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  • Sharp Index Questionnaire

    Thank you for taking the sharp index questionnaire. We look at burnout and mental health to learn more about improving physician work life and reduce suicide. Please note your data is secured on form submission. Note, Results are best displayed on desktop or laptop. Results are emailed 24 hours after the survey is taken.

  • Demographics

  • Can someone on our team text you if we have any questions about your survey?*
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  • Are you a physician MD/DO?*

  • Are you currently employed as a physician?*
  • Are you a healthcare worker?*

  • Do you work with VA patients?

  • What is your gender?
  • What is your ethnicity?

  • Burnout Questions

    Answer these questions about your work.

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    Values for the Copenhagen Burnout Inventory survery

    4 - Always or to a very high degree

    3 - Often or to a high degree

    2 - Sometimes or somewhat

    1 - Seldem or to a low degree

    0 - Never to a very low degree

  • How often do you feel tired?*
  • How often are you physically exhausted?*
  • How often are you emotionally exhausted?*
  • How often do you think "I can't take it anymore"?*
  • How often do you feel worn out?*
  • How often do you feel weak and susceptible to illness?*
  • Do you feel worn out at the end of the working day?*
  • Are you exhausted in the morning at the thought of another day at work?*
  • Do you feel that every working hour is tiring for you?*
  • Do you have enough energy for family and friends during leisure time?*
  • Is your work emotionally exhausting?*
  • Does your work frustrate you?*
  • Do you feel burnt out because of your work?*
  • Do you find it hard to work with clients (patients)?*
  • Does it drain your energy to work with clients (patients)?*
  • Do you find it frustrating working with clients (patients)?*
  • Do you feel that you give more than you get back when you work with clients (patients)?*
  • Are you tired of working with clients (patients)?*
  • Do you sometimes wonder how long you will be able to continue working with clients (patients)?*

  • Over the last 2 weeks, how often have you been bothered by any of the following problems?
    0 - Not All
    1 - Several Days
    2 - More than half the days
    3 - Nearly everyday

  • Little interest or pleasure in doing things*
  • Feeling down, depressed, or hopeless*
  • Trouble falling or staying asleep, or sleeping too much*
  • Feeling tired or having little energy*
  • Poor appetite or overeating*
  • Feeling bad about yourself — or that you are a failure or have let yourself or your family down*
  • Trouble concentrating on things, such as reading the newspaper or watching television*
  • Thoughts that you would be better off dead or of hurting yourself in some way*
  • If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?*

  • field. Please add appropriate fields and text.

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  • Sharp Index

    Delight measurements
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  • Thank you for participating in our Survey- Please stay connected. 

     

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