I work in a family practice with 5 MDs, and 12 FNPs. We have an active patient base of app. 9000 patients; not only do we provide for the "standard" scheduled patients, but we also have a walk in acute care clinic. In our community (primarily rural), we provide a full range of services, chronic disease mgmt, peds, women's health, etc. Having been with the practice for 6 years, we have struggled with being able to provide "quality patient care" and yet make a living for our families. The practice is independent of any hospital system and the senior physicians make sacrifices to see that their staff is adequately compensated. I'm quite sure if we all gave our definition of quality patient care, we might come up with several different ideas of what that exactly is. For me, in addition to many other facets, this involves serving as a patient advocate in a society that allows insurance companies to dictate patient care. Helping our patients to navigate through a sea of papaerwork was not what I bargained for when I went to nursing school. Nonetheless, it is reality. I don't see the doctors I work for making "big bucks". I do see ordinary, hardworking people trying to make a living, taking care of ordinary, hardworking people. We have also over time, come to an agreement, that I will always be a patient advocate, even if that means "redirecting" the focus of the doctor to the needs of the patient instead of his/her own. This has created for us, and environment of mutual respect and pride in the care we choose to deliver. It is quite ashamed that doctors (and nurses) get caught up in making a buck, or complaining about the system, that we forget that the bottom line is working within the framework we have to see that our patients get what they need, while simultaneously changing the system from the inside.