Filling the Gap in
Family Medicine

Across America, rural family physicians are increasingly hard to come by. A recent study in the Annals of Family Medicine found a 15% decline in family physicians in the rural Northeast U.S. between 2017 to 2023, the highest drop among any region in the nation.

Practically, this means rural residents often receive limited care, sometimes waiting months for appointments. In extreme cases, some patients might not see a doctor for over a decade.

These hurdles to medical care can have serious consequences. With primary care physicians (a broad category that includes family doctors, pediatricians, and internists) in the U.S. caring for some 1,500 to 2,500 patients each, the loss of a single doctor in a small town means that those patients have no one to turn to—a situation that can have deadly consequences. Indeed, one calculation found a 5% increase in a town’s mortality rate if they lose even one doctor. And in New Hampshire, with more primary care doctors over 60 than under 40, and 15% planning to stop working in the next five years, health care systems in northern New England are especially feeling the pressure.

To address this shortfall, Cheshire Medical Center, a Dartmouth Health member hospital, has launched a new Family Medicine Residency program. The program provides newly minted doctors with hands-on training in Keene, New Hampshire that gives them experience in a rural setting and prepares residents to become board-certified in family medicine and ready for independent practice. 

“It’s challenging for rural communities to recruit new primary care physicians and family medicine physicians, so this residency was seen as a way for us to train our own,” says the residency program director Karl Dietrich, MD, MPH, MED ’14 MPH ’08. “Even if we only place one or two residents in our community, that will make a huge impact on primary care availability.”

Far-reaching consequences

The decline of family practitioners is driven by many factors. Primary care jobs tend to pay less than other specialties, which can be a hard sell to doctors with half a million dollars in student loan debt. In recent years, the paperwork associated with running a family medicine practice has skyrocketed due to increased demand from insurance companies, administration and lawyers seeking more complex documentation, scaring away some who would otherwise be interested in such a career. One study in 2016 found physicians spend nearly half their time doing desk work. 

Furthermore, becoming a family doctor means learning to be a jack-of-all-trades who can confidently address medical ailments from dermatological issues to gynecologic procedures and everything else in between. For some doctors-in-training, that can be a daunting task, but for others it is the allure.

“One thing that really drew me to pursuing family medicine is that you get so much variety, especially in rural areas,” says family and community care first-year resident Doug Lischke, DO. “I really liked that idea of being a small-town doctor, working with the community.”

Cheshire doctors started the hospital’s residency program in 2024 with significant philanthropic support and with the help of a rural residency and planning grant from the U.S. Department of Health and Human Services. The grant, which aims to increase the number of family doctors country-wide, helped offset the cost of developing the program, and transformational philanthropic support enabled Cheshire to establish the primary care clinic that houses the program. The three-year program gives future family physicians the skills necessary for working with the varied health needs of rural communities.

Best of Both Worlds

The residency’s location in Keene has been a draw to many doctors who like its small-town charm and access to the outdoors. But in addition to providing a rural setting, the program also offers access to extra training experiences across the Dartmouth Health network.

“Being attached to Dartmouth, we have so many resources available to us. But at the same time, we also get the hands-on, intimate residency of a small program,” says first-year resident Trevor Read, DO. “It feels like the best of both worlds.”

The program is designed to support up to 18 residents across three cohorts. While there’s no long-term commitment requirement, Dietrich hopes a few of these residents will want to stay in the community when they’re done. Some residents, including Lischke, are already putting down roots and hoping to stay local after they finish. Regardless of where they end up, the residents will play an essential role in increasing primary care access across America.