Physician Nomination Questionnaire
RE: Top Physician Leaders in Concierge Medicine for 2025 -- Please do not complete this questionnaire if you are not the Physician or without the Physicians knowledge.
Important information about this questionnaire and criteria:
Throughout history, Physicians have been instrumental in driving progress in a wide range of areas in our healthcare culture. In modern times, the presence and recognition of Physicians in leadership roles have significantly increased across many specialties, including academics, leading new business endeavors, involvement in hospital leadership, leading advancements in healthcare technology, creating entrepreneurial opportunities, leading the conversation about healthcare and A.I., and more.
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Full Name of Physician
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First Name
Last Name
Name of Current Practice/Business/Organization
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How many years have you been working within the context/field of "concierge medicine."
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Your current role/title at the organization you are working for:
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CRITERION #1: The Practice of Self-Leadership.
Self-leadership involves understanding oneself, managing emotions and behaviors, setting goals, making decisions, and being proactive, self-disciplined, and adaptable.
Please rate your motivational level to do what it takes for reach a goal you set.
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What habits, mindsets or routines do you have that you believe equip you to aptly lead yourself towards a preferred future?
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For example: daily exercise; meditation; reading certain books; a personal/executive coach; a personal advisory board; etc.
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CRITERION #2: The Practice of Risk Taking.
Risk taking involves making decisions or engaging in activities with uncertain outcomes. It is essential for personal and professional growth.
Please rate your readiness for change or comfort with taking risks.
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Why do you feel you are better equipped to take and manage risks than most people/other leaders around you?
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For example, What do you see that others may not? Please briefly describe your background that has helped shape the leader you are today.
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CRITERION #3: The Practice of Delegation.
Delegation empowers leaders to entrust tasks and responsibilities to others, harnessing the diverse skills and talents within their teams for greater productivity.
Please rate your level of comfort to delegate to others what you know they can handle in times of uncertainty in your business/organization.
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What benefits have you or others on your team experienced professionally (or personally) when you executed 'The Practice of Delegation' effectively. What happened. Please briefly describe.
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My Public Statement or Essay and Comment(s), If Selected:
The recognized Physician leaders exemplify courage, innovation, fresh perspectives, and unwavering determination in their respective fields and organizations. They play a crucial role in inspiring future generations of Physician leaders, emphasizing that self-leadership, risk-taking, delegation, and courage are essential qualities for the next generation of Physician leaders.
Please write a few words about why you feel leadership is important to you in concierge medicine and/or at your respective organization/practice or position of influence.
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Please note, if selected, this statement (above) will be used in the final press release at Concierge Medicine Today [dot] org. If not statement, please put N/A.
Disclaimers, Terms and Conditions
The information you submit will not be published publicly (Minus your Full Name, Name of Current Practice/Business/Organization, and Title") unless you indicate in the questionnaire below that you would like to submit a "public statement" if selected. By submitting this information below, Concierge Medicine Today may, in the future, use criteria to develop trends or future leadership criteria for future Concierge Medicine Today content. You understand and acknowledge that the information you submit/share will be used by Concierge Medicine Today LLC to select the "Top Physician Leaders [List] in Concierge Medicine for 2025" and release Concierge Medicine Today, LLC, its agents and representatives from any and all consequences or claims that should arise from the inclusion of your name, practice and title on this list. Please note that a submission is not a guarantee of acceptance. Only a small number of successful applicants will ultimately be chosen for the distinction by Concierge Medicine Today. Concierge Medicine Today may remove personal information from the information you submit with specific Concierge Medicine Today advisors to help vet nominations before final selection(s) are made. Candidates are evaluated based on their understanding of themselves, ability to manage emotions and behaviors, goal-setting, decision-making, proactivity, self-discipline, adaptability, willingness to engage in activities with uncertain outcomes, and empowerment of others through task delegation for greater productivity. Please note that final selections may also be announced January 15, 2025 at the industry's trade publication, www.ConciergeMedicineToday.org.
Yes, I accept the Disclaimers, Terms and Conditions stated above. Please note, any/all applicants or submissions who do not agree to the terms and conditions will not be considered part of the selection process.
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Yes, of course!
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