While there is concern about harmful queue-jumping by people who pay to get to the front of the queue, the second tier allows people to use their own money to leave completely queue and seek your choice of care. This creates an efficiency gain as individuals who remain in the original queue can move forward in place of those who left the queue to enter the second tier. In addition to the benefit of increased efficiency, new jobs and opportunities are created as new businesses open. As private practices open, jobs become available at various levels such as maintenance, internships, administration, and healthcare professionals. These practices also allow students to gain experience in smaller medical settings. Support staff is extremely important when running a busy practice, and as a result, private practices hire many people to fill employee, associate, and partner positions to help the practice run smoothly (PPA, 1998). The second level exploits the flaws of the public insurance mechanism to create a new system of opportunity and efficiency, for the benefit of overall healthcare and all citizens.