Lewis Mehl-Madrona: Clinic Restructuring I work part-time in a community mental health center in New York. Recently New York's Office of Mental Health has restructured clinical services. I write about what that has meant for quality of care, which inevitably goes down. I argue that this is inevitable in a "fee-for-service" system. I argue that the alternative is to pay physicians to care for panels of people and to do the best job as they see fit for these people.