I work for a community health center and am part of a two person IT team and we support 3 sites, all three using Citrix . We have a single Nextgen Project Manager. We have a combination of Custom and stock templates. Yes NextGen does initially lower production and if I remember correctly they do tell you that. What we have found is better documentation and once the providers get used to it they like it rather well. No it isn't perfect but as far as I can see it is way better than anything else I have seen out there. We are getting ready to go through a major upgrade, and yes it is a lot of work, but if planned out and done correctly everything goes well. The real pain is a KBM upgrade. Difficult due to the custom templates and field changes in the upgrade, but again if planned correctly it goes fairly smooth. SO what I am seeing is disgruntled or poorly trained people here. No I am not accusing anyone of not being dilligent o anything like that, but after reading all this I just don't understand it.