ALUMNI SURVEY : 1996
Public Psychiatry Fellowship

Name: Fellowship year: 19-19

E-mail address (If you have not given it to me before):

Your current primary work setting (include location)

Your position (include management title, if applicable)

Primary work setting: State, Federal, Municipal, Voluntary, Private, Managed Care, CMHC, Solo or Group Practice: # Years in this setting
Percent of patient hours publically financed: <50% or >50% or actual % %

Secondary work setting (if applicable): State, Federal, Municipal, Voluntary, Private, Managed Care, CMHC, Solo or Group Practice: # Years in this setting
Percent of patient hours publically financed: <50% or >50% or actual % %

Academic Appointment (Specify)

Hours/Week Primary Setting: Outpatient , Inpatient , Other (e.g. ER)

Hours/Week Secondary Setting: Outpatient , Inpatient , Other (e.g. ER)

Hours/Week Private Practice (if not listed as primary or secondary setting above):

Hours/Week for each of the following activities (Record private practice hours in separate section below):

Primary Work Setting:
Clinical , Administration , Teaching ,
Supervision , Research , Other

Secondary Work Setting:
Clinical , Administration , Teaching ,
Supervision , Research , Other

Clinical Hours
Hours/Week using the following treatment modalities (total should equal number of clinical hours above for primary and secondary work settings). Report private practice treatment hours in next section:

Primary Work Setting:
Assessment , Therapy , Therapy+Meds , Meds Alone , Other
Total Hours in Primary Work Setting

Secondary Work Setting:
Assessment , Therapy , Therapy+Meds , Meds Alone , Other
Total Hours in Secondary Work Setting

Private Practice
Hours/Week using the following treatment modalities in private practice:
Assessment , Therapy , Therapy+Meds , Meds Alone , Other
Total Private Practice Hours

Answer as many of the following questions as you see fit:

Do you consider yourself working in the public sector? Why or why not?

In what ways did the Fellowship help you in your career?

Do you have any additional information about yourself or your career?

Do you have any comments on the Role of the Psychiatrist?

Do you have any other comments?