Taking Steps Towards a Long-Term Hospitalist Career

Hospitalist Career

The field of hospital medicine arose in the 1990’s in response to hospitals’ need for greater access to primary care physicians. Hospitalists specifically coordinate patient care from admission to discharge. As Ratelle et al pointed out, there are now over 30,000 such inpatient practitioners, with organizations like the National Association of Inpatient Physicians and Society of Hospital Medicine. The field continues to grow, but it requires proficiency in multiple medical disciplines, as a day in the life of a hospitalist includes any number of tasks across the health care spectrum.

Hospitalist Duties

Hospitalists specialize in not having a specialization. In particular, they are experts in patient management and leadership of care personnel. According to Pak and Jones, they must have multiple skills on top of standard clinical expertise, including:

  • The ability to communicate clearly with patients, families, and personnel,
  • Problem-solving skills for prompt evaluation and treatment,
  • Leadership of patients, staff, and hospital administrators,
  • Teaching skills in analyzing and interpreting medical information,
  • Compassion and interpersonal skills to provide comfort and care,
  • And stamina to work long and wide-ranging shifts.

Altogether, these abilities ensure that hospitalists are able to balance, manage, and optimize the hospital health care system. In particular, they work to coordinate patients, family, residents and interns, nursing staff, healthcare professionals, and hospital administrators.

Educational Requirements

Until relatively recently, hospital medicine has been an uncommon career track. However, as Ratelle et al show, around a tenth of current internal medicine residents will end up in this growing field, with specializations in Family Medicine or Pediatric Internal Medicine. The Society of Hospital Medicine details how to become a hospitalist, as follows.

  • Start by attaining a Bachelor’s degree in a related field.
  • Then, complete 4 years at an E.S.-accredited medical school,
  • Train for 3 to 9 years in a hospital residency of 3 to 8 years,
  • Pursue other training, such as post-residency fellowships,
  • Get a state license to practice, although standards vary,
  • Lastly, pursue an optional board certification for specializations.

Licensing may require background checks, training, tests, or fees, and you must renew your credentials every 10 years. An increasing number of residency programs also offer hospital medicine specializations, as the number of related fellowship programs rises each year, as well.

Work Conditions & Compensation

Graduating hospitalists confront a growing and competitive market. However, as the US Bureau of Labor Statistics explains, compensation is high because the work requires fast decision-making in high-stress situations. In general, hospitalists work 12-hour days each day of the week, with every other week off, although schedules can be erratic. Usually, 3 to 4 hospitalists will work on day shifts, with only one at night, and each will care for 15 to 20 patients each day.

In 2014, the Society of Hospital Medicine estimated that there were around 44,000 practicing hospitalists in the United States. Since then, the field has only grown, and wages reflect growing need. In particular, the Medical Group Management Association’s recent survey found that hospitalists earn around $180,000 annually, with variation by location, teaching status, and practice size. In particular, Internal Medicine hospitalists on average earn $218,066 a year, while Pediatric specialists earn $160,038 per year.

The work of hospitalists is essential to coordinating hospital care. You should consider this field if your interests and abilities align with those detailed above. However, it is important to keep in mind that hospital medicine continues to evolve, with hospitalists taking on teaching positions and positions of authority in administration. Although their work is high-stress, hospitalists are essential members of health care teams and play a powerful role in shaping the quality and future of care in hospital contexts.

Would you like to join Elliot Health System as a hospitalist? Browse our open hospitalist career opportunities today.

Physician Careers


5 Simple Ways to Stay Calm as a Physician

Ways to Stay Calm

There is a growing awareness of the extraordinary stress levels facing practicing physicians in the United States. As noted by US News, doctors are fifteen times more likely to burn out than professionals in other fields. Furthermore, almost half of all primary care physicians report a desire to quit their job. To address this problem, medical practitioners must work on managing their stress, especially in emergency situations, in order to avoid burnout. Accordingly, it is essential for medical practitioners to know several key ways to stay calm under pressure.

Stay Positive

Physicians face some extremely stressful situations, but one key way to cope is to consider each situation in context. According to Entrepreneur, instead of forcing yourself to overcome anxiety, you should approach each issue as a challenge or opportunity to grow. Finding your calm should be the effect rather than the strategy, as focusing on how things could go right will help you balance and channel your emotions into more productive behavior.

Rehearse Your Actions

One of the most beneficial ways to stay calm is to rehearse for stressful situations. Visualizing potential complications for surgeries and other procedures, along with your responses to them, will help you prepare for real-life problems. For example, physicians should memorize the initial steps for dealing with different emergencies so that they can quickly take control of such situations. They should also familiarize themselves with how to stay calm in order to avoid making emergencies even worse.

Take a Deep Breath

Panicking is often our first response to stress, but physicians should assess their emotions for the source of anxiety. You can then work out whether and how to mitigate potential damage, even as taking action itself helps you cope with stress. One of the most important ways to stay calm is to nurture mindfulness. As Greater Good in Action has shown, mindful breathing, in particular, will not only shift your focus to your body but also calm your nervous system and prepare you for what comes next.

Manage Conflict

After balancing your own emotions, you should focus on clear communication. In particular, staying calm and de-escalating tense situations go hand-in-hand.

  • You should start by managing your own emotions.
  • Then, speak politely in a soft, non-threatening tone.
  • Use non-confrontational language like “I” statements.
  • Listen carefully, and re-state and clarify what you hear.

Throughout, set aside your own negative emotions, and focus instead on learning more about others’ perspectives.  These tips are especially true for conflict in the physician-patient relationship.

Prioritize Tasks

In emergency situations, addressing the most urgent needs first is essential. Even experienced professionals can get distracted by certain injuries, but the most important tasks are often less obvious. You can only do one thing at a time, so recognize more and less urgent tasks to avoid getting flustered. Even scheduling your personal life can improve your resiliency as a medical professional and accordant ability to adapt to and bounce back from the stress of the clinical environment.

Although staying calm under pressure is utterly essential for medical professionals, we often forget the amount of stress we are under until it feels impossible to manage. At that point, even small amounts of stress can overwhelm an overtaxed person, medical professional or no. However, setting a regular relaxation routine can prevent the chain reaction of health problems that result from stress. You can use the above ways to stay calm to help avoid that burnout – and to preserve your ability to take charge in emergency situations.

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10 Fun New England Winter Activities for Families

New England Winter Activities

It can be tempting to stay indoors during the colder months, but New England winter activities will help you enjoy this awe-inspiring wonderland. From hiking and skiing to riding a sleigh, these family-friendly activities show it’s never too cold to enjoy New England.

1. Take a Hike

This region’s hiking trails are well-known for spanning a huge variety of landscapes. From mountain ranges to verdant forests and stunning coasts, New England’s trails are some of the most unique in the world. Discover New England offers a list of top trails, including the epic Appalachian Trail.

2. Swoosh through the Snow

Take to the slopes for one of the most popular New England winter activities. You can choose from various resorts with novice to advanced and family-friendly skiing or snowboarding. Cross-country skiing offers a more relaxed adventure, including night trips under the stars.

3. Go for a Skate

Many cities offer free or inexpensive ice skating at local rinks around the holidays. In contrast, Nestlenook Farm in Jackson, New Hampshire offers three acres of Victorian skate park. Bundle up, and take the whole family for a nostalgic afternoon, ending with piping hot cups of cocoa.

4. Ride a Sled

When the next snow day hits, take the whole family for a day of gleefully speeding downhill on your local sledding hill. The more adventurous can carve down mountains in a Mad River Rocket at Clearwater Sports in Vermont, though such New England winter activities are not for the faint of heart.

5. Go Tubing

Snow tubing can seem fairly strange at first, but sliding downhill on specially-groomed slopes is fun for children of all ages. No previous experience or special equipment is required, though some facilities offer night tubing or special programs for very young children.

6. Tour on Snowmobile

Exploring sparkling white snowscapes by snowmobile allows you and your family to explore breathtaking areas that might not be accessible otherwise. Options abound for tours and trails, with Maine boasting the most snowmobile trails of any state in the Eastern USA, at almost 15,000 miles.

7. Snowshoeing

This sport is one of the simpler New England winter activities for families. Many resorts offer rentals and guided tours for traipsing through peaceful winter landscapes. Vermont’s Trapp Family Lodge situates snowshoeing among spectacular views and Old World architecture.

8. Fish on Ice

Just as fly-fishing takes over New England’s lakes and ponds in warmer months, ice fishing dominates winter. You can have a more authentic experience of pulling fish out of the ice or take a guided trip with a heated fishing house. Consider taking classes from local, state Fish and Game Departments.

9. Dash through the Snow

Taking a sleigh ride is just as romantic as it sounds, especially when you have a warm hearth to return to. Bring the whole family, and the trip becomes a brisk adventure through a winter wonderland. The most famous place for sleigh rides is New Hampshire’s historic Mount Washington Hotel.

10. Mush Some Mutts

For a unique experience, head to Muddy Paw Sled Dog Kennel in New Hampshire, and can take your family on a dog-sledding tour, during which you’ll meet the dogs and work with the team. Sunny Grange Bed and Breakfast also offers practical classes on harnessing and anchoring dogs.

From skiing to snowmobiling and so much more, New Hampshire winter activities are well worth braving the cold. The Travel Channel offers helpful tips, including adult options like zip-lining, ice climbing, and winter camping. Whatever you choose, bundle up, plan ahead, and be prepared for the adventures that await you.

Are you craving more outdoor adventures? Check out our guide!

Outdoor Adventures


New Year – New Gear: 5 2017 Apps Every Physician Needs

2017 Apps

Mobile health continues to expand, with SNS Research estimating mHealth’s market at over 20 billion dollars a year. While many apps target patients, healthcare providers can also use them to improve their practice. With around 100,000 applications in major stores, purposes range from screening to drug identification, education, and more. Here are some of the most noteworthy 2017 mobile healthcare apps.

1. DynaMed Plus

This recent app from DynaMed includes expanded graphics, images, and specialty content, along with clearer recommendations and semantic search. As iMedicalApps notes, DynaMed Plus is competing with the standard point-of-care reference, UpToDate. For physicians, this translates into a friendlier search window with predictive results, expansive treatment summaries, convenient hyperlinks to PubMed, and Micromedex drug information. Altogether, this evidence-based app is an essential tool for answering your own and patients’ questions on a daily basis.

2. CareKit Apps

As The Verge reports, Apple’s open software platform, CareKit, includes four modules for health management apps: patient care, symptom measurement, treatment impacts, and communication with providers. CareKit apps enable providers to remotely monitor activity, weight, diet, symptoms, and progress. Examples include progress-tracking apps like Start and more specific apps like the diabetes-monitoring One Drop. Among 2017 apps, CareKit options still have to demonstrate quality and privacy control, though information is already anonymized.

3. Epocrates

Epocrates is the top drug information app for point of care support. According to iMedicalApps, its latest iteration includes an extensive drug database with information on dosing, interactions, adverse effects, and pharmokinetics – all of which is searchable by generic name, brand name, or conditions. A helpful pill identifier and multiple clinical calculators round out this multipurpose app. The paid, Plus version adds clinical treatment guidelines, a disease database, an ICD-10 code lookup, and an alternative medication database. Although Epocrates’ price is relatively steep, its many features make this app a useful and essential tool for many healthcare providers.

4. GoodRx for Doctors

While GoodRx helps patients find the lowest prescription prices, the medical professional version adds a comprehensive drug guide. Unlike Epocrates, GoodRx for Doctors also incorporates professionals’ experiences and charts on potential benefits. At the same time, each drug or treatment profile provides a guide to the best available prices and discounts. As pointed out in the iMedicalApps review, GoodRx for Doctors thus helps healthcare providers keep up with the latest medications and treatments and quickly email or text the low prices to patients.

5. RxUniverse

RxUniverse was launched last year by Mount Sinai Health System of New York as an app management platform. It integrates digital health tools into medical practice through the evaluation of 2017 apps in terms of their evidence-based benefits. Accordingly, RxUniverse features a curated list of apps alongside tailored educational content, all of which directly interfaces with the patient’s electronic health file. Perhaps most importantly, RxUniverse allows healthcare providers to directly prescribe curated apps through a link sent to patient’s digital devices.

With these tools on hand, you can get the New Year off to a good start. Although not all apps are free to use, many are, and many more are cost-effective. Options like RxUniverse, in particular, provide a means to adapt to the changing landscape of modern healthcare and even the growing range of 2017 apps. Choose carefully, and you can enhance patient engagement and your practice all in one app.

*Please note that this blog does not imply endorsement by Elliot Health System of specific physician app technology choices.

In addition to apps, it’s crucial to join and interact in relevant physician forums to keep up with the latest medical practice trends. Check out our Physician Forum Guide to learn more.

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How to Maintain a Healthy Diet as a Physician

Maintain a Healthy Diet

Physicians don’t get sick. 

That’s the common refrain propagated by healthcare professionals across the country, according to a 2012 article published in the British Columbia Medical Journal that examined the lifestyle and preventive health behaviors among physicians.

And, not only are physicians supposed to be healthier than their patients, they’re also more independent, competitive and high achieving, according to the article’s author.

Any attention physicians pay to their own needs can only be viewed as signs of weakness. 

Of course the article’s authors found that physicians are actually just like everyone else. They neglect their own health, work too much, sleep too little, don’t eat as well as they should and become ill. 

That’s the bad news. 

The good news is that the profession is starting to pay attention to the needs of physicians beyond the exam room, doing away with the stigma attached to programs designed to help physicians deal with physicians’ physical, mental and emotional challenges. 

But physicians still have to be willing to step up and take care of themselves by exercising, sleeping, caring for themselves and eating right. While it can be difficult to find time to work out and sleep, it’s relatively easy to maintain a healthy diet.  

Here’s a look at three easy ways to maintain a healthy diet while succeeding in the practice of medicine:

1) Grow your own greens

There’s something to be said for growing your own vegetables. The benefits are both intangible and tangible, according to an article published in the Harvard Health Letter.  

When you grow your own food, you’re more likely to eat more vegetables, avoid fertilizers and pesticides (or at least decide which come in contact with your food) and reap the benefits of freshly picked produce, which contain more nutrients than store-bought vegetables. 

It’s never too soon to start planning your garden–and you can start planting seeds indoors during the winter months before transplanting them to your garden after the last frost of the spring. 

2) Outsource your salads

Sometimes growing your own greens simply isn’t plausible. Sometimes you need to outsource the production of your vegetables to someone who grows them locally, cares about quality and makes them available almost as soon as they are harvested.

For these moments, there is the Manchester Farmers Market.

The market draws farmers from throughout New Hampshire, who sell locally grown produce, meat and certified organic products. If you don’t have time to care for your own garden, consider stopping by the Manchester Farmers Market from 3 to 6:30 p.m. every Thursday in June, July, August, September and October.

It’s a great way to get the benefits of garden-grown vegetables without having to do the work yourself.  

3) Update your Rolodex

Your Rolodex can either help or hurt you. It can either be the savior of svelte or the reason you need to invest in new clothing. 

Don’t let it become the bane of your ability to maintain a healthy diet. 

Instead of relying on the same old restaurants that deliver the same old fried food every day, update your Rolodex with restaurants that specialize in healthy options. 

New Hampshire Magazine has published a list of the “healthiest restaurants in Manchester,” and it’s well worth checking out. You’ll find restaurants as committed to the community’s health as you are–and their menus are chock full of healthy options, void of high calories and cholesterol but rich with flavor. 

Eschewing the typical “eat-and-treat” options that you’ve been fueling up on in favor of healthier options will go a long way towards helping you maintain a healthy diet. 

Elliot Health System is passionate about helping providers with their work-life balance. Would you like to join us?

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Favorite Ski Destinations Near Manchester, New Hampshire

Ski DestinationsNew Hampshire is known for low taxes, a high quality of life and an unwielding commitment to living free. 

Perhaps it’s time to add another item to the list: skiing.

With the White Mountains as its backdrop, New Hampshire has established itself as the go-to state for thrill seekers and snow enthusiasts alike. And Manchester, with its plethora of dining and entertainment options, is the perfect place from which to launch your excursions. 

Here’s a look at five of the top (or most convenient) ski destinations near Manchester, New Hampshire:

Loon Mountain

If you look at any list of the top ski destinations near Manchester, Loon Mountain is sure to be near the top. With a 2,100-foot vertical drop, 61 trails, an array of terrain and 11 lifts, the 90-minute drive from Manchester is well worth it. Many people make the drive for the skiing and terrain park, but wind up staying for the dining and lodging, which receive rave reviews. 

Single-day lift tickets start at $48 for novice skiers and climb to $95 for a Saturday or Sunday. 

Learn more about Loon Mountain

Bretton Woods

Bretton Woods is known as “New Hampshire’s largest ski area,” but what really sets it apart is the snow quality. Ski Magazine has ranked Bretton Woods as “#1 in the East” for snow quality for four consecutive years. Combine that with 62 trails on 464 acres and you’ve got one of the best ski destinations near Manchester that is well worth the nearly two-hour drive. It’s also one of the top-rated locations for terrain parks. 

Single-day lift tickets will cost you between $60 and $90. And make sure to ask about the night skiing options. 

Learn more about Bretton Woods

Waterville Valley Resort

If you’re looking for a resort that is steeped in history, look no further than the Waterville Valley Resort. For decades, it’s been a popular destination for snow lovers and ski enthusiasts from Boston, including members of the Kennedy family. 

Waterville Valley Resort boasts 53 trails, eight lifts and an array of other activities for the entire family–dog sled excursions, snow tubing, indoor ice skating and nordic skiing. It’s location is just close enough to keep you close to home and work, yet hidden enough to allow you to escape, which is why it’s long been the go-to place for elected officials and community leaders to escape for a day, weekend or week in the wilderness. 

Learn more about Waterville Valley Resort

Attitash Skiing

With 68 trails spread across 500 acres on two mountains, Attitash offers something for everyone. There are challenging runs, wide-open cruisers and those that wind through large swaths of red spruce and balsam fir. The highlight, though, might be the New Hampshire’s original freestyle terrain parks, which offer X-Game-like opportunities to push yourself to new limits. 

Attitash is in the heart of the Mount Washington Valley, two hours from Manchester. 

Learn more about Attitash

McIntyre Ski Area 

It’s not the biggest. It won’t blow you away with altitude. And more experienced skiers aren’t likely to be pushed to their limits. But, McIntyre Ski Area is the only ski destination located in Manchester, and its a great way to spend a getaway day with the kids. With 200-vertical feet of terrain, nine trails, learn-to-ski-classes for all ages, a terrain park and eight tubing lanes, McIntyre Ski Area is the perfect place to introduce beginners to the joys of outdoor winter fun. 

Full-day lift tickets are between $30 and $38, and kids ages 2-3 as well as seniors 65 and older always ride for free. 

Learn more about McIntyre Ski Area.

Are you still craving more adventures? Check out our free Outdoor Adventure Guide.

Outdoor Adventures


Stay Fit! Quick Workouts for the Busy Physician

Plank Exercise

Two hours and 30 minutes a week.

That’s the amount of moderate intensity physical activity that delivers the most health benefits, according to the “Physical Activity Guidelines for Americans” published by the U.S. Office of Disease Prevention and Health Promotion. 

Good luck committing 150 minutes a week to working out–especially when you’re a busy physician who is working up to 80 hours a week, trying to find time for your family and also attempting to sleep once in a while. 

How is a busy physician, with so little time and so much riding on the profession, supposed to find time to exercise? By breaking down their workouts into easily digestible, 15-minute bites of daily exercise that include these seven easy and efficient moves: 

1) Lateral and Forward Neck Flexion

The key to making sure your in-the-office workout is effective is to spend a little time on each area of the body–from top to bottom. 

Start by taking a seat and then flexing your neck to the left and then to the right. Once you’ve finished 10 lateral reps, do the same thing forward and backwards 10 times to increase neck strength and flexibility. 

2) Shoulder Rolls

Since you are already sitting down, you might as well do some seated shoulder rolls to take care of stress and tension while improving circulation to the joints. Roll them forward 10 times and backwards 10 times. 

3) Chair Dips

Now that your shoulders are warmed up, its time to work the triceps by performing some chair dips. Start by standing over the edge of your chair, body leaning forward, knees flexed. Place your hands on the armrests and slowly lower your body downward into a sitting position.

Put as much weight as you can handle on your triceps for two sets of 10 repetitions in order to tighten up the back of your upper arms. 

4) Isometric Squeezes and Biceps Curls

After you’ve tightened the triceps, move on to the biceps. Start by doing some isometric bicep contractions, which will work to tone and tighten your upper arms. Then grab a book, bottle of water or anything else that’s easy to hold onto and curl them. Do two sets of 10 on each arm to tighten and build your biceps. 

5) Plank

Planking strengthens your core, improves posture and balance, reduces back pain and makes you more flexible.   

And you can easily plan in your office without dropping down onto the floor. Here’s a look at four office-friendly plank poses, courtesy of Livestrong.com, that every busy physician can do throughout the day or incorporate into their lunch breaks. 

6) Inner- and Outer-Thigh Contractions

As a physician, you probably spend a good part of your day on your feet. Stronger, leaner legs allow you to keep going longer. Luckily, you can strengthen and tone your thighs without actually lifting any weights or going for a long run or ride. 

Contract your thigh muscles for five seconds at a time, 15 times in a row. Work your way around your thighs throughout the day. Nobody but you will know that you’re working out!

7) Calf Raises

Every now and then, stop where you’re standing, square your back and shoulders, point your toes forward and lift your heels off the ground by contracting your calves. 

Do two sets of 15 several times a day to strengthen and tone your calf muscles and improve lower extremity circulation. 

These seven exercises might not replace going to the gym, but they are an easy way for a busy physician to work 150 minutes of exercise into the work week. 

*Please note that this blog does not endorse specific exercise regimens or the companies that promote them. Exercise is an individual choice to be made carefully based on your own personal goals, health etc.

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Historical Manchester, New Hampshire: The Top 5 Places to Know and Go

Manchester, New Hampshire

Native Americans used to call it Namaoskeag in honor of the fish that are so bountiful in the nearby rivers and ocean. Today it’s considered the “business capital” of New Hampshire, home to high-tech companies specializing in aerospace engineering and electronics.

It’s been called “plucky” for its ability to bounce back and move forward after economic downturns–but it has never forgotten its storied past. 

It’s Manchester, New Hampshire, and it’s a great place to live, work and play. 

Manchester’s origins date back to the 1700s, when colonists settled the area and began turning it into a manufacturing powerhouse. Over time, it transformed into a textile mill town, an East Coast epicenter of innovation and an axis of artistic expression.

If you ever find yourself with a few free hours in Manchester, lose yourself in these five fabulous places to know and go.

1) Take a little stroll down memory lane

There was a time in the early 1900s when Manchester was one of the nation’s premiere places for textiles. Today, you can take a look at what it may have looked like thanks to the SEE Science Center’s LEGO Millyard Project

According to the center, the display is the world’s largest permanent LEGO installation. The 55:1-scale, 3-million-brick project pays homage to Manchester’s heritage and gives you a little look at what downtown Manchester used to look like. 

2) Appreciate organic architecture

Frank Lloyd Wright is one of the most well-respected and controversial architects of all time. His designs introduced Americans to modern, “organic architecture” that helped houses break free from the constricts of Victorian design. 

While his design principles were borne in the Midwest, he did design one house that wound up being built in New England–the Zimmerman House, which is owned and operated by an art gallery and widely considered to be a work of art in itself. 

3) Watch the wild salmon swim

Native Americans called Manchester “Namaoskeag,” which translates to “good fishing place.” Today, the city’s rivers continue to produce bountiful opportunities to enjoy and appreciate wild salmon, carp and shad.

All three species of fish can be found at the Amoskeag Fishways throughout May and June. That’s when they jump upriver on the cement “fish ladder.” Stop by the award-winning environmental education center, which is located in the heart of Manchester on the Merrimack River, and enjoy interactive exhibits as well as the excitement of the wild salmon swimming upstream. 

4) Get in touch with your wild side

It’s rare in the United States to find an outdoor oasis in the heart of an urban area. But that’s exactly what Dorrs Pond offers. 

This 25-acre fresh-water jewel is surrounded by tall trees and well-maintained trails, allowing you to get in touch with your wild side all year long. When the temperature drops and the pond’s water freezes, you can take part in some ice skating–a Manchester tradition that dates back nearly a century. 

5) Catch and up-and-coming comedian

Manchester is a funny place. If it weren’t, how else would you explain the fact that several of today’s top comedians cut their teeth in the city’s comedy clubs. 

Adam Sandler, Sarah Silverman, Seth Meyers and Mike O’Malley all grew up in New Hampshire and got their start in Manchester’s comedy clubs. That’s a pretty impressive fact for a city with a population of about 110,000 people.

See who else might soon be starring on the big screen by stopping by Headliners Comedy Club, where comedians from across the country–and up and down the New England coast–try to follow in the funny footsteps of those who came before them.  

Elliot Health System is conveniently located in the thriving area of Manchester, New Hampshire. Join us!

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