They keep MAs that are known to do unacceptable things such as invent vitals. The MA I had was passive-aggressive, didn't have much initiative, but you know if you complain they will only give you a worse one. Pay isn't that great considering I had to donate usually 2 hours of my time every day after work to review labs, imaging studies, refill meds, finish charts, and then sometimes 4-5 hours on my days off to finish charts. Patient volume is quite a lot for primary care, and patients that need to be seen right away can be squeezed into an already full schedule. The clinic caters to a lot of pain management/psych patients with chronic conditions.