After a long Thursday shift at Loyola University Medical Center in Chicago, emergency physician Theresa Nguyen, MD, FACEP, heads to the train station. It’s late, but she’s not going home.

Dr. Nguyen and several volunteers meet at the end of the Chicago Transit Authority Blue Line, the Forest Park Station, where patients without access to care, health insurance, or anywhere else to turn, are waiting. Health care professionals, social workers, and students from area universities stay until midnight treating wounds and bruises. They deliver medical care while their community partner The Night Ministry offers information on housing and warm meals.

There’s even a mobile shower unit, something Dr. Nguyen said is a key part of their wound care.

“Our motto is simple: Go to the people,” Dr. Nguyen said. “I love coming out here, listening to people’s stories, and building relationships with individuals who are often neglected by the health care system. It’s actually a great way to unwind after a busy shift.”

The Chicago Street Medicine program is just one example of ACEP members delivering care to underserved populations outside of the traditional emergency department (ED). Volunteers with free time and board certification in emergency medicine work in clinics where all that is required to get blood pressure medication is a diagnosis of high blood pressure. Volunteers work in mobile clinics, where converted vans and buses move where the need is greatest. An increasing number of emergency physicians are working in street medicine programs, removing most of the barriers to health care access.

“Street medicine goes beyond medical care,” said Dr. Nguyen, co-founder of the Loyola Street Medicine program and director at the Center for Community and Global Health at Loyola’s Stritch School of Medicine. “It’s about understanding the full picture of a patient’s circumstances. We’re addressing the roots of their needs, which go far beyond their medical symptoms.”

Street Medicine Movement

Volunteers and the organization “Freestanding Communities”, which provides medical triage and patient screenings, prepare a street medicine clinic in New Orleans. ACEP member Jordan N. Vaughn works with Louisiana State University, volunteers, and other city services to provide care to underserved populations. (Click to enlarge.)

Street medicine is rooted in a movement that began in the 1990s, pioneered by physician James S. Withers, MD, who went into Pittsburgh’s homeless campsites to provide care and gain insight into the lives of people living on the streets. Today, that movement has expanded globally. According to the Street Medicine Institute, more than 140 cities have street medicine programs, serving the unsheltered in 27 countries and six continents.

Volunteers said street medicine demands adaptability and a deep understanding of patients’ lives. To develop this understanding, Dr. Nguyen created a “street medicine inpatient consult service” at her hospital.

This initiative supports homeless patients admitted to the hospital, ensuring continuity of care and safe discharge plans. The program is designed to offer a holistic care experience, building long-term relationships with patients that stretch from the streets into the hospital.

Chicago Street Medicine works with medical schools throughout the city, creating a network of chapters led by students from the University of Illinois Chicago, Northwestern University, the University of Chicago, and Loyola. This organizational structure allows street medicine to be flexible and responsive to the unique needs of each neighborhood.

A Rewarding Learning Experience

Volunteers with the University of South Florida Tampa Bay Street Medicine team head out to deliver care to underserved residents in Tampa, Fla. (Click to enlarge.)

For Qi Charles Zhang, MD, MPH, attending physician at Humboldt Park Health, Chicago, delivering health care is about reaching people the system can miss. Until recently, Dr. Zhang was the medical director of the Chicago Street Medicine program. He learned about street medicine working with Dr. Withers in Pittsburgh as a visiting student for a program called Operation Safety Net, and then helped grow street medicine while in medical school at Tulane University and as resident at Louisiana State University (LSU), before moving to Chicago.

Dr. Zhang said many underserved patients face barriers to accessing clinics or simply don’t feel welcome in conventional health care settings. Street medicine, in contrast, brings a clinic to them—backpacks filled with wound care supplies, antibiotics, and over-the-counter medications, along with essentials like snacks, socks, and water.

For the medical students and residents participating in these street runs, the work is eyeopening and rewarding.

“It’s an important opportunity for these students to really see what it is that these patients go through,” Dr. Zhang said, adding that it fosters a deeper understanding of the barriers faced by underserved populations. Dr. Zhang said this experience is essential, regardless of the specialty students choose later.

“A lot of the things we used to blame patients for—being noncompliant, signing out against medical advice—are so much more complicated,” he said.

Delivering More Than Medicine

The Loyola Street Medicine team at Loyola University Medical Center, Chicago, includes ACEP members Theresa Nguyen, MD, FACEP, (first from left) and Qi Charles Zhang, MD, MPH, (middle). (Click to enlarge.)

Emergency physician Jordan N. Vaughn, MD, clinical assistant professor at the LSU School of Medicine and public health clinical director for the New Orleans Health Department, helps deliver critical health care services to New Orleans’ most vulnerable populations and is keenly aware of Dr. Zhang’s legacy.

Through a partnership with LSU’s Street Medicine Program and the city’s initiatives to improve housing opportunities, Dr. Vaughn and her team bring health care directly to those living on the streets, filling gaps in access, and addressing the complex needs of these communities.

The LSU Street Medicine Program, primarily a mobile health outreach initiative, engages medical students in providing health services to people who are unhoused or facing extreme poverty.

Services are extensive and go beyond traditional medicine, including distributing essentials like toiletries, clothing, snacks, and vitamins, and providing guidance on obtaining identification or filling out paperwork for housing and health care.

“This is a patient population that’s frequently misunderstood,” Dr. Vaughn said. “One decision or one life event can put somebody in this situation. These programs and the outreach we do remind me of why I went into medicine and why, as emergency physicians, we do what we do.”

Partnering with the Mayor’s Office of Homeless Services and Strategy, Dr. Vaughn’s team also coordinates care and resources for residents of New Orleans’ encampments, areas designated for the homeless. The effort is both strategic and empathetic, as they map out high-priority encampments using 911 and EMS data and spend the first two weeks establishing rapport.

“Each encampment, especially in New Orleans, has its own flavor of needs,” Dr. Vaughn said. “A lot of time is just spent introducing myself with ‘Hey, I’m Dr. Vaughn, and I’m coming out every morning.’ You wear them down a little bit because they’re like, ‘Okay, this is familiar. She keeps showing up.’”

Once trust is established, the team works on individualized plans to overcome barriers to housing and health care. Some struggle with addiction. Others face challenges related to disabilities. In cases where it wouldn’t be safe to place a person in independent housing, the team arranges for long-term care. By the end of their outreach period, they’ve created a name list, identified barriers, and coordinated with case workers to ensure everyone receives appropriate support.

In addition to housing and outreach, Dr. Vaughn’s team delivers a range of medical services on the street, meeting many residents’ primary care needs.

“A lot of it is chronic ailments—high blood pressure, diabetes,” she said. “‘I lost my meds, or they were stolen, or I couldn’t fill my medications.’”

Making a Street Run

At the University of South Florida, Enola Okonkwo, MD, participates in a student-driven Tampa Bay Street Medicine program, delivering care to Tampa’s homeless population. Through the program, Dr. Okonkwo and a team of medical students, residents, and faculty embark on “street runs” along a central downtown route frequented by the unhoused community. The team goes out in small groups, carrying backpacks loaded with basic medical supplies and dressed in matching, recognizable green shirts. They don’t provide prescription medications, but they have a “mini pharmacy” of over-the-counter medicine, wound care items, insect repellent, hygiene kits, and Narcan.

“Sometimes, patients just need someone to help them understand when a problem might require an ER visit,” Dr. Okonkwo said. “One patient came to us with a severe hand infection. We got him to Tampa General for IV antibiotics before it became life-threatening.”

For Dr. Okonkwo, whose regular job is serving as associate program director for University of South Florida’s emergency residency program, one of the most impactful aspects of street medicine is the opportunity to connect with patients on their own terms; the population has a totally different demeanor on the street.

“They know we’re there only to help them,” she said. “It’s a different level of trust, without the metrics or pressure typical in the ER. The informal, nonclinical setting helps ease the stigma and guardedness these individuals often feel in traditional health care environments, and it lets us focus on simple medicine and essential care.”

Beyond street medicine, the Tampa program also provides a student-led continuity clinic and a specialized refugee clinic, both of which are commonly staffed by emergency physicians. The continuity clinic operates out of Tampa Hope, a structured shelter with semi-permanent mini-cottages funded by Catholic Charities, and offers a stable location for ongoing care. Volunteers can prescribe medications and provide a primary care bridge to reduce ED visits. For Dr. Okonkwo, it’s this more consistent care model that makes a lasting difference.

“We’re helping to fill the primary care gap, which is essential for avoiding preventable complications in vulnerable populations,” she said.

The student-led refugee clinic, Dr. Okonkwo’s “passion project,” delivers free health care to refugees resettling in Florida. She describes this as “a unique practice where I can incorporate global health training to address specific needs, ranging from preventive medicine to conditions such as parasitic infections and complex nutritional issues, often seen among newcomers who have spent extended time in transition.” Recently, the clinic acquired an ultrasound machine, thanks to grant funding, which allows them to provide real-time diagnostics and reduce the need to refer patients for costly imaging. EM ultrasound faculty regularly volunteer in the clinic, which has been incredibly valuable for patients and medical students to learn alongside the faculty.

Funding for these clinics is a constant challenge, Dr. Okonkwo said, and is sustained primarily by donations, grants, and the support of the University of South Florida faculty who volunteer time and resources.

“Our medical students play a huge role in fundraising, applying for grants, and seeking support,” Dr. Okonkwo said, noting that the dedication of students and residents has been essential to the program’s sustainability.

Accidental Volunteer

When he’s not working his regular job at an urgent care in Columbia, S.C., David Baehren, MD, FACEP, volunteers about two days per week at a free clinic in Beaufort, S.C. Dr. Baehren not only provides care at the Good Neighbor Medical Clinic, but also serves as its medical director. The free clinic serves as a medical home for around 700 patients who would otherwise face challenges in accessing health care; it provides primary care and coordinates specialty care, lab services, imaging, and medications at no cost to patients.

Dr. Baehren was asked to lead the Good Neighbor Medical Clinic when the previous director became ill. He was reluctant. He wasn’t sure an ED background fully prepared a physician for so much primary care. He found that adapting to this new role was a natural extension of his experience.

“If you’re practicing emergency medicine, you have a lot of skills,” Dr. Baehren said. “There are a few things you need to brush up on … but it’s worth it. Our patients get just as good care as somebody who has insurance, and I get to spend more time with them, building connections that can be rare in the ED. A new patient gets an hour of my time.”

The clinic operates with significant support from a network of dedicated volunteers and Beaufort Memorial Hospital. Patients aren’t financially responsible for labs, imaging, or specialty referrals. Paid staff includes an executive director, clinical director, and volunteer coordinator. A shared hourly position and volunteer nurses and nursing students round out most of the team, along with a volunteer dietitian. One volunteer is a physician in his 70s who used to have a family practice in the building where the clinic is located.

Two Years Turned into 22

Dr. Baehren said the need for more access to affordable medical care is enormous in South Carolina, and emergency physician M. Todd Crump, MD, agreed. Dr. Crump is the medical director at The Free Medical Clinic in Columbia, S.C.

The Free Medical Clinic isn’t just part of a broader network of more than 40 free clinics in the state; it’s one of the largest and operates as close to an ED as possible. With most of its patients typically living at or below the federal poverty line, Dr. Crump said the clinic supports individuals who often face the impossible choice between buying food or essential medications.

The clinic provides comprehensive services, including primary care, specialty care, and medication distribution, all free of charge. Patients visit a doctor, and prescriptions are prepared at an in-house pharmacy, allowing them to leave with everything they need.

“We dispense over $2 million worth of medications each year,” Dr. Crump said, noting that partnerships with drug companies and community support make this possible.

The clinic operates a first-come, first-served model to ensure fairness and accommodate the unpredictable schedules and transportation challenges many patients face. Clinic staff posts a daily patient limit on the door, giving patients clarity about their waiting time. Although most services are primary care, specialty visits are also provided with dermatologists, cardiologists, neurologists, and gynecologists—all scheduled in advance. Beyond providing immediate care, the clinic emphasizes preventive health services, a crucial component in reducing long-term health care costs and avoiding ED visits.

Dr. Crump recalled a 52-year-old patient who arrived for a routine checkup with no symptoms but had never had a colonoscopy. He talked her into one. Doctors found a large tumor, which was removed with surgery with no need for chemotherapy or radiation.

Dr. Crump’s journey to the clinic began nearly three decades ago when he was a medical student who enjoyed volunteering. He was asked to become The Free Medical Clinic medical director and agreed to do it for two years. That was 22 years ago.

“I work every other weekend in the ER, but I always make time for the clinic,” he said. “This work is too important.”

Driving Access to Health Care

On oppositive sides of the country, ACEP Washington Chapter Immediate Past President and ACEP Public Health Committee Chair Herbert C. Duber, MD, MPH, FACEP, and New Hampshire emergency physician Deepak Vatti, MD, FACEP, volunteer for the delivery of care that involves driving it to where it’s most needed.

Dr. Duber helped grow the Harborview/UW Medicine Mobile Health Outreach Program, has served as a preceptor for years, and still volunteers when the converted van cranks up for a run. Funded by donations, the program provides a free clinic—staffed mostly by student volunteers, but with clinician help—focusing on residents of several Seattle Tiny House Villages just outside the boundaries of the University of Washington.

Dr. Duber, professor and section head for population health at the department of emergency medicine at UW Medicine, said the van is well-equipped to care for most of what volunteers will see. There’s even a curtain for private conversations.

“We’re very fortunate to have a community that cares about people, and we have amazing student leaders who want to help however they can,” Dr. Duber said.

At the St. Joseph Hospital Mobile Health Clinic in Southern New Hampshire, Dr. Vatti and his team have celebrated some huge victories since declaring the converted rock-band-tour-size bus fully operational about five years ago. One victory was in his neighborhood.

Law enforcement informed him that a park-and-ride lot in the area was where some unhoused people were temporarily sleeping in their cars. They felt safe with security cameras and lighting in place, and the lot offered access to restrooms. Police asked Dr. Vatti if the bus could swing by and see if they needed medical care.

“A lot of people park there and take the train into Boston, so it’s always busy,” Dr. Vatti said. “But I had no idea this was going on, and it’s three miles from my house. We took the bus out there and connected with multiple individuals, provided immediate care where we could, and referred them to long-term resources.”

After deciding to start a mobile clinic, the bus sat still for a couple of years because of financial challenges and difficulty getting it fully equipped to serve in the capacity St. Joseph’s wanted. Today, it’s fully licensed to offer non-urgent, walk-in health care services. The mobile clinic is staffed with nurse practitioners, midwives, nurses, and patient service representatives; it has internet capability, and a staff interpreter is available.

The clinic brings free care to those without insurance and, although it’s a small percentage, a billing system is set up for those with coverage.

The next mobile outreach project is a challenge, said Dr. Vatti.

Immigrants in the area, mostly students around age 20, need to be seen by a physician to maintain their visa status, but they don’t know how to start receiving care and don’t speak much English. The U.S. Public Health Service reached out to St. Joseph’s to ask for help. Its Mobile Health Clinic came to the rescue. The first clinic, Dr. Vatti said, was inefficient and only saw two patients because of state and federal government paperwork.

“We’re going to figure it out; there’s some infrastructure to build,” Dr. Vatti said. “The patients were lovely; they’re just falling through the cracks. It’s a challenge, but we’re going to get these people taken care of.”

Mr. Scheid is ACEP’s Communications Director.