Dialysis is truly hard work at all levels. DaVita has experienced a lot of growing pains as leadership continues to find new ways to expand our business and achieve clinical excellence without losing the "small business feel". Most of the cons I have experienced relate to tightening budgets (caused in part by governmental reimbursement cuts) and increased workload for those who are strong performers. As with any large organization, you will find hiring processes take longer than they should - and shouldering the additional load during the extended hiring process can be quite difficult and even draining. Clinical budgets are mostly set by others and can be difficult to meet. At times it is hard to sort out top priorities with all the tugs and pulls of striving to be a provider, partner and employer of choice. As a healthcare provider, your DaVita experience can be swayed rapidly by nursing shortages, teammate turnover, and difficult patients. I have found this varies by geography and is cyclical in its nature. Compensation could be improved at multiple levels. Promotions aren't necessarily tied to compensation increases. New initiatives are difficult to manage as they come fast and furious - the inbox is never empty.