I also found it difficult to reconcile a corporate-economic paradigm with a clinical one. The managed care mentality had even changed the language I was so accustomed to. In meetings we were now using terms such as "outliers," "market share," "product lines," "penetration rates," and "assumption of risk"—but referring to risk in economic terms, not clinical terms. I thought myself transported to a foreign land against my will. I felt betrayed and angry about this dramatic shift. I also began to feel devalued as a clinician, perceiving my clinical skills as inferior to the prevailing business skills. To survive here, I would need to convert my M.S.W. to an M.B.A. And most of what I felt and thought, I internalized, which is my nature. I was, in essence, losing my clinical center.