Name
*
Your real name is preferred but not necessary. Joe or Jane Doe will work
First Name
Last Name
Gender
*
Male
Female
Children's Ages
*
Please list your minor children's ages.
Community
*
Select below the closest description of the community you serve in now.
Why Medicine
*
Why did you go into medicine?
Business Education
*
What kind of business training do you currently have? Check all that apply.
Organization
*
Please describe the organization where you work.
Reasons for Change
*
What issues / concerns / forces led you to take on a managerial role? (Check all that apply)
Other Reasons for Change
Describe anything not included above that contributed to your decision to take on a management role.
Reasons to not Change
*
What concerns do you have that tend to keep you in patient care? (Check all that apply)
Other Reasons to not change
Describe anything not included above that contributes (or did if already full-time) to your concern about decreasing / ending patient care.