Corporate focuses attention toward large and specialty hospitals. Difficult to retain clients due to high total invoices. Veterinarians and support staff pushed to only offer "best medicine" which is usually way beyond what clients can afford. High employee turn over rate due to low wages. Corporate, or "home office", creates "alliances" with vendors and restricts how patients can be treated. More and more upper level employees have absolutely no animal care experience and only care about increasing profit. As a hospital manager or medical director, you have to bend the rules to keep good employees and clients. As a hospital manager of a smaller hospital, you have to due the work of a business owner without the rewards. This includes 50-80 hour work weeks and always being on call. Large hospitals can "afford" to hire management support such as bookkeepers, department leads, inventory managers and maintenance workers.