-Middle management is retaliatory, almost prosecutorial at times if you express discontent or request accommodations
-Very little opportunity for advancement, raises and bonuses are non-existent and promotions are rare
-Executive leadership finds it easier to cut expenses by cutting employee benefits and compensation than to do anything else
-Constant changes made without feedback from member-facing teams
-Lack of consistency in policy and procedures lead to worse outcomes for patients and there are glaring patient safety issues