Opportunity Evaluation Form

Name of Community/Practice

_____________________________________

Rate the Professional Component:

 Score 5 for yes, 3 for doubtful, and 0 for no.
1. Hospital Administration is supportive.
2. The local physicians are supportive.
3. The local lay people communicate a need for my specialty.
4. I am convinced that there exists the need for the skills I offer.
5. I can obtain the hospital privileges I require.
6. The consultation facilities are suitable.
7. The hospital’s support and diagnostic services are adequate.
8. Office space is available that will fit my needs.
9. Skilled office personnel are available at reasonable rates.
10. Cross coverage for time off is available.
11. Post graduate education is accessible.
12. Practice management assistance is available.
Total
Rate the Economic Component:
1. The area’s population is increasing.
2. The age composition necessary to support my specialty is well represented.
3. The current rates for medical care and services are competitive.
4. Financial assistance is available.
5. The local employment rate is good.
6. The wages are competitive.
7. The industry is stable and diversified.
8. New firms are being attracted to the area.
9. The majority of the population is covered by health insurance.
10. Social services recipients are minimal.
Total
Rate the Residential Component:
1. My spouse/significant other will be happy here.
2. My spouse/significant other’s career needs will be met here.
3. We are within desired proximity to parents/family.
4. The residential areas are attractive.
5. The price of desired housing is within reach.
6. The zoning ordinances protect property values.
7. Local taxes and assessments appear reasonable.
8. The public services in the area are adequate.
9. The school system is acceptable.
10. The appropriate church is available.
11. Cultural events are readily available.
12. The shopping facilities are satisfactory.
13. The recreation facilities meet our needs.
Total
Score for professional component
Score for economic component
Score for residential component
Total Score