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* 1. What is your gender?

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* 2. What is your age?

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* 3. How many years have you been in practice?

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* 4. Are you fellowship trained?

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* 5. If so, in what specialty? (choose all that apply)

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* 6. What is your primary practice setting?

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* 7. In what AUA region do you belong?

We will use the AMA STEPSforward definition of burnout which is, “a long-term stress reaction characterized by depersonalization, including cynical or negative attitudes toward patients, emotional exhaustion, a feeling of decreased personal achievement and a lack of empathy for patients.”

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* 8. How would you rate your current level of burnout?

Burnout is defined as: "a long-term stress reaction characterized by depersonalization, including cynical or negative attitudes toward patients, emotional exhaustion, a feeling of decreased personal achievement and a lack of empathy for patients."

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* 9. Compared to your practice 5-10 years ago, how would you rate your current level of burnout?

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* 10. What do you feel are your three biggest reasons for burnout? 

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* 11. If you currently have physician burnout, do you feel that the care you provide to your patients has been compromised?

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* 12. If you currently have physician burnout, do you feel that this is affecting your predicted time to retirement?

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* 13. If you had physician burnout in either a former or current position, do you feel that this affected/is affecting your decision to change job settings?

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* 14. If you answered (b) or (c) or (d) to the above question, what job position would be more appealing? (choose all that apply)

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* 15. Does your practice have surveys and/or interventions that specifically address physician burnout?

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* 16. If your practice has specific interventions to address this, please mention them below:

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