Big clinics require subsidies to run.
When I started practice in 1975, administrators worked for doctors. In 1999, it appears that doctors work for administrators. This incredible flip-flop was foreseen by Paul Starr in 1982. I can't tolerate this state of affairs myself because I didn't grow up that way, and I think ultimately it will not work. They don't seem to mind working in an environment that, to me, is completely lacking in accountability, for one thing.