Primary Care Doctors Needed
Once again, this year’s graduates of the Geisel School of Medicine have matched at many of the nation’s most prestigious residency programs. Their dedication and accomplishments are especially admirable given the administrative and financial turmoil that has rocked the medical school during their tenure. But while Geisel continues to place its graduates into outstanding training programs, it also continues to render a false accounting of true primary care output.
The medical school reported that 41 of 81 graduates chose primary care programs, including six in family medicine, nine in pediatrics, 24 in internal medicine and two in combined programs. We know, for a fact, that 85 percent of internal medicine residents and 65 percent of pediatrics residents will ultimately sub-specialize, leaving most of them unavailable for the practice of primary care. Hence, primary care output is grossly misrepresented.
Given that the Association of American Medical Colleges predicts a shortfall of up to 30,000 U.S. primary care physicians by 2025, it is apparent that Geisel is not meeting its obligations to the nation or the state of New Hampshire. Well-trained primary care physicians are essential to the maintenance of healthy populations and effective cost-control. Geisel should be actively monitoring the practice settings of graduates five years after graduation, to see who is actually doing primary care. In the course of the Geisel education, steps should be taken to identify and eliminate the “hidden curriculum,” whereby faculty members actively discourage students from careers in primary care. And finally, Geisel should lobby for increased graduate medical education slots for family medicine, pediatrics and general internal medicine. The future of health care in our state demands no less.
Robert S. Kiefner, M.D.
Concord
Dartmouth Unclear About Plans
I fear that Valley News reporter Rob Wolfe may have been led astray by some very carefully crafted language on Dartmouth College’s part when he reported recently that Dartmouth had agreed to “scale down its proposal” for the indoor practice facility on Chase Field.
I was with Planning Board Vice Chairwoman Kelly Dent when she met with Dartmouth College officials and I, too, thought they were offering to scale back the proposal. It was only the next day, when, in a series of emails and phone conversations, we tried to nail down the exact meaning of what they had proposed, that we discovered that this so-called downsizing of the proposal was really something of a legalistic finagle.
When college spokesman Justin Anderson told Wolfe in an email that Dartmouth “agreed to modify the height of the building so that it is consistent with the neighbors’ interpretation of the height, as measured under the ordinance, on all building faces,” most people would reasonably conclude that the building was actually going to be a different height. To put it charitably, Anderson’s words are very carefully chosen. Dartmouth has very carefully never said that the actual height of the building’s ridgeline would be reduced in the slightest. The zoning ordinance (505.1) defines the height as the average height between the eaves and ridge. By which measure, the “height” of a 120-foot-tall A-frame is only 60 feet. As far as I know, Dartmouth is still planning to build a 70-foot-tall building. They have just come up with a way to tweak the roof pitch and eave height so that a 70-foot-tall building has an official “height” of 60 feet. I get that this sort of creative use of definitions on Dartmouth’s part is typical zoning hardball. But to do so in public discourse without clarification strikes me as disingenuous.
Jeff Doyle
Hanover
Proud of Sen. Kelly Ayotte
As a New Hampshire resident, I have been proud of the work Sen. Kelly Ayotte has done to keep the Granite State safe. She worked alongside our police as attorney general, where she was tough on crime and fought to get justice for crime victims. She also continued that work in the U.S. Senate, by leading a bipartisan push to renew the Violence Against Women Act, introducing a proposal to curb sexual assaults on college campuses, and also supporting increased penalties on human traffickers.
Thus, it is very disappointing to see big-money groups come into our state, presumably with the support of Gov. Maggie Hassan, to run appalling ads tearing down Ayotte’s strong, bipartisan record. I have a simple message for Maggie Hassan — those kinds of ads are typical Washington politics, and if there’s one thing we’ve learned this election season, voters have had enough.
Karen M. Cervantes
Lebanon
The writer is a member of the Republican State Committee and holds local and regional party posts.
Which Services Would They Cut?
Most Republicans never cease to say that they want “smaller government.” So in Washington, D.C., and Virginia recently, I questioned some, about as follows.
Now regarding local government, do you want to reduce or eliminate your police and/or fire departments. Of course not, they replied. What about local courts? No. Inspectors who check that foods in local restaurants and grocery stores are properly stored and safe to eat — do you want to eliminate them? No. The water supply system is checked to make sure it is safe — should we eliminate the checks? No. Do you want your local roads maintained, or should they be sold to private interests that would recoup by charging tolls? Of course not. Should public schools be closed and families told to pay to send their children to private schools, or not go to school at all? No, that would be cruel. Should the large public universities be closed. Oh gosh no; think of football! Should maintenance of public parks and open spaces be continued? Yes. And so it went.
I shifted to the federal government. The largest budget item funds national security — the military, homeland security and 17 intelligence agencies. Should we eliminate the Marine Corps, which largely duplicates the Army, or Air Force strategic bombers, or six or eight of the intelligence agencies? Gracious no; in fact, we need more. Should we reduce the State Department, and eliminate 60 or 80 of our 250 or so diplomatic posts? Reduce a bit, but not much. The EPA enforces environmental laws, many introduced by President Nixon, such as the the Clean Air and Water acts — should they be repealed, and we revert to the environmental situation of the 1940s and 1950s, such as permitting companies to discharge waste in the air and rivers? No, although some slimming of regulations is desirable. Should the Commerce Department be eliminated. Oh, yes. The Census Bureau, the patent and trademark offices, trade experts who make sure that our trading partners are living up to their side of agreements, the promotion of American products at international trade fairs, our oceanic and atmospheric experts and data, are in Commerce — you want to eliminate them? Oh no, not those, we should keep them somewhere. But if so, why spend tens of millions of taxpayer dollars merely to move boxes around the government? Mutterings, no responses.
It was clear, to no surprise, that what they really want to drastically reduce, privatize or eliminate, are the large safety-net programs that so many of our citizens depend on — Social Security, Medicare, Medicaid, the Affordable Care Act, unemployment assistance, food and housing assistance for the poor, and such.
But when I asked if they or their parents and friends enrolled in Social Security and Medicare when they became eligible, they were reticent to respond, which I took to mean yes. One ventured that he was pleased that he could now keep his children in college on his family insurance plan, and that he would not have to pay all the cost of expensive treatments for his mother’s declining mental condition.
Raymond Malley
Hanover
Trump Doesn’t Speak for Me
Trump does not speak for this vet! I have been very annoyed at “the Donald” supposedly speaking for veterans. According to him, we are all mistreated and have horrible health care and “thousands are dying.” I wish the media would call him on these misstatements and outright lies.
First, thousands are not dying while waiting for care. Yes, some locations have had issues and these have been addressed and continue to improve. As any VA patient knows, the Veterans Choice Program is a very valid option if you are more than 20 miles from a facility or have to wait for an appointment. You can easily sign up and see any doctor.
Second, the care I receive at the White River VA has been nothing but excellent. We’re lucky to be in a area that shares doctors between Dartmouth and the VA. That said, I moved from Maine and also had nothing but wonderful care from the Bangor, Maine, clinic. I for one cannot speak highly enough about the caring staff and the health care I have received at these facilities. Now more than ever, it’s important for the TV and print media to provide an important public service and fact-check and call out this con man or any other candidate on any outright lies and misstatements.
Tom Gillen
Enfield