Ah...working in primary care can feel like taking you're taking two steps forward, one step back. Or putting out fires with a garden hose...Somehow, it just never seems like you're doing enough.
It's why I left it almost entirely. But I've read your past posts and I see you are passionate about primary care, so what do you do?
I think the new policy at your job regarding possibly reducing ones pay when there are factors that are out of your control, like no shows, etc is B.S.
Particularly when serving Medicaid populations or those with no insurance, often times their life circumstances make it difficult for them to make it to care. You shouldn't be punished for this.
What type of population do you want to serve? I'm all for serving those with limited means, but understand the beaurocracy will be great. When the government is heavily involved (as is the case in FQHCs), obtaining money will be more difficult for these healthcare clinics, and healthcare facilities will make it glaringly obvious (IMHO) that they will prioritize the might dollar over patient care.
If you serve the upper class, you may have a cushier job; however this may have their own set of problems (cash pay will likely dictate, and with the backing of upper management who can pocket the money without having to claim it all, how you diagnose and treat them). You may not feel as fulfilled as you desire for helping make change like you mention.
So, decisions, decisions. Seems like, however, that you aren't happy with the change in your employers policy. And I don't blame you. If there isn't a way for them to negotiate something that is to your liking, then you know what you have to do.