That said, all claims of wrongful discharge must contend with the countervailing public policy of an employer’s freedom to discipline employees, and the success of any public policy argument, therefore, crucially depends on the facts. As the law currently stands in most states, employee speech gains clear protection when the employee is identifying unlawful conditions in the workplace, such as objecting to a boss’s fraudulent conduct. At the other end of the spectrum, employee speech gains no protection when the employee is advocating for his or her individual subjective needs, such as objecting to the lack of candy bars in the vending machine. The hard cases are those in which an employee contends that his or her employer is neglecting a public (rather than a personal) need, but the employer clearly is not breaking the law. In those cases, the courts may not consider themselves equipped to conduct the balance of interests required to determine whether the employee’s disruptive conduct is worth protecting, leaving judges and juries with the default rule of at-will employment and termination. Unfortunately, patient advocacy falls squarely into this category of hard cases. When a physician-employee points out unsafe conditions for patients, he or she is not pursuing a subjective personal interest like candy bars in the vending machine but is not pointing out conduct that clearly is illegal either. Hospital-wide choices to value other goods over patient safety or even other safety and quality initiatives, particularly when those choices are necessary for budgetary reasons, are not illegal, even when they clearly cause harm to patients. In short, most cases in which clinicians’ public-regarding activities might collide with obedience to their employers are subject to state (not federal) statutes and tort precedents, and all such claims currently face the significant hurdle of fitting their facts into explicit statutory or precedential public policy exceptions (Table 1) as well as the hurdle of establishing that protection for the relevant public-regarding behavior will not undermine employers’ disciplinary freedom. Finally, although physicians might seek contracts with explicit protections for patient advocacy, such contracts are by no means universal, and other clinicians, such as nurses, respiratory therapists, nutritionists, and physiatrists, remain subject to at-will termination.