From what a manager told me, the patient population at the county can be shocking to those unfamiliar. It's the underserved of the underserved so by the time they get to the hospital, they are complex cases. There are language barriers, homelessness, mental health issues, substance abuse, lack of support, jail patients, etc. I went to County school so did all my clinical rotations within the system. For me, it was fulfilling to serve people who really needed it. I'm trying to get a job there now. But I can definitely see why some wouldn't want to work there. Also, private hospitals pay more, though benefits at the county are better. That's the only perspective I can offer.