Third, our data indicate that poor supervisory relationships often develop with providers perceived as insufficiently skilled. Providers performing poorly may experience low marks and negative feedback, which by itself does not seem to induce a change in practice. A notable reaction from some providers is to avoid supervision. A dilemma of supervision inequity may emerge, where those most in need of supervision are those most unlikely to benefit from it. This indicates that at least for a group of providers, rewards (which in their absence may be perceived as punishment) may be an ineffective power source and evoke fear and experiences of repeated failure. Our data imply that these providers often perceive the support system to oppose rather than meet their need for meaningful supervisory relations to guide their professional development, so that their competence and autonomous motivation remain unstrengthened.9 In response, any supervisee indeed has the power to reject the role as learner.15 Constructive attention towards providers with performance difficulties thus appears necessary for facilitating improved practice.