However, as a midlevel provider a payment system such as described does not necessarily hurt AAs too much. AAs are "leverage" for the doctors. AAs (and CRNAs) allow the doctors to handle more cases and thus raise the income. They pay AAs and CRNAs at rate that allows for a decent profit margin. Lower payment rates would encourage more leverage, not less. Certainly having less money in the system is not good for health care providers, but AAs, CRNAs, PAs, and NPs may actually be in higher demand following the implementation of such a system.