Street medicine will be a new concentration for UB family medicine residents, thanks to a $2.5 million HRSA grant

BUFFALO, N.Y. – The Department of Family Medicine in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo is developing a program that trains physicians to provide high-quality, compassionate care to individuals experiencing homelessness and housing instability.

UB is the only institution in New York State, and one of 24 nationwide, to be granted a $2.5 million award from the U.S. Health Resources and Services Administration (HRSA) to establish the Primary Care Training and Enhancement – Residency Training in Street Medicine program.

Residents interested in street medicine will be able to apply for this residency starting in June.

The program will serve as a national model for integrating street medicine into graduate medical education, addressing critical gaps in health care access for people experiencing homelessness and housing instability. It directly supports both HRSA’s mission to expand the primary care workforce and UB’s vision of advancing health equity through innovation and community partnership.

“As one of the nation’s oldest family medicine residencies, the Jacobs School program has a history of innovation and advocacy, responding quickly to the challenges that so profoundly affect patients’ social determinants of health,” says Allison Brashear, MD, vice president for health sciences and dean of the Jacobs School. “By developing a street medicine concentration for residents, the department is prioritizing patients whose lived experiences fall outside the mainstream and placing them at the very center of care.”

A growing population

The number of unhoused people nationwide and in Western New York has increased over the past several years. Recent estimates put the approximate number locally at more than 1,500.

Residents in UB’s street medicine concentration will be able to choose either an urban rotation through Erie County Medical Center or a rural rotation in Olean through the Universal Primary Care Community Health Center, a federally qualified health center. And while residents will be based at clinics, they will be physically out in the community, providing care to unhoused people wherever they are — at shelters, at transit depots or on the streets — a critical aspect of effective street medicine.

The residents will participate in the UB Department of Family Medicine peer mentor program, where people with the lived experience of patients, whether that be substance use, behavioral health challenges or housing insecurity, supplement the assistance provided to patients.

“The peer can say to the patient, ‘I was where you are,’” says Linda S. Kahn, PhD, research professor of family medicine and co-principal investigator with Frederick (Mike) Elliott, MD, clinical assistant professor of family medicine at UB and a physician with UBMD Primary Care. “Few programs nationwide can offer their residents the experience of being able to work with peer mentors.”

Residents will receive hands-on training in mobile health care delivery, harm reduction, behavioral health integration and trauma-informed care. The family medicine team is collaborating with academic and community partners that will play an instrumental role in developing and implementing the street medicine curriculum, workshops and rotations. These partners include the Erie County Department of Health, which will provide harm-reduction training and hands-on experience working with its Peer Navigator Street Outreach Team, and the UB Department of Emergency Medicine, which will train residents in street-based approaches to infection management, wound care and urgent psychiatric stabilization.

Family medicine physicians and residents will collaborate closely with UB HEALS, the Jacobs School’s student-run street medicine initiative, and support its mission of providing care in nontraditional settings for people experiencing homelessness. Healthy Outcomes Partnership & Education (HOPE) of Erie County will offer residents experience with justice-involved care and medical-legal partnerships. Plans are also underway for a partnership with the UB School of Public Health and Health Professions’ Health on Wheels program as a possible site for residents and physicians to offer care to people with housing insecurity.

Meeting patients where they are

“Meeting patients where they are is impactful in profound ways,” says Elliott. “All the talk about whether someone has insurance or not, that all goes away because the physical act of going out to the person where they are is how you establish trust and reengage that person into health care.”

Without that trust, he says, street medicine cannot happen, a lesson often reiterated by students in UB HEALS, which provided input and which will be a partner on the grant. UB HEALS students say that unhoused people grow to trust them because they consistently make the effort to come out to see them.

Changing clinical medicine

Ultimately, the street medicine residency will be doing more than providing sorely needed access to care for a severely underserved population; it will also be changing clinical medicine and improving it to adapt to new societal challenges.

“Long term, these residents will be transforming the way that practices operate,” says Elliott. He says just as residents and early career clinicians are now more comfortable treating patients with substance use disorder without the bias that patients might have experienced in the past, these residents will be better able to provide care to unhoused individuals.

“They will be able to help these patients in a humane way, to help them navigate all the things they’re going through without dismissing them or stigmatizing them,” says Elliott. “We are realizing that if we project trust and provide a safe place for the patient, it affects their care and they’re more likely to respond and trust us. It translates to more adherence, better health outcomes and better quality of life.”

Other UB researchers on the project include: Robert Macek, MD, clinical associate professor and associate program director, and Peyton Bulera, training program administrator, both of the Department of Family Medicine residency program; David Holmes, MD, professor; Matthew Thomas, senior research scientist; Meghan Chambers, senior research associate; and Diane Berdine, HOPE program director, all in the Department of Family Medicine’s Primary Care Research Institute, as well as Brian Clemency, DO, professor and vice chair of the Department of Emergency Medicine.