Rural Doctors’ Training May Be in to read article

State Production of Family Medicine Residents  

An article in this month's Family Medicine, the official journal of the Society of Teachers of Family Medicine, compares the production of medical school graduates who enter family medicine residency programs by state, as well as by medical school. Authored by AAFP staff, "Entry of US Medical School Graduates Into Family Medicine Residencies allows states a reputable source of data on their contribution to the family medicine workforce to be referenced in workforce advocacy efforts, as well as strategic planning to address workforce needs. 

The article’s authors captured and analyzed data on medical school graduation rates into family medicine residencies for both allopathic and osteopathic medical schools. They also compared both percentage and raw number of graduates going into family medicine by state. The article includes analysis of family medicine production by region, and by school type (public or private), and by school structure (department, division, or no family medicine administration).

A few of the article's results include:

The five states that produce the most graduates into family medicine are California (194), Pennsylvania (176), Texas (176), Illinois (140) and New York (120). 

The five states that produce the highest percentage of graduates into family medicine were Iowa (25.2%), Arkansas (19.3%), Kansas (17.5%), South Dakota (17.3%), and Mississippi (17.1%).

Of the allopathic schools (MD-granting), the University of Minnesota had the most graduates enter family medicine residency programs (42), and the Uniformed Services University had the highest percentage (19.8%).

Of the osteopathic schools, Des Moines University College of Osteopathic Medicine had both the most graduates enter family medicine residency programs (68) as well as the highest percentage (32.7%).

Two international schools – Ross University School of Medicine and St. George's University School of Medicine – each graduated more than 100 students into family medicine residencies.

Of the entrants into family medicine residency programs, 48% were from U.S. allopathic medical schools, 29% were international medical graduates, and 23% were from U.S. osteopathic schools. 

In aggregate, 8.7% of all allopathic medical school graduates, and 15.5% of osteopathic medical school graduates, entered family medicine residencies, for a combined rate of 10.2% of all U.S. graduates into family medicine.

52% of allopathic schools produced 80% of the graduates entering family medicine residencies. 

Understanding family medicine production on a state basis allows policy makers, state organizations, and both MD-granting and DO-granting medical schools within the states to collaborate to improve family medicine production and retention of graduates. 

Contact Ashley Bentley by email or ext. 6725 with questions.

Exposure to Domestic Violence Can Hurt Children It Should be Reported to Child Protection Services

It’s estimated that 30% of children in the US witness domestic violence each year. It’s a very common problem. The effects on children are significant, long-lasting and harmful to their healthy development.

Known Adverse Effects:

  • Witnessing violence against a caregiver results in chronic feelings of anxiety and helplessness.
  • A child in such a situation develops a destroyed sense of security.
  • The child often feels responsible for the violence and for the safety of siblings and pets.
  • There is an impact on the nurturing relationship with the victimized adult who has unmet emotional needs.
  • Children exposed to domestic violence are more likely to engage in violence as adults.
  • Exposure to domestic violence in childhood is one of the Adverse Childhood Experiences that results in a host of health and social problems throughout life:

Theoretical Risks:

  • The incidence of child abuse or neglect approaches 60% in households where there is domestic violence.
  • Even if there is no direct violence against a child, emotional maltreatment results in a child at risk for aggression, depression, anxiety, self-injury, suicidal behavior, alcohol and drug abuse.
  • Many children exposed to domestic violence are taught not to cooperate with authorities
  • Children can get caught in the “crossfire” when adults are physically violent with each other.
  • An adult may intentionally injure a child in retaliation against another adult.

When you become aware of a child being exposed to domestic violence, you need to do something. Even if the child seems outwardly fine and denies any problems related to the DV, the child is being harmed. Actions for you to take:

  • If you have access to a social worker, ask for their assistance.
  • In an acute situation, call your local crisis center for advice:
  • Call for assistance from the Division for Children, Youth and Families: 1-800-894-5533. DCYF has domestic violence specialists who can help families and reduce the impact of domestic violence on children.
  • Everyone in New Hampshire is a mandated reporter when child maltreatment is suspected. This includes exposure to domestic violence. Calling DCYF can make things much better for a child. It’s your moral and legal obligation to act. And it will help a child immeasurably.

Reference: “The emotional maltreatment of children in domestically violent homes: Identifying gaps in education and addressing common misconceptions. The risk of harm to children in domestically violent homes mandates a well- coordinated response,” Campbell AM, Thompson SL, Child Abuse Negl. 2015 Oct;48:39-49. The New Hampshire Child, Domestic Violence and Incapacitated Adult Fatality Committees, May 2016

NHAFP FP of the year

NH Academy of Family Physicians Physician of the year for 2016

NHAFP Family Physician of the Year Nomination Form

Nomination Letter

Nomination Support from Paquette

Nomination Support from Stein

Thank you



Physicians can listen to a live stream on two important issues (preparing for Ebola and improving access to care for veterans) being presented to the AMA House of Delegates in Dallas this weekend.

  • Robert McDonald, U.S. Secretary of Veterans Affairs, will give an update on improving access to care for America's veterans. This address is scheduled to begin between 3:00 p.m. and 3:15 p.m. Central time on Nov. 8.
  • "Infection control for Ebola: An update from the field" will take place from 4:30 p.m. to 6 p.m. Central time on Nov. 9. Arjun Srinivasan, MD, associate director for health care-associated infection prevention programs at the Centers for Disease Control and Prevention and captain in the U.S. Public Health Service, will discuss how to prepare for and manage Ebola patients in hospital and ambulatory care settings. Click here for the livestreaming.

Don't miss this special opportunity to prepare your practice and earn continuing medical education credit for the Ebola session. The AMA designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits™.

Claim your CME credit by Dec. 19: Visit the AMA Online Learning Center, then sign in with your AMA login or create a free account. Select the activity "I-14-Infection Control of Ebola: An Update from the Field" from the list and use code "4344" when registering.

Additional information and resources created by the CDC and other public health experts is easily accessible to physicians and the public through the AMA's Ebola Resource Center.


The Health is Primary construct is best described in the special edition of Annals of Family Medicine, edited by Bob Phillips, MD, MSPH, of ABFM, and found here,

Special Happenings:

Doug Dreffer, MD, President of NHAFP, presents a token of appreciation to F.B. Dibble, MD for his many years on the Board.

As reports regarding the scandal at the Department of Veteran’s Affairs have emerged, it has become apparent that there is a need for widespread review of this agency and the important medical services it provides. The VA system is huge and complex, and it is difficult for anyone to gauge the breadth of its challenges. However, my thirty year experience as a family physician does give me one insight about the problem and maybe affords a partial solution as well.

Among the panel of patients for whom I serve as a family physician are perhaps fifty to one hundred veterans, some service members from recent conflicts and the wars in Korea and Vietnam, but others who are members of the “greatest generation”, current seniors who served in World War II. As they have aged, the same illnesses that affect others of their cohort increase in prevalence, including cardiovascular diseases, diabetes, cancers, and the like. They receive primary care services from my colleagues and me in the community just like non-veterans, but with one special exception: they are entitled to “free” medications if they also go to see a VA doctor.  And so many of them, especially those without good pharmaceutical coverage, once they have completed their routine chronic and preventive care with me, schedule parallel and duplicate appointments at the VA, where they must see their “other” primary care doctor, often be given identical monitoring tests and examinations, and then receive free prescriptions from the VA pharmacy. Most of my patients who go the VA report that they do it for the free prescriptions.  I have often wondered, from my position outside the VA system, whether the requirement for veterans to be seen by duplicative primary care doctors at the VA has been designed to optimize patient care, or merely to justify budgetary expenditures  of a growing VA system.

Many of my patients, needing the assurance from the longstanding relationship they have with their trusted non-VA family physician, call me after their VA visits to be certain that I am satisfied with recommendations they have received from their VA doctors. Usually, if I have done my job well, no changes are recommended, and they receive their prescriptions and are sent on their way. Only occasionally, despite the vaunted VA electronic medical record system, do I receive any medical notes or lab and x-ray reports from the VA system. The VA seems to function in isolation, not appreciating the duplication of primary care services it is providing or making any effort to coordinate optimal care for its patient/customers.

Many, including Senator John McCain and others, have advocated for an approach that would give veterans the right to get care covered outside the VA.  All World War II and Korean War veterans, and most Vietnam veterans, are already covered for medical care by Medicare, the insurance program that covers all seniors. Medicare’s drug coverage program, however, is not “free”. If the VA wishes to offer free prescription coverage, its rules should be changes to simply eliminate the requirement that patients see a VA doctor in order to obtain the medications. I suspect that, at least in New Hampshire, the volume of patients requesting access to the VA for primary care would dramatically decline, and we would enhance the valued relationship between patients and their community family physicians.

The special services the VA provides to wounded veterans and those with service-connected issues are crucial, and nearly unique, and need our full support. Specialty and in-patient services are another issue, largely provided in southern New Hampshire by contracted private hospitals and specialists, although certain services are available at the VA clinic in Manchester and in hospitals in Vermont and Massachusetts. But the evolution of the VA into a duplicate primary care system seems ill-advised and wasteful. While enhancing the budget and power of the VA system, this system may be profoundly distracting from the provision of the important services which form the core mission of the VA.  And recent reports suggest that the access may not be adequate by any standard. I therefore hope our legislative leaders can quickly go beyond the finger-pointing and consider some simple solutions to the issues of access to care for veterans.

Gary Sobelson, MD
Family Physician
Concord, NH

Please click on any of the following links to read the article

Dean's Lie: Best Medical Schools

SGR Repeal & Medicare Physician Payment Reform

SGR Repeal and Medicare Provider Payment Modernization Act of 2014

*NHAFP provides these notices for informational purposes. This does not signify an endorsement from NHAFP

Click here to read about The 10th Annual State Suicide Prevention Conference

NFID Clinical Vaccinology Courses scheduled for November 15-17, 2013 in Cambridge, MA and to the New Hampshire AAFP members via your website, event calendar, and other member correspondence as appropriate. 

Click here to see the course brochure.

Detailed course information is available as follows:

Clinical Vaccinology Course (

Earn up to 21.75 Continuing Education Credits (CME, CNE, ACPE)

This 2 1/2 day course focuses on new developments and issues related to the use of vaccines. Expert faculty will provide the latest information on both current and prospective vaccines, updated recommendations for vaccinations across the lifespan, and innovative and practical strategies for ensuring timely and appropriate vaccination.

The course is specifically designed for physicians (family, infectious disease specialists, internists, and pediatricians), nurse practitioners, nurses, physician assistants, pharmacists, public health professionals, vaccine program administrators, and other healthcare professionals interested in clinical aspects of vaccine delivery. Faculty includes physicians, nurse and nurse practitioners, pharmacists, and public health officials including representatives from the Centers for Disease Control and Prevention (CDC) and Advisory Committee for Immunization Practices (ACIP) work groups. Learn more

Collaborating partner organizations include:  American Academy of Pediatrics, American College Health Association, American Nurses Association, American Pharmacists Association, Centers for Disease Control and Prevention, and Society for Adolescent Health and Medicine.

Early Registration closes on September 30, 2013.

A Primary Role for Primary Care

Maine AFP has informed us of 2 more opportunities to complete the newly Federally required “Commercial Driver Medical Examiner (ME)” training in Maine.

As you are I’m sure aware, beginning in 2014, the newly passed Federal regulations will require that anyone performing Commercial Driver physicals (including for school bus drivers), will have to:

a) Complete a certified training course every 5 years and
b) Pass a Federal certification exam every 10 years and
c) Register for an individual ME provider number (required on all physical forms) 

I’m sure that there are many Internists, PAs and NPs here in Maine that are doing these exams.  There are only a few training courses being offered nationally, and we are fortunate to be able to partner with the New England College of Occupational & Environmental Health to bring this training twice more here to Maine – Sept. 7th in Portland, and Oct. 26th in Bangor.   

This day-long program will be eligible for AMA Cat I CME credits (as well as AAFP Prescribed credits). 

All of the information (complete brochure and registration form) is located on our website at:

The Great Health Care Sinkhole





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