Ohio AAP Demographic Measures Survey

Pediatrician and Practice Characteristics

To which gender do you most identify?
What is your age?
How long have you been practicing medicine?
With what racial or cultural group(s) do you identify yourself? Select all that apply.
Which languages are you capable of speaking fluently? (Check all that apply)
Which of the following best represents how you think of yourself?

Approximately what percentage of your professional time is spent in the following areas? (Total should equal 100%)

Please describe the community in which your primary practice/position is located. Please indicate only ONE response.

What racial or cultural group(s) describe the personnel in your practice? Enter a percentage or zero for each prompt. (Total should equal 100%)

What racial or cultural group(s) describe your patient population? Enter a percentage or zero for each prompt. (Total should equal 100%)

What is your best estimate of the educational demographic of your parent/legal guardians in your practice? (giving approximate percentages of the practice population)

What is your best estimate of the employment status of your parent/legal guardians in your practice? (giving approximate percentages of the practice population)

Please indicate your primary employment setting, that is, the setting where you spend most of your time. Please check only ONE response.