2010 National Results for Family Physicians.

The following questionnaire was presented to and completed by family physicians in Canada in 2010.

Demographics
National Demographics PDF
A. About You.
Current Status PDF
Q1: Which of these best describes you? PDF
Q2: Age. PDF
Q3: Sex. PDF
Q4a: The following is a list of work settings. Check the category(ies) which best describe(s) the setting(s). PDF
Q4b: Please indicate which of the above settings is your MAIN patient care setting (i.e. the setting where you spend the most time providing patient care). PDF
Q5: In which province(s)/territory(ies) do you currently work? PDF
C. Your Patient Care Setting(s).
Q7a: Do you provide patient care? PDF
Q7b: With respect to your MAIN patient care setting specified in 4b, describe the population PRIMARILY served by you in your practice. PDF
Q8: What languages do you speak with your patients? PDF
Q9: What percentage of your gross professional income goes towards running your pratice (e.g. part-time or full-time staff, leases/rent/mortgage, equipment leasing/rental, personal benefits, vehicle costs, professional fees, malpractice dues, other overhead expenses)? PDF
Q10a: Please indicate how your MAIN patient care setting is organized. PDF
Q10b: Are you incorporated? PDF
Q11: Please indicate with whom you REGULARLY REFER or HAVE COLLABORATIVE CARE ARRANGEMENTS: Other FPs/ Other Specialists PDF
Q11: Please indicate with whom you REGULARLY REFER or HAVE COLLABORATIVE CARE ARRANGEMENTS: Other Health Care Providers PDF
Q12: Are there any barriers that currently exist to prevent you from engaging a Physician / Clinical Assistant in your practice? PDF
Q12: Are there any barriers that currently exist to prevent you from engaging a Nurse Practitioner in your practice? PDF
D. Patient Access to Care.
Q13: Please rate your accessibility to the following on behalf of your patients. PDF
Q14a: Typically, if a patient contacts your office or is referred to you, how long would that patientwait until the first available appointment WITH YOU OR YOUR PRACTICE? PDF
Q14b: To what extent is your practice accepting new patients into your MAIN patient care setting? PDF
Q14c: Approximately how many patients are in your practice? PDF
Q14d: Please estimate the number of patients you see in a TYPICAL week, EXCLUDING patient visits while you are on-call. PDF
E. Your Practice/Work Profile.
Q15: Please indicate if you OFFER the following to your patients and if this is a SPECIFIC AREA OF FOCUS in your practice. PDF
Q16: Please indicate if you care for the following, or if the following populations represent more than 10% of your practice population: PDF
F. Allocation of Your Time
Q17a: Do you do call? PDF
Q17b: Please estimate your average number of on-call work hours PER MONTH: PDF
Q17c: Please estimate how many of your on-call hours each month are actually spent in direct patient care (e.g., phone, email, face-to-face): PDF
Q17d: Do you ever spend continuous 24-hour periods of on-call time in direct patient care? PDF
Q17e: Please estimate the number of patients you SEE on-call per month: PDF
Q18: EXCLUDING ON-CALL ACTIVITIES, how many HOURS IN AN AVERAGE WEEK do you usually spend on the following activities? PDF
Q19a: In the last year, have you used any locum tenens? PDF
Q19b: In the last year, have you personally provided locum tenens services for another physician? PDF
Q20a&b: Do you regularly work as a visiting physician? PDF
Q21a: Please indicate the frequency of use and impact on your practice of the following. PDF
Q21b: Please rate how significantly each of the following has served as a barrier to your participation in CME/CPD. PDF
G. Your Professional Income.
Q22: In the last year, approximately what proportion of your professsional income did you receive from each of the following payment methods? PDF
H. Changes to your Practice
Q23: Please indicate which of the following factors are increasing the demand for your time at work. PDF
Q24: With reference to the LAST 2 YEARS, please check all of the following changes you have already made. PDF
Q24: With reference to the NEXT 2 YEARS, please check all of the following changes that you are planning to make. PDF
Q25: If you plan to retire in the near future, which of the following might entice you to practice longer? PDF
I. Your use of Information Technology.
Q26a: Do you have a practice Web site? If yes, can patients contact your office to request an appointment through it? PDF
Q26b: Do you refer your patients to any websites? If yes, for what purpose? PDF
Q26c: Do you use email IN ANY SETTING to communicate wit: PDF
Q27: Thinking about your MAIN patient care setting, which of these describes your record keeping system? PDF
Q28a: Where do you access electronic records for your patients? PDF
Q28b: In which setting do you use electronic records most often? PDF
Q28c: If you access electronic records in various locations, are the records in these locations electronically connected to each other to allow for access of the same electronic record from different settings? PDF
Q29: Please indicate which of the following you use, or plan to use, in the care of your patients. PDF
J. Your Professional Satisfaction
Q30: Please rate your satisfaction with each of the following: PDF
K. Chronic Disease Management (Note: FP/GPs Only).
Q31a: Do you have summary information on your patient population with chronic diseases (e.g., percent of diabetes patients due for an eye exam)? PDF
Q31b: Do you typically use a flow sheet or checklist for chronic diseases? PDF
Q32a: Do you give your patients with chronic diseases written instructions about how to manage their own care at home? PDF
Q32b: Do you use electronic tools to manage your patients' chronic conditions? PDF
L. Demographics.
Q33: Where were you born? PDF
Q34a: Year of your undergraduate/ most recent post-graduate graduation: PDF
Q34b: Please indicate where you completed your undergraduate medical training. PDF
Q34b: Please indicate where you completed your most recent post-graduate medical training. PDF
Q35: Current medical specialty certification/attestation. PDF
Q36: In what year did you become licensed to practice medicine in Canada for the first time? PDF
Q37a: Do you have children? If yes, what is the age of the youngest and how many hours per week do you have primary responsibility of these children? PDF
Q37b: Do you have any other dependents for whom you personally provide care (grandchildren/elderly/disabled)? if yes, how many and how many hours per week do you spend caring for them? PDF