Ohio AAP Demographic Measures Survey Pediatrician and Practice Characteristics To which gender do you most identify? Female Male Genderqueer or Non-binary Transgender None of the above, please specify: None of the above, please specify: What is your age? 20-30 years 31-40 years 41-50 years 51-60 years >60 years How long have you been practicing medicine? 0-5 years 6-10 years 11-15 years 16-20 years >20 years With what racial or cultural group(s) do you identify yourself? Select all that apply. White, Non-Hispanic/Latino Hispanic/Latino Black/African American Asian Native Hawaiian/Other Pacific Islander American Indian/Alaska Native OtherOther Which languages are you capable of speaking fluently? (Check all that apply) English Spanish Portuguese French Mandarin Arabic Somali Somali Nepali OtherOther Prefer not to say Which of the following best represents how you think of yourself? Straight (Heterosexual) Gay Lesbian Bisexual Queer Fluid OtherOther Approximately what percentage of your professional time is spent in the following areas? (Total should equal 100%) General Pediatrics * Other specialty/subspecialty (specify) * Please describe the community in which your primary practice/position is located. Please indicate only ONE response. Urban, inner city Urban, not inner city Suburban Rural What racial or cultural group(s) describe the personnel in your practice? Enter a percentage or zero for each prompt. (Total should equal 100%) White, Non-Hispanic/Latino * Hispanic/Latino * Black/African American * Asian * Native Hawaiian/Other Pacific Islander * American Indian/Alaska Native * Other * What racial or cultural group(s) describe your patient population? Enter a percentage or zero for each prompt. (Total should equal 100%) White, Non-Hispanic/Latino * Hispanic/Latino * Black/African American * Asian * Native Hawaiian/Other Pacific Islander * American Indian/Alaska Native * Other * What is your best estimate of the educational demographic of your parent/legal guardians in your practice? (giving approximate percentages of the practice population) Less than high school diploma * High school equivalent * Bachelor's degree * Master's degree * Doctorate * Other * What is your best estimate of the employment status of your parent/legal guardians in your practice? (giving approximate percentages of the practice population) Employed full time * Employed part time * Unemployed (currently looking) * Unemployed (not currently looking) * Student * Retired * Self-employed * Unable to work * Please indicate your primary employment setting, that is, the setting where you spend most of your time. Please check only ONE response. Self-employed solo practice Two physician practice Pediatric group practice, 3-10 pediatricians Pediatric group practice, >10 pediatricians Multispecialty group practice with primary care only Multispecialty group practice with specialty care only Multispecialty group practice with primary and specialty care Health Maintenance Organization (staff model) Medical School or parent university Non-government hospital/clinic Non-profit community health center City/county/state government hospital or clinic US government hospital or clinic OtherOther If you are human, leave this field blank.
