Upper leadership often comes across as cold and caring more about money and adhering to rules than the effects these decisions have on the team on the floor and the patients they serve. I don't think that is truly the case, but that's how their actions often read. Some community programs have suffered due to seeming shift in nonprofit portion's mission lately. High turnover, often due to burnout (emergency medicine is stressful). Clients are almost always very stressed and emotional, and sometimes have unrealistic expectations of cost of emergency care/DoveLewis' limited charity funds. This can create stress for employees as well. Working at a nonprofit is not going to make you rich- it's rewarding work, but not necessarily financially.