Despite the importance of the work, productivity was consistently prioritized over clinician wellbeing. Caseloads and performance expectations were often unsustainable, with limited attention to burnout, work–life balance, or long-term sustainability. There was also pressure to stretch or work at the edges of licensing and scope-of-practice restrictions, which created ethical concerns and placed clinicians in uncomfortable professional positions. Overall, the emphasis on output and growth outweighed support for clinicians and regulatory integrity.