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Employment Agreement - Medical Care America Inc. and Donald E. Steen

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                             EMPLOYMENT AGREEMENT

     This Employment Agreement is entered into on November 15, 1993 by and
between Medical Care America Inc., a Delaware corporation (hereinafter referred
to as "MCA"), and Donald E. Steen (hereinafter referred to as "Employee"),
with reference to the following facts:

                                   RECITALS

     A.  MCA desires to employ Employee in the capacity and on the terms and
conditions hereinafter set forth and Employee is willing to serve in such
capacity and on such terms and conditions.

     B.  This Agreement shall replace the Employment Agreement dated March 1,
1993.

     NOW, THEREFORE, it is hereby agreed as follows:

                                   AGREEMENT

     1.  Employment. MCA hereby employs Employee as Chief Executive Officer of
         ---------- 
MCA.

     2.  Duties. During his employment, Employee shall devote substantially all
         ------
of his working time, energies and skills to the benefit of MCA's business.
Employee agrees to serve MCA diligently and to the best of his ability. In his
capacity as Chief Executive Officer of MCA, Employee shall report to the Board
of Directors of MCA and shall have such duties, responsibilities and authority
as are set forth in the By-Laws of MCA for the position of Chief Executive
Officer. In his capacity as Chief Executive Officer, Employee shall have
authority to hire such staff as Employee determines is necessary and to
determine the titles and compensation levels of such staff.

     3.  Compensation. Employee's compensation under this Agreement shall be as
         ------------
follows:

         (a) Base Salary. MCA shall pay Employee a Base Salary ("Base Salary")
             -----------
of $495,000 per year. In addition, the Board of Directors of MCA shall, in good
faith, consider granting increases in such salary based upon such factors as
Employee's performance and the growth and/or profitability of MCA, but it

                                      1.
<PAGE>

shall have no obligation to grant any such increases in compensation. Such Base
Salary shall be payable in equal semi-monthly installments on the 15th day and
the last working day of the month, or at such other times and in such
installments as may be agreed upon between MCA and Employee. All payments shall
be subject to the deduction of payroll taxes and similar assessments as required
by law.

         (b) Bonus. In addition to the Base Salary, Employee shall be eligible
             -----    
to receive bonus compensation in such amounts and at such times as the Board of
Directors of MCA shall, from time to time, determine.

     4.  Expenses and Benefits. Employee is authorized to incur reasonable
         ---------------------
expenses in connection with the business of MCA, including expenses for
entertainment, travel and similar matters. MCA will reimburse Employee for such
expenses upon presentation by Employee of such accounts and records as MCA shall
from time to time require. MCA also agrees to provide Employee with the
following benefits:

         (a) Automobile. An automobile expense allowance of $1,000.00 per month
             ----------
to apply towards the cost of acquiring and maintaining an automobile for his use
in performing his duties hereunder, subject to periodic increases by action of
the Board of Directors.

         (b) Insurance. Major medical health insurance and disability insurance
             ---------
as currently in place.

         (c) Financial Planning. An allowance for financial planning and tax
             ------------------
planning of $2,500.00 per calendar year.

         (d) Fitness Allowance. An allowance of $1,000.00 per calendar year for
             -----------------
fitness dues or equipment.

         (e) Employee Benefit Plans. Participation in any other employee benefit
             ----------------------
plans now existing or hereafter adopted by MCA for its employees.

         (f) Other. Such items and benefits as MCA shall, from time to time,
             -----
consider necessary or appropriate to assist Employee in the performance of his
duties.

         (g) Vacations. Employee shall be entitled (in addition to the usual
             ---------
public holidays) to a paid vacation for a

                                      2.

<PAGE>

period in each calendar year of four weeks, to be taken at such times as may be
approved by MCA.

         5. Term. The term of this Agreement shall be from the date of this
            ----
Agreement to November 15, 1996, and shall thereafter be automatically renewed
for successive two year terms; provided, however, that either party may
terminate this Agreement at any time upon at least 60 days prior written notice.
A determination by MCA to terminate this Agreement may be made only by an
affirmative vote of not less than 75% of the members of the Board of Directors
of MCA then in office. In the event of such termination by MCA, Employee shall
be entitled to severance pay based on his Base Salary at the time of
termination, plus a bonus (payable monthly on a pro rata basis) at a rate equal
to the average annual bonuses paid to Employee for the two calendar years
preceding the date of notice of termination, for a period of 24 months following
termination or until November 15, 1996, whichever is later. Such severance pay
shall be payable in monthly installments and MCA shall continue the benefits set
forth in Sections 4(a) and (b) for the period during which such severance
payments are to be made. In addition, this Agreement shall terminate as provided
for in Section 7 or upon the death of Employee.

         6. Disability.
            ----------
           
            (a) In the event that Employee becomes Permanently Disabled (as
hereinafter defined) during the term of this Agreement, Employee shall continue
in the employ of MCA but his compensation hereunder shall be reduced to three-
fourths of the Base Salary then in effect as set forth in Section 3(a) hereof,
commencing upon the determination of Employee's Permanent Disability and
continuing thereafter until the first to occur of (i) 36 months or (ii) the
death of Employee; and during such period of time, Employee shall not be
entitled to payment of expenses or benefits specified in Section 4 hereof
(except for reimbursement of expenses incurred by Employee prior to becoming
Permanently Disabled), except that MCA shall continue to provide Employee with
the insurance benefits specified in Section 4(b) hereof. The obligation of MCA
for continuation of three-fourths of Employee's Base Salary shall be net of
payments to Employee from the disability insurance referred to in Section 4(b)
hereof .

         (b) Definition of Disability. For purposes of this Agreement, the terms
             ------------------------
"Permanent Disability" or "Permanently Disabled" shall mean three months of
substantially continuous

                                      3.
<PAGE>

disability. Disability shall be deemed "substantially continuous" if, as a
practical matter, Employee, by reason of his mental or physical health, is
unable to sustain reasonably long periods of substantial performance of his
duties. Frequent long illnesses, though different from the preceding illness and
though separated by relatively short periods of performance, shall be deemed to
be "substantially continuous." Disability shall be determined in good faith by
the Board of Directors, whose decision shall be final and binding upon Employee.
Employee hereby consents to medical examinations by such physicians and medical
consultants as MCA shall, from time to time, require.

     7.   Termination by MCA.  MCA shall have the right to terminate Employee's
          ------------------
employment as hereinafter provided.

          (a)   Termination by MCA for Cause.  MCA shall have the right to
                ----------------------------
terminate Employee's employment under this Agreement for Cause by an affirmative
vote to so terminate by not less than 75% of the members of MCA's Board of
Directors, in which event, no compensation shall be paid or other benefits
furnished to Employee after termination for Cause. Termination for Cause shall
be effective immediately upon notice sent or given to Employee.

          (b)   Definition of Cause.  For purposes of this Agreement, the term
                ------------------
"Cause" shall mean and be strictly limited to: (i) conviction of a crime
constituting a felony under state or federal law; (ii) commission of any
material act of dishonesty against MCA; or (iii) willful and material breach of
this Agreement by Employee.

     8.   Definition of Change of Control.  For purposes of Section 9 of this
          -------------------------------
Agreement, "Change of Control" shall mean: (i) a change of stock ownership of
MCA of a nature that would be required to be reported in response to Item 6(a)
of Schedule 14A promulgated under the Securities Exchange Act of 1934, as
amended (the "Exchange Act") and any successor Item of a similar nature; or (ii)
the acquisition of beneficial ownership, directly or indirectly, by any person
(as such term is used in Sections 13(d) and 14(d)(2) of the Exchange Act) of
securities of MCA representing 25% or more of the combined voting power of MCA's
then outstanding securities; or (iii) a change during any period of two
consecutive years of a majority of the members of the Board of Directors of MCA
for any reason, unless the election, or the nomination for election by MCA's
shareholders, of each director was approved by a vote of at least two-thirds of
the directors then still in office who were directors at the

                                      4.

<PAGE>

beginning of the period.  Notwithstanding the foregoing, no Change of Control
shall be deemed to have occurred in connection with any merger or similar
transaction to which MCA is a party if at least one-half of the members of the
Board of Directors of the ultimate parent corporation of the surviving corporate
group consist of persons who were members of MCA's Board or on the date hereof
or persons elected or nominated for election by such persons.

     9.   Stock Options.  In the event that MCA elects to terminate this
          -------------
Agreement pursuant to Section 5 or there shall be a Change of Control of MCA (or
in the event MCA breaches this Agreement by termination of Employee without the
notice required under Section 5 or without Cause under Section 7), then MCA
shall amend all MCA stock options held by him and all restricted stock awards
made to him (whether issued subject to forfeiture or to be issued when and if
they become vested) so as to (a) cause to vest, immediately prior to the date of
such Change in Control or termination of employment, all such then unvested
stock options and restricted stock awards, and (b) provide Employee 90 days to
exercise such options (or such greater period as may have been provided in the
terms of such options). In addition, MCA will, consistent with all applicable
laws and regulations, use its reasonable efforts to assist Employee in securing
independent third party financing of the funds required by Employee to exercise
all vested but unexercised stock options held by him. If such financing is not
so obtained by Employee, then MCA shall loan to Employee the funds required by
Employee to exercise such options, which loan shall be repayable one year from
the date made, will be secured by MCA's common stock purchased upon exercise of
such options and will bear interest at the prime rate (floating) of Bank One -
Texas, N.A. To the extent that MCA refuses or is unable to comply with the
provisions of Section 9(a) hereof, the time period contemplated in Section 9(b)
shall commence on the date MCA complies with the provisions of said Section
9(a).

     10.  Non-competition and Confidentiality.
          -----------------------------------

          (a)   Non-competition.  Employee recognizes and understands that in
                ---------------
performing the responsibilities of his employment, he will occupy a position of
fiduciary trust and confidence, pursuant to which he will develop and acquire
experience and knowledge with respect to MCA's business.  It is the expressed
intent and agreement of Employee and MCA that such

                                      5.
<PAGE>

knowledge and experience shall be used exclusively in the furtherance of the
interests of MCA and not in any manner which would be detrimental to MCA's
interests.  Employee  further understands and agrees that MCA conducts its
business within a specialized market segment throughout the United States, and
that it would be detrimental to the interests of MCA if Employee used the
knowledge and experience which he currently possesses or which he acquires
pursuant to his employment hereunder for the purpose of directly or indirectly
competing with MCA, or for the purpose of aiding other persons or entities in so
competing with MCA, anywhere in the United States.  Employee therefore agrees
that so long as he is employed by MCA and for a period of the greater of (i) the
time Employee is receiving a salary or severance payments or (ii) the time
granted under Section 9 to Employee to exercise stock options if options are
exercised or (iii) such time as MCA is loaning money or has a loan outstanding
to Employee, unless Employee first secures the written consent of MCA, Employee
will not directly or indirectly invest, engage or participate in or become
employed by any entity in direct or indirect competition with MCA's business
(which shall include the ownership and/or operation of outpatient ambulatory
surgical centers and outpatient eye care services and alternate site infusion
therapy services) anywhere in the United States, or contract to do so.  These
non-competition provisions are not to be construed to prohibit Employee from
being employed in the health care industry, but rather to permit him to be so
employed so long as such employment does not involve Employee's direct or
indirect participation in a business which is the same or similar to MCA's
business (as defined above).  In the event that the provisions of this Section
10 should ever be deemed to exceed the time or geographic limitations permitted
by applicable laws, then such provisions shall be reformed to the maximum time
or geographic limitations permitted by applicable laws.

          (b)   Remedies.  Employee acknowledges that the restrictions contained
                --------
in Section 10(a), in view of the nature of the business in which MCA is engaged,
are reasonable and necessary to protect the legitimate interests of MCA. 
Employee understands that the remedies at law for his violations of any of the
covenants or provisions of Section 10(a) will be inadequate, that such violation
will cause irreparable injury within a short period of time, and that MCA shall
be entitled to preliminary injunctive relief against such violation.  Such
injunctive relief shall be in addition to, and in no way in limitation of, any
and all other remedies MCA shall have in law and equity for the enforcement of
those covenants and provisions.

     11.  General Provisions.
          ------------------

                                      6.
<PAGE>

          (a)   Notices.  Any notice to be given hereunder by either party to
                -------
the other may be effected by personal delivery, in writing or by mail,
registered or certified, postage prepaid with return receipt requested.  Mailed
notices shall be addressed to the parties at the addresses set forth below, but
each party may change his or its address by written notice in accordance with
this Section 11(a).  Notices delivered personally shall be deemed communicated
as of the actual receipt; mailed notices shall be deemed communicated as of
three days after mailing.

     If to Employee:      Donald B. Steen
                          5715 Thomas Court
                          Dallas, Texas 75252

     If to MCA:           Medical Care America, Inc.
                          13455 Noel Road, 20th Floor
                          Dallas, Texas 75240

          (b)   Partial Invalidity.  If any provision in this Agreement is held
                ------------------
by a court of competent jurisdiction to be invalid, void or unenforceable, the
remaining provisions shall, nevertheless, continue in full force and without
being impaired or invalidated in any way.

          (c)   Governing Agreement.  This Agreement shall be governed by and
                -------------------
construed in accordance with the laws of the State of Texas.

          (d)   Attorneys Fees and Costs.  If any action at law or in equity is
                ------------------------
necessary to enforce or interpret the terms of this Agreement, the prevailing
party shall be entitled to reasonable attorneys' fees, costs and necessary
disbursements in addition to any other relief to which he or it may be entitled.

          (e)   Assignment.  This Agreement shall inure to the benefit of and
                ----------
bind the parties hereto and their respective legal representatives, successors
and assigns.

          (f)   Entire Agreement.  This Agreement supersedes any and all other
                ----------------
Agreements, either oral or in writing, between the parties hereto with respect
to employment of Employee by MCA and contains all of the covenants and
agreements between the parties with respect to such employment.  Each party to
this Agreement acknowledges that no representations, inducements or agreements,
oral or otherwise, have been embodied herein, and no other agreement, statement
or promise not contained in this Agreement shall be valid or binding.  Any
modification of this Agreement will be effective only if it is in writing signed
by the party to be charged.

                                      7.
<PAGE>

     IN WITNESS WHEREOF, the parties have executed this Agreement as of the date
first written above.

                                        MEDICAL CARE AMERICA, INC.


                                        By
                                          --------------------------------------
                                        Name
                                            ------------------------------------
                                        Title
                                             -----------------------------------



                                        EMPLOYEE


                                        ----------------------------------------
                                                     Donald E. Steen



                                      8.