2 - Know Your Numbers in a Contract Negotiation with Dr. Mona Bakshi-Kamath

In every operating room, in every ward, in every clinic, and every team meeting, a silent battle brews. Conflict, negotiation, identity. Welcome to the Scalpel and Sword podcast, where I, Dr. Lee Sharma, physician and conflict analyst, Explore the hidden negotiations behind modern medicine. Let's trade burnout for boundaries and learn the art of healing with precision and power.

Hello everybody. Welcome to The Scalpel and Sword, our podcast looking at conflict in medicine. And I'm so excited today to have as my guest, Dr. Mona Kamen. She's one of my dear friends. I can't get away without saying that. She actually grew up in California. She went to undergraduate at the University of California Riverside. She went to medical school at the American University of the Caribbean. After this, she did a residency in family medicine at St. John's Medical Center in St. Clair Shores in Detroit, Michigan. After that, she did work with some locum tenens. I think one of my favorite things in her bio that I did not know till today is that she worked at West Point Military Academy base in West Point, New York. I just think that you must have amazing stories from that. And she's currently working in Valley, Alabama with East Alabama Medical Center. practicing family medicine. It is a joy and a delight to have you on the podcast, Mona. Thank you for being here.

Thank you for inviting me and having me join you on this. And I was just mentioning earlier that I just hope that I can give you something that's worth it from value and content.

I know you will. I have no doubt. I'm just so happy you're here. One of the stories I was sharing with Mona before we started recording Was I have this really strong memory of sitting around with our group of girlfriends. We have this really awesome group of women that all of us are in medicine in some way, shape, or form, but we get together to hang out and talk and support. And we were at a local lovely restaurant called Botanic last August. And one of the things that came up was one of the colleagues was having to negotiate her contract with the hospital. And Mona immediately jumped in talking to her about her billing practices. And this doctor was concerned that she wasn't getting appropriate reimbursement for her services. Mona gave her really solid, constructive advice about how to make sure that she was getting reimbursed appropriately. And I went home and I told my husband, dude, if I ever have a question about billing, I'm going to Mona because she is on it. How did you get so literate with this process of billing and reimbursement?

I think for me, medicine is so many different areas, and I didn't realize until starting medicine and starting— I started in locum tenens, which billing was not so much of an issue. It was done for me. But private practice, but more as I became a hospital employee when— through East Alabama in 2017. Each state is different how they reimburse.

Yes.

Insurance, whether it's Medicare or commercial. And when we're trying to figure out how to navigate all of this and at the end of the day provide care and get reimbursed fairly, I came into a lot of confusion. And so I think the best way for me to sort that out was to figure out how is the hospital getting paid and then what does that mean for me? So as a hospital employee, there's RVUs, but then there's a work RVU and they calculate everything from overhead to our pay that we get through insurances to them and through the rest of the office that's under that one building and to them. But how am I going to do this? So I have other colleagues who are also employed family physicians in other states, and I realized that at least initially each state pays differently and it's based on a lot of the insurances. So some states are more of an advantage because there's a higher payout. As I was talking to family members and I was talking to other colleagues, their states had higher payouts and some states did not. And so I thought, am I in the right place? Should I still work here? And I think that's where I started looking to figure out how is that going to come out for me and how, you know, and is that going to affect how I see patients? Am I going to have to speed up? And then is that going to impact my quality of care and that time that I spend with them? In this population, I joined my father-in-law, who's a gastroenterologist and does endoscopic medicine. The population's older. I would say at least 50, more, 65. I can't do a quick visit, and I don't want to. I feel like it's going to compromise their care. It's going to compromise me to be able to do everything I need to do for them. Although I became a hospital employee in 2017, we joined a bigger group in 2021, which is now still under East Alabama, but it's called Valley Area Primary Care. Mm-hmm. And our medical director is Dr. Dave Fagan. And when I first joined, he said, why don't you come with me? We spoke with the CFO. There was a big algorithm that he laid out on a dry erase board saying, this is how we kind of calculate work RVUs. And so I could keep up with that because I had already started doing that research. So I thought, at the end of the day, we get a certain salary and it's based on all that. How do we know, instead of shooting in the dark, how do we know how many people to see every day? What is your goal? Just to at least make the salary and then a little bit more if you wanted, or to not shortcut that? And is this something you're willing to do?

Mm-hmm.

are okay with that. And that's how it started. So based on that and the value that's placed for every office visit, knowing that my majority of my patients might be older, there's a different level. And if this podcast is more dedicated to physicians, there's 213s, 214s, and primary care primarily. If you're older, it's going to take a little longer. And that criteria has changed over the years. And so majority, it was 214s. And then our value unit also changed in in 2021, and it was higher. So it helped out our primary care. So with that, I crunched the numbers before a meeting with our CFO at that time. I said, if you need a minimum amount just to make a salary, this is how many patients need to be seen based on if the majority of your patients are going to be 2-up-4. It was nice to see that we don't have to see over 100 patients really just to make that salary. Then it was up to each individual. And so that helped a lot so that I didn't have to— with our software systems, it takes so much time. It delays us to be able to get through that visit and document everything. I know that's all changing with AI, which I'm trying to use and figure out a little bit for our practice to hopefully start using next week. Oh, cool.

Yeah.

So we're using the hospital-based AI. I tried it out last week. It didn't work for me, but a lot of East Alma employees are using it. And it's working. So I'm going to try that out again this weekend. That way I can get everything that I say in my note along with the patient. You're going to have a little bit more of a comprehensive note, and some of the assessment plan and our recommendations are going to be laid out. And that will help us get through the note and see more. And what I've also realized, at least for primary care, there's a big push for preventive health visits. And I would agree. And I think after COVID, things changed a lot. We're just seeing a lot more people unhealthy. And I think that we were doing all those preventive health measures, cancer screenings, vaccinations, discussions, goals, getting your goals for blood pressure and diabetes and all of that, and closing gaps in care. So I think that just became even more of a priority for insurances, Medicare and commercial, and therefore our hospital. They want us to do all of this for our patients.

Yeah.

And when we do, it takes more time. And I thought, Let me try it out and try a different method. Let me make sure with each of my patients I schedule that, but also have routine visits. Because in preventive healthcare, if you discuss a problem, then the patient gets billed. And I didn't want surprises for the patients either, especially the older patients. They don't— even the younger ones, they're like, this is my wellness visit. I don't want to pay anything. And I said, that's fine. But if you want to discuss, I'm going to give space for you. So then I gave a trial run to see Am I going to make enough that the hospital wants me to make for them in terms of their RVU for my salary? And I tried out in the last quarter what I do, and then I don't use that same spot to do 2 visits. I use 2 spots.

I know.

So you're going to see less in a day. And I didn't lose anything. In fact, in the last quarter, this is the most I've made in the past couple of years.

Wow.

I was surprised because they want us to do this. We're closing the gaps. I space it out so that especially my older, my Medicare patients, now with commercial, it doesn't take me that long, so I don't need to do that, but I make it 2 visits and the patients are always going to want, most of the time they want me to take care of their other issues and it didn't compromise that. And I finally got to spend that time with the patient. They can discuss anything they want with me. My medical assistant, who's also an LPN, She doesn't have that much load. She could do those questions that are needed initially, then she has that time and space afterwards to do calling patients back. And I didn't compromise care for the patient, and the hospital's happy that we're closing these gaps, getting preventive health measures. I think even this year, Medicare's even giving more than that and more incentives. So I gave it my about 3 months' try, and I made more than I, in these 3 months that I have, in the past, I don't know how many years. It's probably the most I've ever brought in terms of RVUs.

Wow.

Without, without compromising care and seeing less patients.

Yeah.

I think it's cool that the impetus for this was when you were sitting down and working with a hospital about the number of patients you were going to see and what was going to meet those benchmarks. Was the impetus for you to take this deep dive and actually look at what this reimbursement was going to look like. And not even just reimbursement, but you actually took that extra step as part of negotiating and working with the hospital of how many patients is this? What does my day look like? You actually made it very practical.

Right.

And I think that's one of the biggest things that people, when they're walking into negotiation and especially women, We don't always walk in there with that armamentarium of knowing exactly, this is the reimbursement, this is what I need. But you said something also really cool as you were talking about all this, which was, it wasn't even just a negotiation about you. It was a negotiation about what that day was gonna look like for your patient. You kept that a priority in the negotiation. And I think that's such a great perspective, 'cause a lot of times when we talk about negotiating, we talk about things. And it can feel or come across as being very selfish or very one-sided. I'm negotiating for me. But as doctors, we're never just negotiating for us, right? We're always negotiating for the patient too. Those two are absolutely connected. So I love the fact that you made that part of your deep dive. What is that experience going to be like for the patient?

Now, I have dealt with our administrative for other job duties. I was a medical director at the nursing home. It was Taking too much time out, and I couldn't balance all of that. I had to really think, is this all worth it? Because there's a difference in payments in different states and crossing over to the border to another state, just in Georgia, the reimbursement's higher. And I had to then decide in 2017 when I had to renegotiate my contract, I brought that up to the table because I was able to do that math. And I had talked to my colleagues who are also hospital employees. And I said, look, I couldn't reconcile within myself to not bring this up to them. When I worked with admin, I work right at the border of Alabama and Georgia. And if I crossed 1 mile over, I would be in Georgia. The pay was going to be so much different with the same number of people. So that meant to me, I could see less and just be able to have that quality of life, just to be able to be home with the kids. Take care of my own health. And I brought that to the table. I do want to let you know that it will be hard to stay here if knowing I go 1 mile further, which isn't much of a distance at all, and I can still live in my same community, in the same house, my kids can go to the same school, and I will have a different reimbursement. So they took that into account. And I think for all the next hirees, they changed the pay rates.

Wow.

Yeah.

Wow.

Oh no. Because I was shocked because we had some new docs when I went into our new area and by the Valley Area Primary Care, when I joined that bigger group and that it's, nobody talks about salary, but it was quite transparent how much primary care in general would get and salary. It was supposed to be fair and it was much more, but it was the same pay that they had for me before I even joined them. But I said, I cannot— I don't think I can stay here. And I was ready to walk. So, I knew— I think at that point, I had already realized my worth just as a fair pay rate. I wasn't getting paid fairly, and I couldn't do that anymore. So, I was ready to walk, and I was just— and I was only going to go a mile down. And so, they changed it for me, but then they changed it across the board for entering.

Oh, wow.

Yeah.

That's incredible.

I, I was shocked because I thought it was only me that they changed it for, but then I, when I went into the negotiation or when I went into the talk with the CFO, he said, this is what we're gonna give as the base salary.

Wow.

Yeah.

One of the things that you mentioned before we started recording, and I wanted to make sure I came back to this because I thought this was just amazing. So often as physicians and especially as women, we're not really given tools to negotiate. We're not taught how to do that. Unfortunately, sometimes we are eager to please. We want to acquiesce. We don't really want to, even though we have priorities and things that we really feel like we need and would be beneficial to us. And we also deserve, I think that's the word sometimes we don't always use. You grew up with a father who taught you how to negotiate, right?

He is, he's an engineer by trade. He does food engineering. His math skills are amazing. And I'm such a math geek. Lucky. I'm lucky. That stuff was so easy. But when we had to win an argument with him or convince him to allow us to do what we wanted to do, we had to leave emotions out of it. And so it had to be very, we had to do the research, we had to calculate it out. And one of the important things he said, he's, you may get my permission, but you don't always have to have my approval. And so that stayed within me. A lot of times, like you say, we're always trying, so eager to please. And to get approval, not only just from our colleagues, our patients, and everyone else. And it can be just our— either it's our race or our gender, it could be a mix of all that, our upbringing, whatever it was. But he had said that to us decades ago. And so I had learned through him how to win an argument and to get things done. So that's what I brought to the table because it was black and white and they knew it. And so I wasn't going to lose anything because I wasn't going to lose my house or the kids are still going to be in school. I would just go somewhere else. And I was okay with that at that point. But they came back and they understood and they realized, they even said, yes, we know that there is that discrepancy. And I had done that research before I went in. So they realized it, but they were okay then to make those changes. I had to realize I don't always have to, and that's a hard thing to feel like you don't have to please.

Yeah.

And you don't have to keep proving yourself or get somebody else's approval all the time. It's okay if somebody doesn't like you all the time. And that's tough sometimes, right?

Because—

And certain employed physicians, they have all those ratings from the patients as well. We're in an underserved area as it is. Our clinic this year also got one of those ratings that it was one of those clinics that got the star ratings from the community. So I think we were— that's— we're already there. We didn't have much competition. And so they're happy that we're there, but we still need to provide good care. And I think if we can work out more time for them, they're older, and really help them do that with us also getting that reimbursement for all that time we've done, I think they finally realize primary care does a lot of things behind the scenes. We're not using the fancy equipment all the time, but there's a lot of organization for home health or hospice or coordinating the care or looking at patients who are discharged from the hospital. So because I've changed my schedule to give a buffer and give enough time, anytime somebody's discharged from the hospital, it comes into my system and I can see them within a week with ease.

Wow.

And that's a bigger pay rate too. They want you to do that so that the patients don't get back in the hospital. Then I see when they get discharged and we have a system in our office to contact them, make sure everything's fine. It's medications that usually change. And they're a lot of time older and they get very confused. So if I get them within the week, I have them bring their medicine, I give myself enough time, and then it helps to decrease that readmission. And when I went into negotiations, I think I had to be smart about it to say it's for patient care. If I focused on me to say it's just for me, I don't think that would be important enough for them. For them, it's the bottom line. It's still a business. So if they feel like it's patient-centered and it helps the hospital in terms of reimbursements, that's really what I knew was going to be able to help. I had to keep all of that in mind. So one of the—

when you are a master negotiator, I don't know if you realize how good you are at this, but let me just go ahead and tell you, you're amazing. One of the biggest pitfalls people fall into with conflict resolution or negotiation is the concept that there has to be compromise, that everybody has to agree across the board. I love it that you did not fall into that. And you, when you talked about how your dad said, I may allow something and not agree with you, the household doesn't, doesn't have to agree with what you're asking for. When you justify, I can go a mile across the border and I can make 30% more than what I'm making with you right now. They don't have to agree with what you are asking for to know that what you're asking for is not only legitimate, you have a viable option. You can walk without losing your quality of life or the quality of your family's life. And when you lay that out, and also too, I love the fact that your dad talked about doing that without emotion. You're not pounding your fist on a table.

You don't have to.

Your words and your numbers, numbers are powerful in any kind of negotiation, but your numbers spoke for themselves. I think the other thing you did that was so smart in that negotiation is that you presented this Very rightly so, is this is not just about me. This is about the patient. This is about the things that we're providing to keep the patients out of the hospital, which means that's going to be less of a ding for you guys. That the way you presented this to them was, you don't have to agree with me, but you do have to understand that my position is powerful. And it's not just powerful for me, it's for the patients I speak for and I treat. You literally gave them no reason to say no to you. You walked into that negotiation and there was no way they could legitimately say no to you. Now, they could have said no to you, but there would be no legitimate reason why. The only reason why they would've said no is they just didn't wanna pay you. And at that point, they would've had to cop to that. But when you walked in there with all of this data, very clear in the reasons you were asking for what you were asking. And being able to do that without any kind of emotional investment from that standpoint, from where you were coming from, you're at that point, you've already won the negotiation. You have already won. And sometimes you're going to walk out of those things, especially as a physician negotiating an employment contract. You want to be the winner. This is not about making everybody happy. And I loved it that you went into it with that in mind. And I think that's such a huge lesson. Again, doctors are not tough to negotiate. And there's a large percentage of us that are people pleasers that, you know, I'm going to walk into a room and I'm going to feel the vibe and I'm going to want you to be happy with me when I walk out of it. And that's not really important because my quality of life has nothing to do with your happiness or mine. It has to do with my quality of life is mine. And if I am responsible for that, then I'm going to negotiate in that way. You did that. And that is so huge. That is the kind of thing that you have a daughter who's thinking about going into medicine. So this is going to be the kind of thing that she's looking at. She's looking to you now as a role model. And because she has you as a role model, she is always going to have the power and ability to negotiate for herself. What an incredible—

I feel the same way in terms of whether it would be my son or daughter, but for some reason, I also feel that pull to help Us female physicians, I feel like sometimes there can be a mentoring, and I feel like still our field, there can be more. When we walk into some of our organizations, there can sometimes still be— I don't know if it's changing now, but the mentoring was always— a lot of times it was a male mentoring another male. But I do appreciate Dave Fagan pulling me to go in with the CFO because I was, you know, I was helping out my father-in-law in our previous clinic. And I did a lot during COVID how to organize that for us, and had talked about it when we weren't in the same building. But I do appreciate him doing and pulling me in with him, which was great. And he does give a little— he gives that mentorship. So I can do the math part of it.

Mm-hmm.

And he does a lot of the other stuff too. So I do give him credit for having me come up with him. And then that way you can just lay it out. And I said, we can see this many patients. And now with each year when things change, we have the hospital Admins come and say, these are the changes. And that keeps going into calculations. We have— right now, there's a nurse practitioner who just started. She's got 2 little ones, both under the age of 3. And I'm like, I know she's tired. And I said, this is what I've done. She said, maybe you just cracked the code. I said, look, I haven't seen admin upset with my numbers of patients that I'm seeing. I still see a decent amount. And they haven't been upset with my RVUs because it's more than it was before. No one has said anything in any negative way. She said, maybe you just cracked it. So I see her making that change for herself. So that she can get in time and enjoy that with her family. I think that's where we help each other out. The more we learn, then we just keep passing it forward. And like, maybe that'll— who knows what'll happen when our following generations are going to go on. I don't know how much that'll change, but I think the more you learn about all aspects of it, then you have more in hand. I did step down from that directorship because I also felt like they were 2 directorship duties, and I wasn't getting paid for 2 different types of duties.

Mm-hmm.

Our cost of thrive the year I was director, we were recognized in Newsweek as one of the top nursing homes. And I thought that would have enough for them to give me that fair pay. And they did not want to find another director. And they kept trying to string me along. And I do feel a lot. I don't bring that to the table, but I do feel a lot of perfectionism. I didn't want to let them down, so then I Finally had to and said, I will see patients, but I will no longer do the directorship because now they incorporated a SNF unit in there. It was too much. And they agreed that the next director should get paid more. They wouldn't be— I said, I will stay on for the next couple months for you while you find somebody you want. They found somebody, but they didn't like them. So they just wanted me to stay on. So I said, I need that pay and I need some back pay if you want me to stay another month. And they wouldn't do it. So I just ended it then. They didn't agree to all my terms, which was fine, but then I'm happy for it and I'm fine.

You knew enough about your priorities and enough about what you're worth. You knew what your time was worth. You knew what you were willing to give to that responsibility. And it was not going to be commensurate with what you were putting into it. And you recognized that and you walked away from it. That in and of itself, again, is a very successful negotiation. Because you said, this is what I'll accept. And then you set that line and it's, I'm not going to accept anything but this.

I love it.

And I think it's so great that Dr. Fagan was a great mentor to you and encouraged you. And I feel like I've definitely had that with some male physicians. The only reason I'm in robotics is because of Rishi Rajan, because he called me and said, hey, this is coming and I want you in it. And if it wasn't for him, I wouldn't have been with the start of Robotics East Alabama. I do think That, and I agree with you on this, that sometimes because medicine, as we were coming up, was a much more male-dominated entity, most of those mentors that were going to go out of their way to find us were men. And I think about my dad, who was a physician. He was always very into mentorship, but he had a daughter. I think men who have daughters, female relatives, sometimes they got a leg up on being a mentor to other women because They were doing it in the home. But now that we are getting into that point where we are in our careers, we've had life experiences that we have successfully negotiated and structured our lives, that we have balance and we had appropriate reimbursement, that we do wanna mentor other younger women. We do want to have them, you know, benefit from your experiences. One of the things I'm hoping will come from this podcast is that there's going to be medical students and residents that are gonna listen to this and go, oh wow. Look what Dr. Kamath did. Look how she negotiated all of this. I can do that too. And so you are actively mentoring people just by being here today, which I so greatly appreciate. I think going forward in terms of negotiating, is there anything else that you would, if you were going to share this, you were talking to a younger resident, a younger physician going out into practice, what other tips would you give them? In terms of their negotiating contracts and trying to structure that life so it actually reflects the effort they're putting into it and what they want from a call?

I honestly feel like the younger generation is probably better at going into things with the goal of a better work-life balance. And I think that shift happened after I left residency. It was more, you just gotta do it. You just gotta do it. They've done it. Work so many hours and you, this is just part of it. And I see the difference where they do advocate for themselves more. So I think coming into it, they already have that. But I think as I'm getting older, what is the goal anyway? There's so many balances. It's your work, it's your health, it's your family, it could be spirituality. You just, you need to figure out what your goals are and then how that fits in.

Mm-hmm.

And then you can figure out how the day will work for you and patient-wise and schedule. And I think hospitals are probably going to be able to be much more flexible, I think, years to come, because I think this population, you've talked about it, I think they already go into advocating for themselves much more than we did, for sure. Good and bad.

Yeah.

I would say, before you sign anything, try to vision what is your goal. And for me, that goal is, what is my today? What is my tomorrow? How is my after-work life? How am I going to be able to get out? And is this enough? Is this enough for my needs? And more than that, am I going to enjoy life? You just figure out what your goals are and is that going to meet it? So before you go in, before you go into any contract, just thinking, what are your goals in terms of what you need financially for the type of lifestyle? Is that going to meet it? And then sometimes I go in thinking, what is the minimum I want to work to be able to have that life and enjoy what I do? Instead of saying, I want to make so much, what is the minimum I really have to do just to be able to do this so that I have more for life outside of work instead of it being only focused on balancing work. So I would say, go in thinking, what are your goals first? Work, life, possibly family, anything else. See if that fact is going to work for you. And is that schedule going to work? And ask to see if they could be flexible because I think they will move towards that. That's my gut.

Absolutely. I love how you structure that in terms of it's a micro kind of day-to-day thing, and then a macro in terms of what's the minimum I'm gonna work? What was my next level? What's okay, this is about the maximum that I can have and have quality of life. So you've really got that structured in such a way that it's not even, again, it's not a target. It's not, I wanna make X. It's not that at all. Right. It is, this is a minimum, this is a maximum, and this is what my day looks like because ultimately that's what's important. What is my day-to-day life going to look like? I can negotiate a lot of money, but if I'm miserable in my day-to-day job, and if I'm having to see X number of patients, I'm getting home at 7 o'clock at night and I haven't done my notes yet. Is that really justifying what I'm having to, what I'm doing or what I'm getting financially? I love how you visualize that and you emphasize visualizing that you can actually feel how that's going to feel. What's my, what's that day going to feel? I think that's beautiful.

Yeah. That took some time this past year. But I've gotta say, this is the best I've felt in a really long time. I think I have that balance. I was just telling you before, hair is wet cuz I, every Saturday morning I hit the gym. I wanted a trainer. I wanted to feel good. I have time for the kids today. My daughter has prom next week, so we're just after this, we're gonna go to pick her dress.

Oh.

My notes are done. I've been struggling for years and the notes are done and Good things are about to come. I'm always going to keep learning. AI is now available for us. I'm going to practice that this weekend and do it next week. Just, you just have to keep learning all that. So I feel like if we have each other to kind of say, who knows how to do it, pull the strengths from everybody. I'm always willing to learn. And if someone can do it better than me, I will learn from you.

You are so amazing. You have such a beautiful, humble, but yet very strong and very informed and knowledgeable presence. And I just love that. And I love that you are giving this information. So Mona, thank you so much for being on the podcast. Thank you for your time. Thank you for being able to share your wisdom with the listeners. I think that's going to help them a lot. And I hope that you will not just mentor Moni, but I know you're going to mentor a lot of other people as well. Because this is the thing that happens, and I will say this, that as your daughter gets into school and beyond and she says, oh, my mom would know this, and she's going to be able to share that wisdom with other people. You're going to start getting calls from her friends. Hey, Dr. Mona, what'd you do with?

How'd you do with?

And then all of a sudden, you're going to have this whole new group of women that you're going to get to mentor because of her. And I can definitely see you being a blessing to a lot of things.

You have too, Lee. You're always advocating for us, and I think we need to keep doing that for each other. In medicine, there's not as much of a glass ceiling anymore. Then we have to figure out what's best for us. I think the mentors are each other now at this point, right? So thank you.

Thanks for.

Doing this to help everyone else, and hopefully this will help others down the road.

Have no doubt that it will. Thank you so much, Dr. Madhavakshi. Thank you for being on the podcast, and thank listeners for being at the scalpel and sword today. We look forward to seeing you next time. Bye bye.

Every episode is an invitation to speak, to negotiate, to choose. I'm Dr. Lee. Join the dialogue by subscribing to Scalpel and Sword. Until next time, peaceful warriors, may your choices be sharp and your voice be even sharper. This podcast is a reflection of lived experience and research in conflict resolution. The Scalpel and Sword is not intended as medical or legal guidance. For personal matters, please consult a qualified professional.