Q&A with Jimmy Miller, MD

After a year and a half providing care in our adult medical clinic at Fallsway, Jimmy Miller is moving into a newly created Director of Outreach Services role. He earned his doctorate at The Ohio State University College of Medicine, completed his residency at Johns Hopkins, and spent five years building and leading a street medicine program with the Allegheny Health Network in Pittsburgh. Overseeing our outreach, mobile clinic and street medicine programs in this role, Jimmy brings deep compassion and respect for the people he serves with an approach that's rooted in recognizing humanity and dignity in others. Get to know Jimmy and more about outreach services at the agency below. 

Looks like you had a strong interest in medicine, starting in undergrad. What pulled you toward this career path specifically?

I cared more, I think, about serving people experiencing urban poverty. My experience growing up in Reading, PA, was very informative. I went to public school, and Reading had a reputation as having a lot of poverty, violence, and drugs, and was kind of looked down upon. Going to school there, we kind of had a chip on our shoulders and thought, “No, there’s a lot more here that’s good that is being ignored.”

I was also frustrated by the fact that there were opportunities that I received that others didn’t; some of it was racial, some of it was socioeconomic. I wanted to see how I could use my education to give back to the community. Medicine really seemed to me like a tool to serve communities that were hurting.

You’ve had experiences providing care across many settings – from rural India to West Reading to five years of street medicine in Pittsburgh. How did these experiences lead you to work at Health Care for the Homeless in particular?

My first exposures to homelessness were in high school and college, but my experience really changed in medical school when I participated in homeless outreach through a church I attended and served in a free medical clinic. Later during medical school, I spent time with a health care organization providing mobile care and street medicine, which opened my eyes. The thing that struck me was how connection and relationship building were at the center of this approach to care.

I crafted my residency around getting the training and tools I needed to serve people experiencing homelessness. I came to Hopkins for their Urban Health Program. As a resident, I actually had a two-week rotation at Health Care for the Homeless. And during my fourth year, I worked with staff at the Convalescent Care Program and on the Mobile Clinic.

At the time, Health Care for the Homeless wasn’t in a place to do street medicine. In Pittsburgh, I had the opportunity to get some fantastic mentorship from Jim Withers – who is one of the founding fathers of Street Medicine – and Pat Perri. Over my five years there, I helped to build a street medicine and outreach team. I was doing shelter clinics, street medicine and low-barrier suboxone clinics. During COVID, our street medicine work actually increased. The County Health Department began requiring medical care to be part of any outreach efforts. We worked with shelters, offered testing and referrals to the quarantine spaces. Many clinics were closed, so there was a big need to provide care directly.

In 2023, my wife wrapped up her fellowship and centered her job search in Baltimore. It was obvious that Health Care for the Homeless was the best fit for me. And I was really excited about the potential to be involved in developing street medicine here.

Your role as Director of Outreach Services is new for the agency. What are the different programs under the "Outreach" umbrella that you’ll oversee and how do they fit together?

Over the last few years, there has been a lot of energy put into sustaining our core services at Health Care for the Homeless. Thousands of people access our clinics and receive amazing services. But some of the most vulnerable people, those who are sleeping outside or in abandoned buildings, for many reasons do not make it into our buildings for care.

The combination of outreach, the Mobile Clinic and street medicine provide different components of connecting with people where they are:

• Our Mobile Clinic is essentially a clinic on wheels. We’re going into neighborhoods where otherwise there is limited access to health care. People are experiencing homelessness and can’t easily get to other clinical spaces. We can draw blood, do full exams, including cancer screenings like Pap smears. We can do vaccinations, and we do. People can sustain care with our mobile clinic team or eventually move care into a fixed clinic site. It’s an extension of the clinic.
• Our Outreach team has dwindled, but the goal is to really start rebuilding. Fundamentally, outreach is about relationship building, networking and connection. It’s about understanding where people are, why they’re in these places, building trust and then helping them connect with resources – not just health care resources. Outreach also dignifies people who have felt disenfranchised or excluded; going to them in their space demonstrates they matter. We show that we care, we see them and affirm that they don’t need to change to receive care and services.
• Street Medicine in some ways is more akin to outreach than clinic-based care, but it combines both. The team works together to build relationships and to provide care where people are. Unlike an exam room where you see different providers independently, everyone on the street medicine team is together and engaging from different areas of expertise, and treatment and care are provided in a uniquely team-based approach. The conversation may flow organically from outreach worker for non-clinical needs to a nurse to a medical provider and then back to outreach as different needs are identified and addressed.

How is street medicine distinct from the kind of care we have already been providing through the Mobile Clinic?

Street medicine is fundamentally different. With the Mobile Clinic, someone chooses to come in the door and into an exam room. There’s an understanding that this person is willing to be asked questions that may be sensitive, willing to be touched, and wants treatment.

In street medicine, it really flips. We’re going into people’s spaces—not always with an invitation. So we’re doing outreach, we’re building trust and seeking invitation about health care needs. It really is person-centered care in a space that’s not ours as clinicians. I liken it to a home visit for people experiencing homelessness. If we were doing a home visit, we would knock on the door and ask permission to enter. I would only enter the home if invited in. And I would still be careful to seek ongoing invitation because it is not my space.

Overall, street medicine is a less burdensome approach for people who may want to seek care but have been afraid or traumatized in the past. They may not feel safe coming into a clinic because they are not in control, and they don’t have power. People carry a lot of institutional trauma with them—not necessarily from our clinics but from the larger health system. Street medicine gets past that because the power and control are with the client.

As we near the launch, what will street medicine at Health Care for the Homeless look like?

The team includes an outreach worker, a peer, a nurse and a provider.

The first few weeks will be focused on medical outreach in Downtown Baltimore and in Brooklyn. We’re seeking to understand from a medical perspective the needs of the community. We don’t want to just go in and fix problems. We want to be able to see the strengths of communities. There are so many times I’ve gone into a camp and been amazed at the resources that are already there.

Our job is to ask, “How can we support you? What are the areas you can’t access or where can we provide a connection that you don’t have already?”

In terms of care, we anticipate pretty quickly starting to provide services like wound care. In Brooklyn, for example, we know there are a lot of chronic wounds related to injection drug use. The stigma and even self-shame that is associated with substance use often precludes people from coming into clinical spaces, regardless of how low we make the barriers.
Harm reduction-based care helps people recognize that the larger HCH community is invested in their well-being and cares about them. So services like wound care, safe use kits and Medication Assisted Treatment will be early cornerstones of our street medicine services.

We also expect to grow into more primary care. For someone who will never set foot inside a clinic space or even our mobile clinic, we’ll do as much as we can and as much as they’ll let us—which may include checking someone’s labs, managing blood pressure, and even giving vaccines on the street.

What are you reading or listening to that you’d recommend for others interested in this work?

I highly recommend this 17-minute TED talk by Jim Withers. He expertly communicates the heart and ethos of street medicine. For a book, I’d say “Rough Sleepers: Dr. Jim O’Connell’s urgent mission to bring healing to homeless people.”

What brings you joy or helps you find balance outside of work?

My family relationships. I have two young kids (my son is three next month and my daughter is eight months old). They aren’t old enough to understand what I do, but they smile at me and laugh at me and hug me. It’s a good reset no matter what happened during the day.

The other thing is my personal faith, which keeps me really grounded. My wife and I attend a local church in the Inner Harbor here that’s really focused on caring for the community and social justice.

Whether you want to talk street medicine or parenthood, give Jimmy a wave and congrats when you see him next!