Ten Keys to Physician Retention
Medical Staff Survey Sample Survey Instrument
( Name of facility ) is committed to meeting the needs of our medical staff. We would like to learn more about the challenges you face, the staffing, equipment, and operational needs you would like to see addressed, and how we may be able to assist you with these and other matters. Please take a moment to complete the attached survey. You may take the survey anonymously, or include your name and contact information if you would like the results of the survey sent to you. Please complete the survey and return it by (insert date). We greatly appreciate your consideration and look forward to assisting you.
Your name (optional):
Your specialty (optional):
Would you like results of the survey sent to you?
Yes
No
If yes, please include your contact information, Address:
Email:
1. What type of medicine do you practice?
Primary Care
Surgical Specialty
Diagnostic Specialty
Other
2. Which of the following best describes your current practice?
I am too busy
I am not busy enough
I am as busy as I want to be
3. Which best describes your current feelings about your practice?
I am very satisfied with my practice
I am somewhat satisfied with my practice
I am somewhat dissatisfied with my practice
I am very dissatisfied with my practice
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