Q&A with Dr. Mike Van Scoy of UPMC

Q. Mike, thank you so much for joining us. Your career has spanned roles in internal medicine and now focuses on street medicine at UPMC. Can you share a bit about your journey and what inspired you to specialize in this area?

When I first started in medicine, I pictured myself as that small-town doctor who gets paid in cookies—the kind of person who builds real relationships with their patients. That was always the most important thing to me.

When I moved to Harrisburg, I began working in a more traditional setting—split between inpatient, outpatient, and teaching residents. But then I started doing home visits for a small group of patients who were frequent users of the emergency room. Those visits let me see patients where they lived, and I got a much clearer picture of what was going on in their lives.

Over time, that work naturally evolved. We began getting calls to visit people in boarding houses or on the streets—“Can you meet this person by the Capitol steps?” It felt like an extension of what I was already doing, meeting patients where they were and understanding their lives. It became clear that street medicine was the next step.

Q. As your work progressed from home visits to street medicine, how did your team adapt to meet the needs of this population?

It really was a step-by-step process. When we started with home visits, we were seeing just a few patients. As the need grew, we began connecting with other street medicine programs in Pennsylvania—like Lehigh Valley—which have been very successful. It’s a very collaborative community, and we received a lot of advice on structuring our program.

One pivotal moment was recruiting a nurse who had helped start the Lehigh Valley street medicine program. She helped us formalize our approach, bringing structure to our team with defined roles for community health workers and nurses. We presented this plan to leadership, making the case for why this work was critical.

We started in Harrisburg with a nurse, a community health worker, and me. Now, we’ve expanded to Cumberland and Harrisburg counties, with each area following a similar model. The community health workers and nurses are on the ground daily, and I or a nurse practitioner go out a few times a week.

Q. When you think about the people you serve, do you organize care by specific groups or conditions, or is it more individualized?

It’s definitely individualized. While people may face similar circumstances, their needs and priorities vary a lot.

For example, one person might be very focused on managing their diabetes or blood pressure, while another might not care about those things because they’re more worried about finding housing or getting Suboxone.

We meet people where they are, both physically and emotionally. Some patients can manage a 90-day prescription for their blood pressure medication, while others might lose their medication every week, and we have to adapt accordingly. It’s all about understanding what matters most to them in that moment.

Q. Pennsylvania seems to be a leader in street medicine. What barriers—or advantages—have you encountered in building this program?

Pennsylvania has been very progressive in this space. It was one of the first states to recognize the street as a legitimate place of service for billing, alongside California and Hawaii, even before it became a federal policy. That’s been a huge help.

We’ve also benefited from the legacy of Dr. Withers, the “grandfather” of street medicine in Pittsburgh. His decades of work, alongside programs like Lehigh Valley, have created a foundation for this kind of care in the state.

At UPMC, we’ve been fortunate that our program falls under community initiatives, which supports our work as part of the hospital’s community benefit requirements. Additionally, we’ve shown that our program reduces emergency department utilization, especially among frequent users, which strengthens our case for support.

Q. When you made the ROI case to leadership, what points resonated most?

Financially, street medicine isn’t going to bring in revenue like a traditional office practice. I could see 20 patients a day in an office, but in the field, I might spend 45 minutes with one patient who doesn’t have insurance. Instead, we framed it as a community benefit. We aim to reduce emergency department visits because we’re able to help patients with both legitimate health needs as well as social care needs like needing a warm place to stay. 

We also emphasized that this program fits UPMC’s mission to serve vulnerable populations. It’s not just about finances; it’s about doing the right thing for our community.

Q. You’ve also engaged medical students and residents in street medicine. How have you incorporated them into the work, and what has that experience been like?

When I was the Associate Program Director of the Internal Medicine Residency Program, it was a requirement for residents to join me in the field. They’d come out four or five times a year to Harrisburg or York to gain experience in social determinants of health, trauma-informed care, and treating individuals they often saw in the hospital.

What surprised me, though, was that many internal medicine residents didn’t connect with the work. A lot of them pursue fellowships—cardiology, pulmonology, or other specialties. That was tough for me to understand because I find this work so fulfilling.

Since stepping away from my associate director role, I’ve started working more with emergency medicine residents, and they’ve been fantastic. They see many of these patients in the ER and understand the challenges firsthand. They’re enthusiastic about learning how to connect patients with community resources and other forms of care. We don’t have a family medicine residency program here, but I think they’d align well with street medicine too.

One of the coolest things we’ve added is a program called Street Feet. A local podiatrist comes out with us into the encampments once a month with their residents to provide podiatric care. They evaluate foot conditions—something so common but often overlooked for people living unsheltered—and offer follow-up care in their office if needed. Programs like this show students and residents how powerful it can be to bring specialty care directly to the community.

Q. Street medicine often involves addressing complex issues like addiction and behavioral health. How does your team approach harm reduction and mental health care?

For opioid use disorder, we’re fortunate to work closely with an addiction clinic. We can start patients on Suboxone in the field with support from specialists.

We also focus on harm reduction, distributing Narcan, and testing for HIV and Hepatitis C. Pennsylvania’s laws still restrict distributing syringes, but we do everything we can to support patients.

Building trust is key. Many people wouldn’t seek help on their own, but when we show up consistently and say, “We’ll walk this journey with you,” they start to believe us. That trust makes all the difference.

For mental health, it’s a challenge. Wait times for psychiatrists can be six months, even for Medicaid patients. We’ve had to become comfortable managing conditions like bipolar disorder and schizophrenia—things most internists aren’t trained for.

We’ve also implemented a collaborative care model, where I consult with a psychiatrist regularly. And recently, Catholic Charities opened the Lavery Clinic in Harrisburg, a psychiatry clinic specifically for unsheltered individuals. It’s free and offers walk-in appointments, which has been a game-changer.

Q. Collaboration seems central to your work. How do you evaluate whether a community organization is a good fit for partnership?

Collaboration is essential in street medicine. We rely on community organizations for so many things—helping patients get housing, phones, EBT cards, or other resources.

The key is trust. Just like we build trust with our patients, we need to trust that these organizations will deliver on what they promise. If a patient is let down, they may never engage again.

We’ve been lucky to partner with organizations like Daily Bread, which provides mailing addresses, showers, and food, and the Veterans Village, a community of tiny houses for homeless veterans. These partnerships allow us to address needs beyond medical care, which is often the smallest part of what we do.

Q. For organizations considering starting a street medicine program, what advice would you give?

You have to go all in. Street medicine isn’t something you can do part-time. Patients need to know you’ll be there consistently, not just on a Tuesday night once a month.

You also need sustainable funding. Medicaid billing alone won’t cover the costs, so you’ll need support from foundations, grants, or your health system’s community benefit funds.

Finally, focus on trust and relationships. This work isn’t about high patient volumes or revenue; it’s about showing up, building connections, and meeting people where they are.