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Physician Practices Survey Template

Physician Practices Survey Template offers questions for evaluation of hospital and the services provided. This sample can be edited by the survey maker according to the required details about hospitals and their services. Some of the question examples of this questionnaire are "What is your medical specialty", "When a patient needs hospital care, who selects the hospital or other care facility?" et al.

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What is your medical specialty?

Anesthesiology

Cardiovascular surgery

Emergency medicine

Family practice

General surgery

Hematology/ Oncology

Internal medicine

Neonatology

Neurology/ Neurosurgery

Obstetrics/ Gynecology

Otorhinolaryngology

Opthalmology

Orthopedic/ Surgery

Pathology

Pediatrics

Plastic surgery

Psychiatry

Radiology

Thoracic surgery

Urology

Other

How many years have you been practicing medicine (post-internship)?

< 5

5-9

10-14

15-19

20 or more

Is your practice

Hospital based

Individual practice

Small group practice (5 or fewer physicians)

Large group practice (6 or more physicians)

Other

The next section refers to the hospital where you admit the most patients.

	Strongly agree	Somewhat agree	Neutral	Somewhat disagree	Strongly disagree	No opinion
Administration listens to physician concerns	Strongly agree	Somewhat agree	Neutral	Somewhat disagree	Strongly disagree	No opinion

Administration listens to physician concerns, but responds to the wrong physician groups	Strongly agree	Somewhat agree	Neutral	Somewhat disagree	Strongly disagree	No opinion

I have a good professional relationship with administration	Strongly agree	Somewhat agree	Neutral	Somewhat disagree	Strongly disagree	No opinion

During the last year my professional relationship with administration has improved	Strongly agree	Somewhat agree	Neutral	Somewhat disagree	Strongly disagree	No opinion

Professional referrals may be made based on a number of factors. For each of the following items, please indicate the extent to which you think each is important in selecting a hospital for your patients.

	Very Important	Important	Not too Important	Not at all Important	No Opinion
The price of hospital services	Very Important	Important	Not too Important	Not at all Important	No Opinion

Your satisfaction with the medical staff	Very Important	Important	Not too Important	Not at all Important	No Opinion

The reputation of the hospital	Very Important	Important	Not too Important	Not at all Important	No Opinion

The reputation of hospital based physicians	Very Important	Important	Not too Important	Not at all Important	No Opinion

The reputation of specialists practicing at the hospital	Very Important	Important	Not too Important	Not at all Important	No Opinion

Communication between you and the consulting physician	Very Important	Important	Not too Important	Not at all Important	No Opinion

Competence of nursing staff	Very Important	Important	Not too Important	Not at all Important	No Opinion

Past experiences of patients	Very Important	Important	Not too Important	Not at all Important	No Opinion

Economic condition of the patient	Very Important	Important	Not too Important	Not at all Important	No Opinion

Convenience of hospital for patient and family	Very Important	Important	Not too Important	Not at all Important	No Opinion

	Very Important	Important	Not too Important	Not at all Important	No Opinion
Patient hospital preference	Very Important	Important	Not too Important	Not at all Important	No Opinion

Religious preference	Very Important	Important	Not too Important	Not at all Important	No Opinion

Patient referral	Very Important	Important	Not too Important	Not at all Important	No Opinion

When a patient needs hospital care, who selects the hospital or other care facility?

I usually decide

I decide based on information from the patient

The patient and I decide together

The patient decides based on information I provide

The patient decides

Thank you for taking the time to respond.

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