Survey of Clinic M Survey of Clinic Medical Directors- Chiro

Medical Directors Survey

Chiropractic Sites

May 2005

1. Please make any corrections to the label below.

2. What is your title within this organization?

3. What is your discipline?

MARK (X) ONE ANSWER

1 ¨ Physician (MD or DO)

2 ¨ Dentist (DDS/DMD)

3 ¨ Physician assistant

4 ¨ Nurse practitioner

5 ¨ Certified Nurse midwife

6 ¨ Registered nurse

7 ¨ Chiropractor

8 ¨ Pharmacist

9 ¨ Other (Specify)

4. When did you begin working for this organization?

Month: Year:__________

5. Direct patient care includes face-to-face contact with patients, as well as patient record-keeping, travel time connected with seeing patients, and communication with other physicians, hospitals, pharmacies, and other places on a patient’s behalf.

Do you currently provide direct patient care?

1 ¨ Yes

2 ¨ No GO TO Q6

A. (If you provide direct patient care) During a typical week, approximately what percentage of your work time is spent in direct patient care activities?

Percentage of time in direct patient care

6. Which of the following categories best describes the ownership of this clinic?

MARK (X) ONE ANSWER

¨ A group practice

¨ A nonprofit community-based care clinic (run by a nonprofit board of directors)

¨ A community-based primary care clinic run by the health department or other government agency

¨ A community-based primary care clinic run by a hospital

¨ A community-based primary care clinic run by a university medical center

¨ Other (Specify)

7. How many clinics are in your network?

Number of clinics

8. If this is a multi-site network, please answer the remaining questions only for this site.

At this site, how many patient visits do you have in a typical week?

Number of patient visits in a

typical week

8a. In a typical week at this site, how many patient visits are for treatment of neck and lower back pain?

Number of patient visits

9. Please record (1) the number of full-time equivalent (FTE) staff and (2) the number of current job openings for each of the clinician categories in this site.

Please include MD’s and DO’s in each physician category. Include both NHSC and non-NHSC clinicians.

Clinician Type	(1) Number of Current FTE Staff	(2) Number of Job Openings
1. General and Family Practitioner
2. General Internist
3. Pediatrician
4. OB/GYN
5. Psychiatrist
6. Other physician specialists
7. Dentist
8. Dental hygienist
9. Physician Assistant
10. Nurse Practitioner
11. Certified Nurse Midwife
12. RN and LPN
13. Chiropractor
14. Physical Therapist
15. Registered Pharmacist
16. Pharmacy Technician
17. Mental Health Provider (other than psychiatrists)
18. Other clinical personnel (Specify)

10. Does this site have any NHSC clinical staff or job openings for NHSC clinicians at this time?

1 ¨ Yes

0 ¨ No IF NO, GO TO Q12, PAGE 4

11. For each of the clinician categories listed below, record the number of full-time equivalent (FTE) NHSC clinicians on your staff at this site.

Clinician Type	Current Number of NHSC Staff in FTEs
1. General and Family Practitioner
2. General Internist
3. Pediatrician
4. OB/GYN
5. Psychiatrist
6. Dentist
7. Dental hygienist
8. Physician Assistant
9. Nurse Practitioner
10. Certified Nurse Midwife
11. Chiropractor
12. Registered Pharmacist
13. Mental Health (other than psychiatrists)
14. Other clinical personnel (Specify)

12. In the last three years, have you offered a position to a chiropractor to practice at this site?

1 ¨ Yes

0 ¨ No IF NO, GO TO Q14

12a. Thinking about the last time you decided to offer a position to a chiropractor at this site, did you consult with any other clinicians?

1 ¨ Yes

0 ¨ No IF NO, GO TO Q14

13. Which of the following types of clinicians did you consult with before deciding to offer a position to the chiropractor?

MARK (X) ALL THAT APPLY

1 ¨ Physician (MD or DO)

2 ¨ Physician’s assistant

3 ¨ Nurse practitioner

4 ¨ Certified nurse midwife

5 ¨ Registered nurse

6 ¨ Other chiropractor already on staff

7 ¨ Pharmacist

8 ¨ Other

14. When a patient at this site seeks treatment for neck or back pain, does your staff always treat the patient here, always refer the patient to a provider at another practice or location, or do you sometimes treat on site and sometimes refer the patient?

MARK (X) ONE ANSWER

1 ¨ Always treat on site

2 ¨ Sometimes treat on site and sometimes refer to another site or location

3 ¨ Always refer to another practice

or location GO TO Q16, PAGE 5

15. If you sometimes or always treat patients with neck or back problems on site, answer Q15A.

A. Do any clinicians on staff specialize in the treatment of neck and back pain?

1 ¨ Yes

0 ¨ No IF NO, GO TO Q16, PAGE 5

B. What is the discipline of the clinician on staff who spends the most time treating neck and back pain?

MARK (X) ONLY ONE

1 ¨ Medical Doctor (MD)

2 ¨ Doctor of Osteopathy (DO)

3 ¨ Doctor of Chiropractic (DC)

4 ¨ Physician Assistant

5 ¨ Nurse Practitioner

6 ¨ Physical Therapist

7 ¨ Other discipline (describe)

C. What percentage of this clinician’s time is devoted to the treatment of neck and back pain?

MARK (X) ONE ANSWER

1 ¨ Less than 10 percent

2 ¨ 10 to 25 percent

3 ¨ 26 to 50 percent

4 ¨ 51 to 75 percent

5 ¨ More than 75 percent

16. If you sometimes or always refer patients with neck or back problems to other locations, answer Q16A. If you always treat patients on site for neck and back pain, go to Q17.

A. Do you refer patients to providers at another clinic within your network or to a practice outside your network?

1 ¨ Another clinic within our network

2 ¨ Practice outside the network

3 ¨ Always treat on site GO TO Q17

B. What is the discipline of the clinician(s) to whom you refer patients for treatment of neck and back pain?

MARK (X) ALL THAT APPLY

1 ¨ Medical Doctor (MD)

2 ¨ Doctor of Osteopathy (DO)

3 ¨ Doctor of Chiropractic (DC)

4 ¨ Physician Assistant

5 ¨ Nurse Practitioner

6 ¨ Physical Therapist

7 ¨ Other discipline (describe)

17. Does the clinic currently have a chiropractor on site?

1 ¨ Yes

0 ¨ No IF NO, GO TO Q23, PAGE 6

18. Where do referrals to the chiropractor at this site come from most frequently?

MARK (X) ONE ANSWER

1 ¨ Other clinic staff at this site

2 ¨ Staff from other sites in the clinic network

3 ¨ Providers from outside the clinic network

4 ¨ Self referrals

19. At this site, how often does the chiropractor co-manage patient care with physicians?

¨ Always

¨ Usually

¨ Sometimes

¨ Rarely GO TO Q.20

¨ Never GO TO Q.20

A. What types of patients are co-managed by chiropractors and physicians? (Describe below):

20. An interdisciplinary care team is comprised of three or more professionals from different care disciplines dedicated to the ongoing and integrated care of one patient, set of patients, or clinical condition. Does this clinic have any interdisciplinary care teams?

1 ¨ Yes

0 ¨ No IF NO, GO TO Q23, PAGE 6

a. How many interdisciplinary care teams does the clinic have?

Number of teams

b. Do any of the clinic’s interdisciplinary care teams include a chiropractor?

1 ¨ Yes

0 ¨ No IF NO, GO TO Q23, PAGE 6

c. How frequently does the interdisciplinary care team that includes a chiropractor meet?

MARK (X) ONE ANSWER AND THEN GO TO Q18

1 ¨ Regularly, at least once a week

2 ¨ Regularly, at lease once a month

3 ¨ Regularly, but less than once a month

4 ¨ On an ad hoc or as needed basis

21. What is the main objective of the interdisciplinary care team that includes a chiropractor?

MARK (X) ALL THAT APPLY

1 ¨ To manage the care of specific patients

2 ¨ To develop and implement process of care

protocols

3 ¨ To monitor quality of care initiatives

4 ¨ To maintain a disease management program

5 ¨ Other (describe)

22. When this site has a job opening for a clinician, who usually identifies the pool of candidates?

¨ On-site clinic staff

¨ Other staff within the organization

2 3. In the last 12 months, how much of a problem, if any, has it been to recruit each of the following types of clinicians at this site?

MARK (x) FOR EACH CATEGORY. IF YOU DID NOT ATTEMPT TO RECRUIT ANYONE FROM A CLINICAL GROUP IN THE LAST 12 MONTHS, CHECK THE BOX NEXT TO “NOT RECRUITED”.

Clinician Type	Big Problem	Small Problem	Not a Problem	Not Recruited
1. Physicians (MD/DO)	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
2. Dentists	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
3. Dental hygienists	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
4. Physician assistants	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
5. Nurse practitioners	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
6. Certified nurse midwifes	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
7. RNs and LPNs	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
8. Chiropractors	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
9. Physical therapists	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
10. Pharmacists	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
11. Pharmacy technicians	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
12. Mental health providers (other than psychiatrists)	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited

24. In the last 12 months, how much of a problem, if any, has it been to retain each of the following types of clinicians at this site?

MARK (x) FOR EACH CATEGORY. IF YOU DID NOT EMPLOY ANYONE FROM A CLINICIAN GROUP AT THIS SITE IN THE LAST 12 MONTHS, CHECK THE BOX NEXT TO “NOT EMPLOYED”.

Clinician Type	Big Problem	Small Problem	Not a Problem	Not Employed
1. Physicians (MD/DO)	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
2. Dentists	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
3. Dental hygienists	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
4. Physician assistants	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
5. Nurse practitioners	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
6. Certified nurse midwifes	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
7. RNs and LPNs	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
8. Chiropractors	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
9. Physical therapists	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
10. Pharmacists	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
11. Pharmacy technicians	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
12. Mental health providers (other than psychiatrists)	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed

25. If you could add a chiropractor to your clinic, do you think that would improve your ability to retain other clinicians or not?

1 ¨ Yes IF YES, GO TO Q25a

0 ¨ No IF NO, GO TO Q25b

2 ¨ Unsure IF UNSURE, GO TO Q26, PAGE 10

A. (If yes) Which of the following types of clinicians would be easier to retain?

MARK (X) ALL THAT APPLY

1 ¨ Physicians	7 ¨ RNs and LPNs
2 ¨ Dentists	8 ¨ Chiropractors
3 ¨ Dental hygienists	9 ¨ Physical therapists
4 ¨ Physician assistants	10 ¨ Pharmacists
5 ¨ Nurse practitioners	11 ¨ Pharmacy technicians
6 ¨ Certified nurse midwifes	12 ¨ Mental health providers (other than psychiatrists)

B. (If no) Why wouldn’t adding a chiropractor to your clinic improve your ability to retain other clinicians?

26. During the past 12 months, how much of a problem, if any, was it to obtain primary care services for patients seen at this clinic when you or your staff thought they were medically necessary?

1 ¨ A big problem

2 ¨ A small problem

3 ¨ Not a problem IF NOT A PROBLEM,

GO TO Q27

(If a big or small problem) Please rate the importance of each of the following reasons why you might not be able to obtain primary care services.

A. There aren’t enough qualified primary care providers in the area.

1 ¨ Very important

2 ¨ Moderately important

3 ¨ Not very important

4 ¨ Not at all important

B. Health plan networks and administrative barriers limit patient access.

1 ¨ Very important

2 ¨ Moderately important

3 ¨ Not very important

4 ¨ Not at all important

C. Patients lack health insurance or have inadequate insurance coverage.

1 ¨ Very important

2 ¨ Moderately important

3 ¨ Not very important

4 ¨ Not at all important

27. During the past 12 months, how much of a problem, if any, was it to obtain pharmacy services for patients seen at this clinic when you or your staff thought they were medically necessary?

1 ¨ A big problem

2 ¨ A small problem

3 ¨ Not a problem IF NOT A PROBLEM,

GO TO Q28, PAGE 11

(If a big or small problem) Please rate the importance of each of the following reasons why you might not be able to obtain pharmacy services.

A. There aren’t enough qualified pharmacists in the area.

1 ¨ Very important

2 ¨ Moderately important

3 ¨ Not very important

4 ¨ Not at all important

B. Health plan networks and administrative barriers limit patient access.

1 ¨ Very important

2 ¨ Moderately important

3 ¨ Not very important

4 ¨ Not at all important

C. Patients lack health insurance or have inadequate insurance coverage.

1 ¨ Very important

2 ¨ Moderately important

3 ¨ Not very important

4 ¨ Not at all important

28. During the past 12 months, how much of a problem, if any, was it to obtain treatment for neck or back pain for patients seen at this clinic when you or your staff thought it was medically necessary?

1 ¨ A big problem

2 ¨ A small problem

3 ¨ Not a problem IF NOT A PROBLEM,

GO TO Q29

(If a big or small problem) Please rate the importance of each of the following reasons why you might not be able to obtain services to treat neck or back pain.

A. There aren’t enough qualified providers in the area.

1 ¨ Very important

2 ¨ Moderately important

3 ¨ Not very important

4 ¨ Not at all important

B. Health plan networks and administrative barriers limit patient access.

1 ¨ Very important

2 ¨ Moderately important

3 ¨ Not very important

4 ¨ Not at all important

C. Patients lack health insurance or have inadequate insurance coverage.

1 ¨ Very important

2 ¨ Moderately important

3 ¨ Not very important

4 ¨ Not at all important

29. Who pays the salary of the NHSC chiropractor at this site?

¨ The clinic

¨ The network

¨ Another entity (describe)___________________

30. If the NHSC chiropractor left the clinic, would you replace him or her with another chiropractor?

1 ¨ Yes

2 ¨ No Why not?____________________

31. Please describe the impacts, if any, of the NHSC chiropractor on the following:

Access to care:

Patient satisfaction:

Quality of care:

Costs of care:

Utilization patterns:

Stability of clinical staff:

32. What is your age now?

MARK (X) ONE ANSWER

1 ¨ 18 to 24

2 ¨ 25 to 34

3 ¨ 35 to 44

4 ¨ 45 to 54

5 ¨ 55 to 64

6 ¨ 65 to 74

7 ¨ 75 or older

33. Are you male or female?

MARK (X) ONE ANSWER

1 ¨ Male

2 ¨ Female

34. What is the highest degree that you have completed?

MARK (X) ONE ANSWER

1 ¨ Some college or 2-year degree

2 ¨ BA or BS Degree

3 ¨ MA or MS

4 ¨ MBA or MPH

5 ¨ DC

6 ¨ PhD

7 ¨ MD, DO

8 ¨ DMD

9 ¨ PharmD

10 ¨ Other (Describe):

35. Are you of Hispanic or Latino origin or descent?

MARK (X) ONE ANSWER

1 ¨ Yes, Hispanic or Latino

2 ¨ No, not Hispanic or Latino

36. What is your race?

MARK (X) ALL THAT APPLY

1 ¨ White

2 ¨ Black or African-American

3 ¨ Asian

4 ¨ Native Hawaiian or other Pacific Islander

5 ¨ American Indian or Alaska Native

6 ¨ Other:

FOR MPR PURPOSES ONLY:

/home/ec2-user/sec/disk/omb/icr/200701-0915-004/doc/1552401

(REV—5/10/05) 2/6/2021 8:23 AM

6126 - 074

Jen revised for Richard Strouse

Prepared by Mathematica Policy Research, Inc.