| 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 | |||||