus assistant only time so it can actually be represented on the schedule.
How does the slash and X system actually represent a procedure on the schedule?
A slash represents assistant time without the doctor in the room, and an X represents doctor time, almost always with the assistant present too. A 70 minute crown prep might look like one slash for the first 10 minutes while the assistant seats the patient, four X's for 40 minutes of doctor time actually prepping the crown, and two more slashes for the last 20 minutes while the assistant makes the temporary and the doctor pops in briefly to check it before the patient is discharged.
How much time can double booking actually save in a single day?
In the walkthrough example, seating a second patient 30 minutes before the first one is discharged, instead of booking the two back to back, meant that second patient was out the door by 9:30 instead of 10:00, a full half hour saved on just two appointments. Spread across a whole day, that adds up to hours of extra capacity without adding a single extra hour to the schedule.
How should a true emergency be handled without wrecking the day's schedule?
Bring the patient in, address the immediate problem, whether that's an antibiotic for a toothache or some other palliative step, and schedule the actual procedure, a root canal or extraction, for the next available opening rather than forcing a full hour long procedure into an already packed day. Genuine emergency patients, especially ones calling around because nobody else can see them, are usually happy to be worked in briefly and often turn into long term patients of record.
Why does time to sell need to be built into the schedule, and where should consults go?
A practice can't produce what it doesn't sell, and presenting treatment has an organizational side as well as a skill side, even a great closer won't convert cases if they're only given five rushed minutes to explain a $3,000 to $7,000 treatment plan. Consults work best scheduled first thing in the morning and right after lunch, when the doctor is fully focused rather than mid procedure elsewhere, and as a bonus, a last minute cancellation in that block can often be filled just by moving a consult patient's treatment up to that opening.
Episode Transcript
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Hello everybody, it's Jeff, and I want to welcome you to episode 50 of Dental Business Rx. It's our first notable milestone, and it went by fast. I want to start this show by thanking all of you, our listeners, for your support and your feedback, they've been vital in making the show successful, and truthfully, without you there is no show. I look forward to recording every week, and that's genuinely because of you. So again, a big thanks.
Let's get down to business. This episode is part two of a two part series on designing the ideal schedule for your dental practice. The idea behind these two episodes was to really dig into the subject rather than just running through a handful of scheduling tips, and to look at the basic components of constructing a schedule that actually works for you. In last week's episode we covered what your scheduling system needs to be able to do, how to set monthly and daily goals, the different classes of procedures as they relate to your schedule, and moving from a 15 minute appointment book to a 10 minute one. We also left you with a bit of an assignment, to figure out procedure durations for the most common procedures you perform. If you missed last week's episode, I'd suggest going back to catch up, though if you're like me, you might just skip straight into this one, that's completely fine too, the episode will always be there.
In this week's episode we're going to wrap up the subject by covering how your dental assistant fits into all of this, double booking, how to structure your schedule including fitting in emergency appointments, and how to put all these tools together. Full disclosure, this one is probably going to run longer than our usual 30 minutes, I haven't recorded it yet as I say this, but based on what I need to cover, I'm expecting it to run long. I have no idea exactly where it'll land, just wanted to warn you ahead of time since we do advertise 30 minutes or less.
Let's jump in. I want to start by looking at schedule efficiency, double booking, and how your dental assistant fits into all of it. What your dental assistant can and cannot do is legally governed by the Dental Practice Act in your state, and if you don't already know the specifics, definitely take a look, since it tells you exactly what they are and are not allowed to do. That said, you may have an assistant who's legally allowed to do certain things but simply hasn't been trained to do them yet, in which case you'd want to train them, since the whole point is maximizing efficiency in your practice. You don't want to be doing things yourself that a properly trained assistant could be doing instead, that's the entire reason to have one.
So what is double booking? Let's first cover what it isn't, since some people think double booking just means working out of two rooms with a single assistant, no assistant assigned to each room individually. That's not true double booking, that's you and one assistant moving between room one and room two, with the assistant stepping out for a minute to seat room two while you finish up and someone else cleans room one behind you. Real double booking means an assistant assigned to each room, which we'll get into. To properly double book, you first need to know exactly what your assistant is legally allowed to do in your state, which might include things like taking notes, making temporaries, taking x-rays, applying topical anesthetic, removing sutures, and so on, it varies significantly by location, so check before you build a system around it.
When it's done properly, double booking can make your practice immensely more productive and efficient. True double booking, working out of two rooms, means an assistant in each room working alongside the doctor as the doctor moves back and forth between them. For this to actually work, four conditions have to be in place.
The first condition: every treatment room the doctor uses needs its own assigned dental assistant. I've seen practices where assistants bounce between rooms freely, which isn't terrible, but I'm more of a fan of each assistant being tied to a specific room, room one has its assistant, room two has its assistant. They might help out elsewhere occasionally, but that's their operatory, they keep it stocked, they keep it clean, it's theirs. At minimum, you need one assistant per treatment room the doctor is actively using.
The second condition: the appointment book needs adequate primary procedure time blocked every single day to actually meet your production goal. We covered what a primary procedure is last week, essentially a high dollar procedure, though that doesn't necessarily mean a single big case, ten composites in one day might qualify as primary time based on total dollar value. I mentioned last week that I prefer having primary time scheduled in the morning, since it means your production goal is largely met by lunch, but whatever you decide, that time has to be blocked out every day without exception.
The third condition: the doctor can never be scheduled to be in more than one place at the same time, full stop. I remember a client telling me about a brand new scheduler, genuinely a go-getter, really wanted to keep the book productive and full. He looked at the schedule one day and found three root canals booked at the exact same time, in three different chairs, all assigned to him. He wasn't upset, he just calmly explained to her that this was a physical impossibility, since he can't be in three rooms at once. That's an extreme example, but the basic rule of double booking is that the doctor is only ever in one room at a time, since they genuinely can't be in two.
The fourth condition, assuming you've already worked out your procedure times from last week's assignment, say you've determined that a single crown, start to finish, seating the patient to discharge, takes an hour or seventy minutes, is that each of those procedures has to be broken down into doctor time versus assistant time. This is the part I was genuinely worried about explaining on a podcast, since it's inherently visual, so I do have downloadables you can follow along with, on the episode webpage, though obviously not while driving.
Doctor time is any time the doctor is physically in the room, almost always alongside a dental assistant, with rare exceptions like popping into the hygiene room solo for a quick new patient exam. Assistant time is the assistant working in the room without the doctor present. The schedule needs to visually represent that split for every procedure. During any given procedure there are steps that genuinely require the doctor and steps that don't, depending on the procedure itself, what your assistant is legally allowed to do, and their actual skill level. Taking all of that into account, you want the schedule to clearly show when the doctor is in the room with the assistant, and when the assistant is working solo.
The most common way this gets represented is with a slash and an X system, a backslash, similar to what you'd see typing a web address, and the letter X. Most scheduling software supports this, and it used to be done by hand on paper appointment books too, some practices use a dot instead of an X, it varies. I'll use slash and X here since that seems to be the most common convention, and you can typically configure your software to use it.
Here's an example: say you've determined a single crown prep takes 70 minutes in your practice. On a 10 minute book, that's seven units, since it takes longer than 60 minutes but under 75, which is exactly why a 10 minute book beats a 15 minute one, on a 15 minute book you'd either lose 5 minutes of unused time or run short. So how would 70 minutes break down into assistant and doctor time? The first 10 minutes is the assistant seating the patient and prepping the room. The next 40 minutes is the doctor, fully in the room, actively prepping the crown. The last 20 minutes might be the assistant making the temporary while the doctor pops in briefly to check it before the patient is discharged, again, exactly what the assistant can legally and practically handle depends on your state and their skill level. How long any given procedure actually takes you personally as the doctor is entirely your own, some doctors move faster than others on certain procedures, that's simply how it works, and your schedule has to reflect what's true for you, not some universal standard. And as I mentioned last week, once you turn your procedure times into a formal scheduling policy, you'll want to build in a small buffer, if something genuinely takes 60 minutes, you might represent it as 70 in your policy, I'll explain why shortly.
So for that 70 minute crown prep, you'd represent it as one slash for the first 10 minutes of assistant time, four X's for the 40 minutes of doctor time, followed by two more slashes for the last 20 minutes of assistant time. You can apply the exact same process to delivery appointments too, figure out how long it actually takes you to deliver a crown or an onlay, and break that time into doctor versus assistant segments the same way.
Now we've got procedure time figured out and represented as X's and slashes, this is where it actually gets useful, this is where double booking comes into play. Using this system lets the doctor operate effectively out of more than one chair at once, starting with the next patient in one room while the assistant in the other room finishes wrapping up with the patient the doctor just left.
Let's walk through a concrete example. Picture a two room appointment book, room one and room two, broken into 10 minute units, starting at 8:00 AM. A patient named Bill is in room one for a crown prep starting at 8:00, represented as a slash, four X's, then two slashes, a 70 minute appointment, so Bill is discharged at 9:10. Now say the next patient is Sally Smith, coming in for a root canal. Since we have a dedicated assistant for each room, the assistant in room two seats Sally at 9:40, which is 30 minutes before Bill is set to be discharged. That first 10 minutes is Sally's assistant getting her seated, represented as one slash, followed by four X's, since for this particular root canal the doctor needs to be present for essentially the whole procedure. So Sally is being seated at 9:40, and the doctor is already about 20 to 30 minutes into her appointment by the time Bill is discharged from room one.
Compare that to not double booking properly, running the same two patients back to back with a single assistant. Bill occupies room one from 8:00 to 9:10, Sally isn't seated until 9:10, and she wouldn't be discharged until roughly 10:00. In the double booked version, Sally is discharged by 9:30, a full half hour saved on just these two appointments alone. Multiply that across a whole day and it adds up to hours of extra capacity.
One note on double booking: I've had people ask whether they should be doing this right out of the gate. If you've just opened your practice with 65 or 75 patients total and you're still doing your own hygiene, no, you don't have the patient volume to justify it yet. But if you've got one or two hygienists who are genuinely busy, absolutely start double booking, there's no reason not to, you'll see more patients, work more efficiently, and likely work fewer total hours doing it. I have a set of downloadable slides, numbered one through four, on the episode webpage that walk through exactly this progression, a single appointment, then adding a second appointment back to back, then the same two appointments properly double booked. There's also a slide showing how a full productive morning might look: Bill in room one at 8:00, discharged at 9:10, Sally seated at 9:40 for her root canal, discharged at 9:30, and right after Bill leaves room one at 9:10, a patient named Jim Johnson is seated to start veneer preps on teeth seven through ten. That's a genuinely productive morning well before 10 AM.
A few more basics before we move on: you obviously need to know your common procedures and how long they actually take, split into doctor and assistant time, and your scheduling software needs to support the X and slash system while also preventing two X's from ever being scheduled at the same time, since that would mean the doctor is booked in two places at once.
Let's talk about emergencies for a second. What actually counts as a dental emergency? This is a question I ask constantly in our seminars. Say I call your office and tell you my tooth has been a little painful, upper right side, toward the back. You ask if I'm in pain, I say yes, and you offer to squeeze me in at 11. If I say 11 doesn't really work for me, could we do 3:30 instead since I get off work at 3, that is absolutely not an emergency. If I were a genuine emergency and you told me you could squeeze me in at 11, I'd be thrilled and make sure I was there at 10:50 so I didn't miss it, whatever it takes.
Emergencies are interesting for two reasons. First, a genuine emergency shouldn't be brushed off, especially if it's an existing patient of record, you want to get them in. Second, emergencies represent real new patient opportunity, someone who's called around and can't get seen anywhere else that day is exactly the kind of person you want to see immediately. You do the emergency treatment, then put them on your normal new patient track afterward, and they become a regular patient of record. That said, you can't slam a full hour long root canal into an already packed, efficiently double booked day without wrecking the whole schedule, so that approach doesn't work either. A few things I've seen practices do successfully, though obviously you'll decide what you're personally comfortable with clinically: bring the patient in, and if it's a toothache, you're likely giving them an antibiotic before doing any actual procedure anyway. Take a look, determine whether it's an extraction, a root canal, or something else, prescribe what's needed to get them out of acute pain, and schedule the actual procedure for the next day or the day after. The patient leaves happy, out of pain, and you've accommodated them without derailing your day.
Inevitably someone asks about a broken tooth specifically, and no matter what you do, that's going to take more than five minutes to address. In that case you'll need to actually find room in the schedule to work them in. I had exactly one true emergency of my own, back in 1999, I was in Orlando for a seminar, nowhere near my own dentist, and my tooth started hurting badly enough that I had to find someone to see me. I knew the office I found was genuinely busy that day, but they worked me in, I waited a while, and I was completely fine with that, because I understood I was the emergency being squeezed into someone else's day. That's the mindset most genuine emergency patients bring, they're willing to wait if it means getting seen.
A few more pointers on building the schedule itself, and I'll say again, this is a massive subject, we run a full two day seminar on it here at MGE, the Scheduling for Production seminar, and about seven hours of scheduler training on our online platform, DDS Success, including an Art of Scheduling Productively course for the whole team and a dedicated Schedule Coordinator course. Links for both are on the episode webpage.
Whatever procedure times you land on, you'll eventually need to turn them into an actual written policy for your scheduler, it doesn't need to be elaborate, it could just be a list of CDT codes with associated time blocks. Before finalizing that policy, slightly exaggerate each procedure's actual duration, that's how you build in a buffer. If you schedule exactly the real time a procedure takes and anything goes even slightly wrong, you're immediately behind, and you'll also have no room for recall exams, which I'll get to. A few extra minutes of padding is far better than constantly running behind, and it also lets you fit in quick opportunities you otherwise couldn't, an Invisalign start, for instance, time seems to appear out of nowhere.
You also have to account for hygiene and recall exams, and new patient exams, on the schedule. I generally wouldn't put an explicit X block on the schedule for a recall exam specifically, because if you've properly padded your procedure times, say a 60 minute appointment represented as 70, that extra time already gives you room to step into the hygiene room for a quick recall exam without needing a dedicated block. A new patient exam is different, that's a full 20 minute commitment, and if it's happening in hygiene, you'd still want those X's represented so the doctor can't be double booked into another room during that window, same if the new patient exam is happening directly in your own treatment room. Recall exams are quick and flexible enough that walking in a few minutes into the hygienist's cleaning versus right at the start genuinely doesn't matter, whereas a new patient exam usually needs the doctor there once the data gathering is complete. If you've got three hygienists and you're a solo practitioner, you likely don't have enough padded time built in for this to work smoothly, and that's probably a sign you need an associate.
If you want to practice this concept before applying it live, we have a downloadable scheduling drill on the episode webpage alongside an updated version of our Art of Scheduling Productively course launching soon on DDS Success. The drill includes a blank two room appointment book at 10 minute intervals, plus a written scenario describing a series of patients with primary, secondary, and tertiary procedures, complete with their X and slash breakdowns, and challenges you or your scheduler to fit them all into the book efficiently. It's genuinely worth running through yourself or handing to your team as an exercise.
One more thing that has to be built directly into your schedule, which I touched on last week when covering what any scheduling system needs to include, is time to sell. I've talked about this in other episodes too, but it's worth summarizing here since it connects directly to scheduling. Ultimately, you can't produce what you don't sell. In dentistry we're used to allocating time for diagnosis and for clinical treatment, but we rarely allocate time specifically for sales. There's a skill side to sales and an organizational side, and they're not the same thing. If I have the best salesperson in the world, someone who genuinely needs a half hour to properly close a certain type of deal, and I only ever give them five minutes, they're going to close nobody, regardless of how skilled they are, they simply don't have the time. Flip it around: give a mediocre salesperson, someone who only closes 40 percent of the time, a full 30 minutes with each of 10 prospects, and they'll walk away with four closes, versus zero for the highly skilled person working with no time at all. Time genuinely matters as much as skill.
Here's how this typically plays out in dentistry, even with existing patients of record. You do a recall exam, the patient has some real treatment needed, say $4,000 or $5,000 worth of work, you spend five rushed minutes explaining it, with no real time to answer questions or explain why it's actually needed, and they head to the front and tell your treatment coordinator they want to think about it, landing on the incomplete treatment list, possibly never to be seen again for six months or longer. The same thing happens with new patients, you spend 15 minutes on the exam and building rapport, and you're left with five minutes to present treatment, nowhere near enough time to properly explain it. I think we lose the thread on this because when people think of consultations, they picture something dramatic, a second opinion appointment or an hour-long consult for a full mouth reconstruction or an all-on-six case. But even a moderate treatment plan, $4,000 to $7,000, deserves real time. Think about it from the patient's side: if someone makes $80,000 a year and you tell them they need $7,000 of dental work, that's essentially a month's salary, that decision takes real time to process. If I asked you to commit to spending an entire month's salary and only gave you five rushed minutes with no real explanation, you'd probably say no. So even moderate treatment plans, in the $2,000 to $3,000 range, deserve real explanation time, though obviously use your judgment based on the specific patient, an existing patient of record with an established relationship might genuinely need less time than a brand new patient hearing this for the first time. But even a $2,000 to $3,000 case might reasonably take 20 minutes to properly explain, and if you don't take that time, the patient simply isn't going to move forward.
So you have to build real time into the schedule to sell. I mentioned in our reception episode the idea of a 90 minute new patient appointment for certain patient profiles, worth checking out if you missed it, but the average new patient initial appointment tends to run about an hour. In a lot of cases that leaves no real room to present treatment properly that same day. If you do have the time, and the patient does too, absolutely present it right then. But if either of you is short on time, bring them back for a dedicated consult instead.
Where should that consult time actually go on the schedule? I'm a fan of placing consult slots first thing in the morning and first thing after lunch. A few reasons: scheduling it there means I'm not mentally split between several other patients I'm mid-procedure with, especially first thing in the morning when nothing else is competing for attention. We also teach a basic rule at MGE: if you don't have time to finish the sale, don't start it, so I want enough uninterrupted time blocked to go from start to finish and fully answer the patient's questions. Technically, a consult counts as a tertiary, no-charge procedure by the classification we covered previously, so it might seem odd to prioritize it in your most productive morning hours, but consults are a bit of a specialized appointment type, worth that placement anyway.
Here's a concrete example, drawn from a set of slides on the episode webpage called Time to Sell, slides one through four. Picture rooms one and two from 8:00 to roughly 10:00 AM. At 8:00, Bill is in for a 20 minute consultation, represented as slash, X, X, slash, the assistant seats him, the doctor spends the middle portion with him, and the assistant dismisses him. At 8:20, Molly Miller is seated for a 40 minute consult, same slash-X-slash structure. At 8:40, Mary Jimson comes in for veneer preps on teeth seven through ten. All three rooms are double booked with a dedicated assistant each. Then you get a call from Mary Jimson canceling last minute, a genuine family emergency, she's already on a plane out of town, and you only find out that morning. Her 8:40 appointment is now open, and your scheduler is scrambling to fill it. Rather than pulling a procedure forward from tomorrow, since we've got two consults already sitting in that morning, Bill and Molly, there's a real chance one of them could simply move into Mary's now-open slot instead. Say Bill has some crowns he needs done, you check in with him that morning, he's ready to move forward with treatment, and you let him know a slot just opened up unexpectedly, could he start today? He mentions he's off work and had actually been hoping to get in soon. You work out the financial arrangements, and instead of an empty 8:40 slot, you're now doing crown preps on teeth 3, 4, 5, and 13 for Bill. That's the full progression shown across those four slides, and it illustrates why placing consults strategically in the morning and after lunch can genuinely recover production you'd otherwise lose to a last minute cancellation.
That covers the basics of how this all works with your dental assistant and how to structure the schedule around it. Try the scheduling drill as a hands-on exercise to see how it feels in practice. There's obviously a lot more to this subject overall, scheduling policy, troubleshooting a schedule that's already struggling, getting a new scheduler fully up to speed, filling last minute openings, and we haven't even gotten into hygiene scheduling specifically, but between this episode and last week's, we've covered the core structure and concepts. I hope you found it useful and that you're able to start applying some of this in your own practice.
A few basic implementation steps to leave you with. If you're not already setting monthly production goals, start now, that's business ownership 101, and break those down into daily targets the way I covered last week, factoring in how many days you're working that month and subtracting hygiene production so you know exactly what the doctor needs to produce each day. I'd strongly recommend coordinating case presentations and production with a morning production meeting, I've talked about making your morning huddle more productive in an earlier episode, and we also have a video on this on DDS Success. Take your most commonly performed procedures and figure out the actual average time each one takes, you can literally start timing them, have your scheduler jot down notes like, assistant brought patient Jane back at 10:00, Jane's crown was completed and she was discharged at 11:01, that's an hour right there.
I'd also strongly recommend switching to a 10 minute appointment book if you haven't already, very few practices are still running 15 minute books at this point, though of course you have to do what actually works for your practice. What I would not recommend is flipping the switch overnight and blowing up your existing schedule. Instead, pick a point where your book naturally starts thinning out, and begin shifting away from scheduling strictly on the fives from there, keeping the existing schedule intact until you reach a point where you can reasonably move a few things around without a ton of disruption. But the shift to a 10 minute book genuinely makes a significant difference.
Make sure you know exactly what your assistants are legally allowed to do in your state, and honestly assess their actual skill level. Then take the procedure durations you've worked out and break each one into its X and slash components, identifying assistant-only time versus doctor time. Assuming you have the patient volume to support it, you'll need two assistants to properly double book, so you might pick a future date to formally go live with the new system, rather than trying to retroactively rearrange existing appointments, which usually isn't worth the disruption unless you're genuinely booked out far enough in advance that adjusting makes sense. I'm not a fan of calling patients just to shuffle them around for no real benefit to them, that's just redoing work you've already done. If you're currently booked out six weeks or more, which is often a symptom of exactly this kind of inefficiency, that's actually a reasonable window to start adjusting toward double booking while you look for a second dental assistant. You should be able to find one within six weeks, and worst case, a temp can bridge the gap if needed.
Designate your primary time on the schedule, I recommend mornings, though as I mentioned last week, you might flip that on certain days if you have patients who'd be genuinely inconvenienced by a morning-only policy. And build real time to sell into the schedule, this one matters enormously. Run the scheduling drill yourself, or hand it to your office manager or your scheduler to work through and see how it feels in practice.
Last suggestion: think of this like paper trading, a term you may have heard in investing, where someone wants to learn how trading works without risking real money yet. You can do the same thing with your schedule, take last week's actual schedule and map out what it would have looked like if you'd been properly double booking the whole time. You might find you'd have ended up with two extra open hours in the morning, and here's the thing, that's not lost production, that's two open hours you can now fill with additional patients, meaning your total production actually goes up while the practice runs more efficiently. This lets you see the potential impact before you've changed a single real appointment.
There's a lot more to learn on this subject if you want to go deeper, I'd definitely recommend checking out the Art of Scheduling Productively course on DDS Success, the updated version should be dropping soon, along with the Schedule Coordinator training course, which covers all of this in even more depth. You're also welcome to attend our in-person Scheduling for Production seminar here at MGE, I'll put a link on the episode webpage. This is genuinely one of those areas where the more you know and the more policy you have in place, the more of a real framework you're working within, and it makes the whole office more efficient, more productive, and honestly just more enjoyable to work in. You get to enjoy an easier life too.
That's all I have for you this week, folks, I hope it helped. If you have any questions, you can always email me directly at jeffb@mgeonline.com, or visit us online at mgeonline.com for more information. You can also call us at (800) 640-1140. I've linked everything I mentioned today, the downloadables, the scheduling drill, and the DDS Success and in-person scheduling seminar details, on the episode webpage. Otherwise, folks, have a great week, and I'll see you at the next episode.