Please answer all questions in reference to the agency where you spend most of your professional time
1. Name
2. Phone Number
3. e-mail address
4. Age years
5. Gender male, female
6. Medical Graduate US, or International
7. Locality Large Urban (>500,000),. Urban (<500,000), Suburban, Rural
8. Which best describes your race Caucasian, African-American, Asian-American or Other (describe)
9. Are you of Latin descent? Yes, No
10. Name of Agency
11. State
12. Job Title
13. Years in current agency
14. Years in current job title
15. Auspice of agency (choose one) State, Federal, Municipal, Nonprofit, Private (for profit)
16. How many hours per week do you work at your agency?
17. Size of Work Group (number of staff you work with regularly - at least monthly)?
18. Is your job best described as that of (A) consultant, (B) staff psychiatrist, (C) medical director of program, or (D) medical director of agency?
19. IF MEDICAL DIRECTOR (program or agency level), do you function (chose one) (A) as director of medical staff only, (B) as director of all clinical staff, or (C) as overall director of program or agency (clinical and administrative)
20. Do you have (1) your own (program or agency) budget, (2) input on (program or agency) budget, (3) no input on budget?
21. Prescribe Medication: Record number of patient contacts per week for medication only Job satisfaction
22. Provide direct psychiatric services (evaluation, diagnosis and therapy): Record number of patient contacts per week for psychiatric services Job satisfaction
23. Oversee other medical care (e.g. physical assessments, lab tests, referrals to internists): Task Frequency
24. Negotiate care for individual patients (e.g. case management, referrals) with other provider agencies or insurance companies: Task Frequency
25. Supervise other medical staff (including reviewing of chart documentation): Task Frequency
26. Supervise non-medical staff (including running team meetings and treatment plan reviews): Task Frequency
27. Provide informal (i.e. unscheduled curbside) consultation to other staff: Task Frequency
28. Participate in (but not run or supervise) team meetings, rounds, case conference, etc.: Task Frequency
29. Provide formal training to staff and/or trainees(e.g. lectures on diagnosis, treatment or psychopharmacology): Task Frequency
30. Participate in policy development (e.g. program design, strategic planning, fund raising, legal issues): Task Frequency
31. Participate in routine administration (e.g. executive staff meetings, program management, fiscal management): Task Frequency
32. Provide linkage or consultation to outside agencies (program-related rather than individual patient contacts): Task Frequency
33. Participate in quality assurance (e.g. review of trends) or program evaluation (process or outcome) activities: Task Frequency
34. Interact with certifying/regulatory agencies: Task Frequency
35. Negotiate contract with, or market services to, consumers, employers, insurance companies or government: Task Frequency
36. Interact with Boards of Directors or Community Boards: Task Frequency
37. Other Tasks - Please specify (e.g. clinical research, political or professional advocacy): Task Frequency
38. Please enter the number of any of the above tasks you wish you performed more often.
40. What is your current salary (on a FT basis) <$75,000, $75,000-$99,999, $100,000-$124,999, $125,000-$149,999 $149,000-$199,999 >$199,999.
41. Compared to a staff psychiatrist at your agency, how much more salary (on a FT basis) does a psychiatrist make as a(n) program medical director? <$5,000, $5,000-$9,999, >$9,999; 42. agency medical director? <$10,000, $10,000-$19,999, $20,000-$29,999, >$29,999.
43. To what extent does salary contribute to job satisfaction?
44. Do you have any other comments?