The midlevels are underpaid. If one is a midlevel, can never be a partner like the MDs or DOs, only employees. The focus is on productivity. If a site is "slipping" regarding this, then upper management steps in and the work environment suffers. It is impossible to please patients 100% of the time, but if the provider,, whether he/she be a midlevel or physician, has a consistent "poor patient satisfaction review,", there will be consequences, sometimes severe. If a site consistently is not profitable, they will withdraw from that site. Ultimately, it's all about money, as in many other companies rather than making the world a better place. Management will often be quite secretive about current situations or issues and will consistently keep you in the dark. CEP will go to great lengths to keep a contract despite the humans that keep that contract with a hospital functioning.
