Long wait times for patients due to inefficient systems and staff out of office without adequate coverage in their absence. Toxic attitudes. Little respect for clinical hierarchy or experience. Unlicensed staff issuing clinical directives to clinical staff. NPs operating without sufficient MD support. Staff pick and choose what they want to do. Focus is on blame for issues resulting from systemic problems rather than finding root cause and solutions. Labor union too often used to shield people from accountability (workplace bullies, incompetence). Top leadership inaccessible or unresponsive. Pay not in line with industry standards. Very disorganized. Top talent not retainable.