This working paper synthesizes critical problems identified by interviews with more than 40 leaders in the Boston area health care industry and places them in the context of work and family issues. At present, the defining circumstance for the health care industry nationally as well as regionally is an extraordinary reorganization, not yet fully negotiated, in the provision and financing of health care. Hoped-for controls on increased costs of medical care have fallen far short of their promise. Pressures to limit expenditures have produced dispiriting conditions for the entire healthcare workforce. Under such strains, relations between managers and workers providing care are uneasy. Five key issues affect a broad cross-section of occupational groups, albeit in different ways: staffing shortages; long work hours and inflexible schedules; degraded and unsupportive working conditions; lack of opportunities for training and advancement; professional and employee voices are insufficiently heard. The paper concludes with possible ways to address such issues.