Physician Wellness & Professional Practice Screening Questionnaire
Your Health Matters
Purpose
This confidential screening tool helps identify physicians who may benefit from additional support, assessment, coaching, wellness resources, or participation in a professional rehabilitation program.
Instructions
Please check any statements that have been true for you during the past 6–12 months.
Emotional Health & Well-Being
☐ I frequently feel overwhelmed, exhausted, or emotionally depleted.
☐ I have experienced ongoing anxiety, depression, hopelessness, or excessive stress.
☐ My work-related stress is negatively affecting my personal relationships.
☐ I have lost interest in activities I previously enjoyed.
☐ I find it difficult to manage frustration, anger, or emotional reactions.
☐ I have experienced significant life stressors (marital, family, financial, legal, or personal).
Professional Practice & Workplace Behavior
☐ I have received feedback regarding my communication style, professionalism, or interactions with others.
☐ I have been involved in recurring workplace conflicts with colleagues, staff, administrators, or trainees.
☐ I have reacted in ways that I later regretted, including anger, sarcasm, intimidation, or disrespect.
☐ I often feel frustrated by workplace demands and find myself withdrawing from teamwork.
☐ I have difficulty accepting feedback or constructive criticism.
☐ Others have expressed concern about changes in my behavior or demeanor.
Health, Wellness & Self-Care
☐ I frequently experience fatigue, sleep problems, or difficulty concentrating.
☐ I have neglected my own physical or mental health needs.
☐ I have noticed changes in my mood, judgment, memory, or performance.
☐ I have concerns about burnout affecting my ability to provide optimal patient care.
☐ I struggle to maintain healthy work-life balance.
Substance Use & Coping
☐ I use alcohol, medications, or other substances to cope with stress.
☐ I have concerns about my use of alcohol, prescription medications, or other substances.
☐ Family members, friends, or colleagues have expressed concern about my substance use.
☐ I have attempted to reduce or stop substance use but found it difficult.
Patient Care & Professional Performance
☐ I have noticed a decline in my job satisfaction or professional fulfillment.
☐ I am concerned that stress, burnout, or personal challenges may be affecting my clinical performance.
☐ I have become less responsive, less engaged, or less collaborative in patient care activities.
☐ I have experienced increased complaints, performance concerns, or professional scrutiny.
☐ I am worried about my ability to continue practicing at my highest level without additional support.
Self-Assessment Results
Low Concern
- 0–3 items checked
- No immediate concerns identified. Continue prioritizing wellness, self-care, and professional support.
Moderate Concern
- 4–8 items checked
- Consider speaking with a trusted colleague, mentor, wellness coach, employee assistance program, or physician health program representative.
Elevated Concern
- 9 or more items checked
- Additional assessment may be beneficial. A confidential consultation with a physician health or rehabilitation program is recommended to identify appropriate support resources.
Immediate Attention Recommended
Regardless of total score, seek professional assistance promptly if:
- There are concerns related to substance use.
- Patient safety may be impacted.
- Significant behavioral concerns have been reported by colleagues or staff.
- You are experiencing thoughts of self-harm or severe emotional distress.
Remember: Seeking help is a sign of professionalism and strength. Early intervention can protect your health, your career, and the patients you serve. Physician health programs exist to provide confidential support, assessment, treatment recommendations, and pathways toward recovery and restoration.
Take the first step.
Whether you’re seeking help for yourself, concerned about a colleague, or supporting a loved one, reaching out is often the most important first step. Confidential consultations are available to discuss concerns, answer questions, and help determine the best path forward. Call or email us today.
You care for others. Let us help care for you.
William Zitzmann, MD
Medical Director, Maryland Physicians Health Program and Maryland Healthcare Professionals Program
Karen Dionesotes, MD, MPH
Medical Director, Maryland Professional Rehabilitation Program
Margaret Ann Kroen, LCSW-C
Program Director
410.962.5580, ext. 5411
Michael C. Llufrio
Director of Operations
410.962.5580, ext. 5412
Domenica Stone
Chief Administrative Officer
410.962.5580, ext. 5413
Astrid Richardson-Ashley, LCSW-C
Senior Clinical Manager
410.962.5580, ext. 5417
Amber Thrasher, LCSW-C
Clinical Manager II
410.962.5580, ext. 4405
Holly Wade, MA, LCPC
Clinical Manager II
410.962.5580, ext. 5415