| Why are you seeking to continue your ABFM certification at this time? |
a. Maintain professional image b. Personal preference c. Professional advancement d. Maintain or improve patient satisfaction e. Patients prefer being treated by board certified physicians f. Certification program helps me update my medical knowledge g. Certification program helps me monitor or improve the quality of my patient care h. Required by my employer i. Required for hospital privileges/credentialing j. Required by one or more payer/insurance company k. Other (please specify)
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| Which of the following describes your principal practice site: |
a. Academic health center / faculty practice (residency or university teaching environment) b. Federal (Military, Veterans Administration/Department of Defense) c. Federally Qualified Health Center or Look-Alike d. Government clinic, non-federal (eg, state, county, city, maternal and child health, public health center, etc.) e. Hospital-/health system-owned medical practice (not including managed care or HMO) f. Independently owned medical practice g. Indian Health Service h. Managed care / HMO practice i. Other, please specify: j. Rural Health Clinic (federally qualified) Indian Health Service k. Worksite clinic
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| Which of the following best describes your role in the ownership of your principal practice |
a. No official ownership stake (100% employed) a. Sole owner b. Partial owner or shareholder c. Self-employed as a contractor (including locums) d. Other, please specify:
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| Which of the following describes your principal practice size: |
a. Solo practice b. 2 to 5 providers c. 6 to 20 providers d. >20 providers
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