I place much of the blame on the hospital administration. They basically hold hostage the careers of their staff and are more willing to set up questionable policies to pull funding into the clinic. They also use it as a way to self aggrandize their own accomplishments. It becomes a positive feedback loop. Create kids who need to be transed, require more funding, require more staff, require bigger salary for managing more staff, use salary to imply your own knowledge and importance, insist on more capacity at the clinic to bring in more kids... Repeat.